Who is this vaccine for?

• Abattoir workers
• Vets and Vet students
• Farmers
• Cat and Dog breeders
• People who handle cattle

Vaccination Process

Dr Jay Chelladurai offers Q-Fever vaccination at The Surgery, Kincumber. Do not make an online appointment. Please ring the surgery on 4369 6777 to get more information and book. Two appointments must be made 7 days apart — the first a long one (30 mins) and the second a standard appointment (15 mins).

• Number of Doses: 1
• Immunity After: 14 days

1st Appointment

• Discuss the need for the vaccine and previous Q-Fever infection or contact
• Explain the Q-Fever vaccination process
• Administer Q-Fever skin test
• Referral for blood test (must be done on the day of the skin test)

2nd Appointment (7 days later)

• Checking blood test results
• Check for any reaction at the site of the skin test
• Skin test MUST BE checked on the 7th day
• If both blood test and skin test are negative: vaccine is administered
• If blood test negative but skin test inconclusive: a repeat skin test is required at a follow-up appointment
• If either blood test or skin test is positive: certified as immune (no vaccine needed)

About the Vaccine – Q-Vax

Q-Vax is an inactivated Coxiella Burnetii vaccine. It is a purified suspension of formalin inactivated Coxiella burnetti prepared from the Phase 1 Henzerling strain grown in yolk sacs of embryonated eggs. Trace amounts of ovalbumin (<1 mcg) may also be present.

Who MUST NOT have it?

• Anyone who has had laboratory confirmed Q-Fever infection
• Has positive or equivocal antibody when tested by serology
• Has previously been vaccinated
• Has anaphylaxis to eggs
• Is immunocompromised

Side Effects

• Pain at injection site (48–95%)
• Redness over injection site (33–58%)
• Headache (43.9%)
• Tiredness (42.7%)
• Joint pain (24.6%)
• Previously vaccinated people can have severe injection site reaction and post Q-fever like symptoms lasting a few days

Q-Fever – The Disease

Caused by the bacteria Coxiella burnetii, which infects domestic and wild animals including cats, dogs, cattle, kangaroos and camels through ticks. Humans can be infected by inhaling, ingesting (from handling contaminated objects), or through broken skin and mucosa. The bacteria can survive at 4°C for more than a month and up to 60°C.

People who contract Q-fever can experience a spectrum of conditions from total unawareness to severe flu-like illness, and can also affect the liver (jaundice), heart, and cause severe pneumonia requiring ICU care. Some people experience long-term illness including tiredness, weight loss and pain.

References

1. Seqirus, Q-Vax Q-Fever Skin Test – Product Information
2. Department of Health, Commonwealth of Australia Immunisation Handbook – Q-Fever
3. Ananthanarayan and Paniker's Textbook of Microbiology 2005

Dr Jay Chelladurai offers Skin Checks and Skin Cancer procedures at Central Coast Skin Cancer Clinic, East Gosford

Which of these are Melanoma?

The middle ones are Melanoma. As you can see, 2 moles which may appear very similar can be very different. One can be a deadly melanoma and another can be a harmless condition called Seborrhoeic Keratosis or sometimes even just a freckle.

Who needs skin cancer checks?

• People with a fair skin.
• People who have spent time in the sun.
• People who have many moles.
• People who have lots of freckles.
• People who have previously had a skin cancer.
• People who have a family member who may have had a melanoma or another skin cancer.
• People who have had radiotherapy.
• People who have had an organ transplant.

What Happens at a Skin Check Consultation?

Just as the name suggests. Check your skin. The doctor will greet you. Ask a few questions to better understand your risk of skin cancer. Then it would be the stage of skin examination. You would need to undress, usually down to your underwear. Lie on a bed. The doctor would examine your skin from head to toe/toe to head aided by bright light +/- magnification. Some moles would need to be felt by touching, to see if it is thick or raised. Each suspected mole would further be examined with a special device called dermatoscope (skin microscope). Some times photos of some moles may be taken to be stored to explain to you or for future comparison for interval change.

What if I am not comfortable to undress?

Unfortunately a thorough skin examination would not be possible without undressing. You can bring in your partner/parent/children if that may help. You can ask for a chaperone (usually a nurse) to be with you during the examination. Or you can elect to only have part of your skin examined, in which case, potentially dangerous skin cancers may not be picked. Contrary to some beliefs, a dress penetrating camera is not used.

How often do I need a Skin Check?

It depends on multiple factors. Your skin colour, your sun exposure, your age, number of moles/freckles you have. The higher the risk, the more often you would need. Most people are advised to have a check once a year. Some may need 6 monthly. Some may not need a check for 3-4 years. You will be advised about your next visit during the consultation.

How do I prepare for a Skin Check?

Most often, you do not need any specific preparation. But some of these would be very helpful

• Wearing clothings that can be easily removed and worn back can make the process easy.
• Avoid wearing make up. Some make up materials can be hard to wipe away and can make evaluating some moles very difficult.
• Remove nail polish if possible. Some nail changes from underlying cancers may not be visible if covered by nail polish
• If you had to have fake tan, try to schedule a skin check 3-4 weeks after so the skin can be examined better.
• If you have very dry skin, applying some good moisturisers can be helpful.

What happens if an abnormal mole is found?

We will explain to you about the mole as to what it could be. Then offer management pathways as 

• Asking you to self monitor until your next planned visit.
• Come back for a follow up in an earlier interval eg 3 months instead of the usual 12 months.
• Have pictures of the mole taken to monitor the progress.
• Some moles can be treated with a process called Cryotherapy
• Some moles may need to be further ascertained by a process called Biopsy.
• Some moles may need to be completely removed by a process called Excision

Will I die if I get a skin cancer?

Most skin cancers are slow growing and do not spread until they have become really big. However, there are some skin cancers such as melanoma that can be deadly if not treated. So they are not entirely harmless, if that makes sense.

The commonest skin cancers are squamous cell cancers and basal cell cancers. Then the melanoma. Most common of the melanoma are early stage melanoma or melanoma in-situ. Most early stage melanoma once removed, the never come back. And generally once we find a mole is a melanoma we almost always do a further procedure to take some more skin around it (Wide Local Excisio) to make sure there are no more melanoma cells in the vicinity. 

However, for some cancers, especially advanced melanoma, we would need to refer you for further treatment.

Yellow Fever Vaccination is available at The Surgery Kincumber. Yellow Fever Vaccination is required for Travellers/visitors to certain countries in South America and Sub Saharan Africa who are over 9 months of age. We are a government accredited Yellow Fever Vaccination centre. We offer Yellow Fever Vaccine to our own patients as well as patients from other practices.

Vaccination Process.

The vaccination is by one injection in the shoulder.

• Number of doses: 1
• Presumed immunity after: 10 days

Passport information is required to be entered in the special vaccination booklet.

You will be provided with evidence of Yellow Fever Vaccination in the internationally recognised format.

Please remember to bring your passport for this appointment

Yellow Fever Vaccine - STAMARIL

What is it?

Attenuated 17D strain Yellow Fever (Live) Vaccine in a freeze dried form.

Manufacturing process?

Virus is propagated in specific pathogen free chick embryos.

Who must not have it?

• People who have severe allergic reaction to egg or chicken.
• Children under 6 months of age.
• People with reduced immunity.
• Symptomatic HIV positive people
• Pregnant or breast feeding women
• People with disease of thymus or have their thymus gland removed.
• People who are currently unwell with an infective process.

Other considerations:

• Yellow fever vaccination can not be done within 4 weeks of another live vaccine.
• Yellow Fever Vaccination can however be done at the same time with other live vaccines.

Common Side Effects:

• Headache - 18%
• Tiredness - 16.6%
• Injection site pain, swelling, bruise - 14%
• Fever 8.3%

Rare Adverse Reactions:

• Yellow Fever Vaccine Associated Neurotropic Disease (YEL-AND), a potentially life threatening condition of the nervous system
• Yellow Fever Vaccine Associated Viscerotropic Disease (YEL-AVD) previously known as Febrile Multiple Organ System Failure

Yellow Fever

What is it?

A potentially deadly illness presenting in a wide range from hardly any symptoms at all. Some people can fever, muscle pain back pain, headache, nausea and vomiting losing for 3-4 days. In a smaller number of people, they can go onto have severe fever, and failure of multiple organs leading to bleeding, jaundice and can lead to death in about 50% .

Treatment?

There are no specific treatments. Management is mainly supportive.

How to prevent?

Having Yellow Fever Vaccine, general mosquito bite prevention strategies.

Where is the disease present?

The disease is present in many South American countries as well as Sub-Saharan African countries. The latest list of Yellow Fever endemic countries can be found here.

Yellow Fever Virus

What is it?

It is a micro-organism belonging to Arbovirus (arthropod/insect born) group of viruses belonging to a group called Favivirus. It is carried by day biting mosquitos. Monkeys and humans can remain as reservoirs for the mosquitos to transmit the infection.

References

1. Therapeutic Goods Administration STAMARIL Australian Product Information
2. Work Health Organisation - Yellow Fever Information
3. Center for Disease Control USA - Yellow Fever
4. New South Wales Health - Yellow Fever Fact Sheet

Dr Jay Chelladurai is an Authorised Health Practitioner. He provides Railway Medicals Cat 1,2 and 3 at The Surgery Kincumber. 

Please ring the practice to make this appointment. Do not make online appointment. Make sure you inform if it for Cat 1, Cat 2 or Cat 3. This process requires a long appointment and an appointment with the nurse as well.

Step 1

Before Consultation

1. Fill the relevent 2 forms online, print and bring them with you
   • Cat 1 and 2
     • Request and Report Form. (fill employer and worker sections only)
     • Worker Notification and Health Questionnaire for Cat 1 and 2
   • Cat 3 - need
     • Request and Report Form. (fill employer and worker sections only)
     • Worker Notification and Health Questionnaire for Cat 3
2. Book appointment and have hearing assessment done at Connect Hearing Umina.
   • Hearing test is necessary for all. We have liaised with Connect Hearing in Umina. Please organise your appointment with them and inform them that you will be following up with us for railways medicals. They will then forward your hearing assessment reports directly to us.
3. Please ring The Surgery Kincumber on 43696777 to make appointment. Explain to staff about what category assessment you need.
4. Request referral forms for blood test for HbA1c, Cholesterol and Kidney functions for Cat 1 and 2 as well as for ECG for Cat 1. Having these tests prior to consultation will speed up the signing off process. These tests can be done at any pathology provider such as Douglas Hanley Moir or Laverty Pathology.

Step 2 

Consultation with nurse 

Cat 3 (15 mins) to Cat 1 and 2 (45mins)

• Vision assessment
• Breath Alcohol Test
• Urine Drug Screen
• Height, weight, Blood Pressure (only for Cat 1 and 2)

Step 3 

Consultation with doctor

Cat 3 (15 mins) to Cat 1 and 2 (45 mins)

• Clinical examination. Cat 1 and 2 or Cat 3
• Colour Vision assessment (Cat 1 and 2)
• Australian Cardiovascular Risk Assessment (Cat 1 and 2)
• Psychological Evaluation (Cat 1 and 2)
• Sleep Apnoea evaluation (Cat 1 and 2)
• Referral for ECG (Cat 1), Blood test for HbA1c, Cholesterol, kidney functions (Cat 1 and 2), if not already done.

Step 4

Final Signing Off by doctor

• After completion of clinical examination, hearing report (Cat 3)
• After completion of clinical examination, hearing, blood and ECG (Cat 1 and 2)

Latest and further information can be found at National Transport Commission website. If any links in this page are not working, the relevant forms can be accessed from this page.