We have always known that one role of the community pharmacy is to protect its local community. The introduction of influenza immunisation services through community pharmacy is one example of this. The aim is to raise community immunity to influenza so when we come to the season as many people are immunised. Community pharmacy and General Practice should work together to achieve the highest possible level of community immunity possible.
I am particularly happy to see that there may be bonus schemes coming. Examples where a £1 a patient may be paid out at the end of the season should the community pharmacists and GPs hit s certain level of immunisation. The NHS Alliance advocated joint goals and rewards for achievement for several years and it may now be happening.
I am also happy to see community pharmacists commissioned to deliver other vaccines. They should do more to support community immunity to prevent disease and protect the individual and the population.
The transfer of group A strep within a community is an important problem. Someone with a strep A sore throat can remain infective for 14 days or more without proper diagnosis or treatment. The infection will pass from person to person and is facilitated by crowded areas such as schools, care homes or places of work. Although most people understand strep A sore throat it is not the only condition caused by this bacteria. Strep A causes scarlet fever (mainly in the young) and invasive disease (mainly in the older person) which has an estimated fatality of 15 – 16%.
The risk of secondary related invasive group A streptococcal disease in household members of patients with invasive disease is 2.9/1000, a rate almost 200 times that of the general population. This risk of disease among close contacts and the overall case fatality rate of invasive group A streptococcus disease of 15% are similar to those for sporadic meningococcal infections. It does make you think – and we have about 90 outbreaks a year.
We have the opportunity to better diagnose strep A infections through a rapid antigen test that produces a result within 10 minutes. It would seem very sensible for community pharmacists, who see the majority of patients with sore throats to offer the test and initiate suitable antibiotic treatment as soon as possible. Patients should stay away from school or work for 24 hours and wash their hands carefully to reduce spread. There is no resistance to penicillin, so assuming that the patient takes the full course, they can go back to work or school knowing that they are unlikely to spread the disease further.
I could say that it is my personal responsibility, should I have a sore throat, to visit a community pharmacy and be tested if my Centor score predicts that I might have a strep A infection. I would hate to believe that I passed this on to a child who then had scarlet fever or a person who developed invasive disease.
There is something here about protecting the community, personal responsibility and the provision of testing in community pharmacy. Of course any community pharmacy can offer this privately – if they want to.