A recent article in the British Medical Journal discusses work-related stress and burnout in healthcare workers. These are important problems in the NHS workforce in the UK a well as amongst healthcare workers in other countries. Addressing the underlying cause, which may relate to factors such as workplace demand, relationships, and support is necessary for sustained recovery and full engagement with work.
Healthcare workers may experience guilt or shame due to stigma, preventing them from seeking help if they experience work related mental illness. Time off work and workplace changes to control the triggers may be necessary to allow recovery and sustainable return to work.
Healthcare workers experiencing work related stress can seek support from colleagues, their own GP, occupational health, and specialised services for healthcare workers such as local mental health and wellbeing hubs and NHS Practitioner Health.
Our recent article in the Journal of the Royal Society of Medicine discuses the diagnosis and management of Monkeypox in UK primary care settings but is also relevant to primary care clinicians working in other countries outside West and Central Africa that have seen Monkeypox cases in 2022.
Since its discovery in 1958 in monkeys, the Monkeypox virus has been rarely found outside west and central Africa until the current global outbreak. The first human case of the virus was in an infant from the Democratic Republic of Congo (DRC) in 1970; the infection has since spread to other regions, primarily in Africa. The first case of the current outbreak was confirmed on 6 May 2022, in the UK and was linked to travel to Nigeria. Two subsequent UK cases were detected a week later; however, neither affected individuals reported contact with the primary case in the UK nor travel to Africa.
On 23 July 2022, the World Health Organization (WHO) declared the current Monkeypox outbreak a public health emergency of international concern, as the number of cases increased rapidly around the world. As of 9 September 2022, 57,016 cases have been confirmed in 96 non-endemic regions, with the UK having one of the highest number of cases worldwide (3484 cases).
As we understand more about the current outbreak, particularly the community transmission of the virus, primary care clinicians may be the first point of healthcare access. Therefore, awareness of the signs and symptoms of the disease and current management strategies is crucial to providing optimal care and advice to patients.
Much of the discussion about vaccination in the UK is on Covid-19 and flu vaccines or vaccines for children. But there are also other important vaccines for adults – such as for shingles – where there is scope to increase uptake and improve health outcomes for older people and the immunocompromised.
Shingles is caused by the reactivation of latent varicella zoster virus (VZV); sometimes decades after the primary chickenpox infection. For some people – particularly the elderly and the immunocompromised – shingles can be a very unpleasant illness with significant complications.
In the UK, two vaccines are licensed for shingles:
– Zostavax which contains live, attenuated virus and which is given as a single dose.
– Shingrix which is a recombinant vaccine and which his given in two doses.
The main target group for shingles vaccination in the UK is people aged 70-79 years. Most people in this group will receive the Zostavax vaccine. People in this age group who are immunocompromised should receive the Shingrix vaccine. The rationale for vaccinating the elderly is because complication rates are much higher in this group. For example, hospital admission rates for shingles (zoster) are around 20 times higher in people aged 75 and over than those aged 15-59.
When people turn 70, they should receive an invitation for shingles vaccination from their GP. If they didn’t take up the offer of a vaccination at that time, they can still get a shingles vaccination until they are 79. Once they turn 80, you will no longer be eligible for shingles vaccination. Shingles is a disease that has many complications in the elderly. It can result in considerable pain and discomfort and reduce your mobility. In more severe cases, it may require hospital treatment as an outpatient or inpatient. Vaccination reduces these risks substantially.