The shingles vaccine, Zostavax®, has been approved by National Immunisation Program (NIP), to be provided free of charge from 1 November 2016 to people aged 70 years, subject to vaccine supply. There will also be a five year catch-up program for people aged 71 – 79 years.

• Efficacy in this age group is 41%
• Zostavax is contraindicated in the immunocompromised
• A single dose of vaccine should be administered subcutaneously in the deltoid region
• Zostavax can be co-administered with an inactivated vaccine at a separate injection site
• It’s not necessary to check VZV serology before vaccination
• Zoster vaccination is not recommended in people previously vaccinated with varicella vaccine
• People who’ve had shingles can be vaccinated after a wait of at least a year

Individuals who should not receive the vaccine include the immunocompromised, pregnant women, and those who have previously had anaphylaxis to any varicella zoster virus-containing vaccine or its components.

 Immunocompromised patients are as follows:

• Haematological or generalised malignancies (including those not on treatment): eg. lymphoma, acute or chronic leukaemia, Hodgkin's disease
• Solid organ or bone marrow transplant recipients (with exceptions as advised by specialists)
• HIV/AIDS (with exceptions as advised by specialists) or other congenital/acquired immunodeficiencies
• Current or recent high dose systemic immunosuppressive therapy: eg. chemotherapy, radiation therapy, oral corticosteroids, disease modifying anti-rheumatic drugs

Psoriasis is a chronic inflammatory skin condition characterised by red and scaly plaque rash. It is thought to be immune-mediated inflammatory (autoimmune) disease. It is not contagious. Psoriasis also can affect nails and joints (causing psoriatic arthritis). Psoriasis affects 2-4% of males and females. It affects at any age from childhood to adult. It has peaks onset of 30-39 years and 50-69 years.

Risk factor for triggering or worsening psoriasis:

• Family history especially in those with first degree relatives. Genetics suspectibility with major histocompatibility complex on chromosome 6p21, IL-12 and IL-23 genes had been implicated in psoriasis
• Smoking
• Obesity
• Drugs such as Lithium, Beta- blockers, antimalarials, nonsteroidal anti-inflammatory drugs
• Infections due to viral or bacterial infections. Poststreptococcal infection causes flare of guttate psoriasis. HIV is known to worsen the condition of psoriasis.
• Excess alcohol consumption
  

Clinical features:

Psoriasis usually presents with symmetrically distributed, red, scaly plaques with well defined borders. The scale can be silvery white and may have peeling surface. Scaling and redness of skin occurs due to increased growth than normal and cells turnover in psoriasis with inflammation. In normal skin, the skin cells turnover is 27 days but in psoriasis, the skin cells turnover become shortened to 4 days. The most common sites affected are scalp, elbows and knees. In severe form of psoriasis, it can affect the whole body. Some patient can complain itchy of the skin leading to scratching and lichenification (thickened leathery skin).

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Tinnitus is the perception of sound experienced by a person as noise in the absence of external noise. Tinnitus is not a disease itself. The sound can be buzzing, hissing, whistling, roaring, ringing, humming or hissing. It can be continuous or occur intermittently. It may be pulsatile or non-pulsatile. Tinnitus does not have to dramatically affect your quality of life. You should avoid focussing too much attention on your tinnitus. Avoid excessive noise, find relaxation and stress management techniques that work for you.

Approximately, 17 to 20% of Australians suffer from some degree of tinnitus, varying from mild to severe. It is common for a person's to be affected by stress or tiredness.

Tinnitus can be triggerred along the auditory pathway. The majority of patients have tinnitus due to hearing loss at the cochlea or cochlear nerve level. PET scanning and functional MRI studies indicate that the loss of cochlear input to neurons in the central auditory pathways (such as occurs with cochlear hair cell damage due to ototoxicity, noise trauma or a lesion of the cochlear nerve) can result in abnormal neural activity in the auditory cortex causing tinnitus.

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