Overdoses linked to illicit vape juice

November 20, 2023 by Liz Farquhar Leave a Comment

NSW Health has issued a community drug alert after at least three overdoses, including one death, were linked to potent opioids in black market vape juice used for refillable vapes.

The opioid overdoses in NSW have been linked to powerful synthetic opioids called nitazenes (a potent synthetic opioid) in illicit vape juice.

In one case, the person thought the vape refill liquid contained a synthetic cannabinoid (similar to THC), but it actually contained a nitazene.

Nitazenes can be stronger and last longer than fentanyl. They are far stronger than most other opioids and an overdose can be caused by taking even a small amount.

Nitazenes can also affect a person’s breathing more than other opioids. Overdose has occurred in a matter of minutes, with as little as 6–8 puffs of a vape if it contains a nitazene, even in people who are used to using opioids.

Fentanyl test strips will not detect nitazenes.

A woman in a lab coat and safety glasses using a pipette and test tubes. — Vapes are regularly tested at our Forensic & Analytical Science Service laboratories

Be aware that opioids (like nitazenes) and other drugs can be present in illicit vape juice – and you might be sold something different than what you think you’re buying.

NSW Health regularly informs the public of known high risk drugs in circulation and has collaborated with the NSW Users and AIDS Association (NUAA) to issue a Community Drug Alert.

NSW Health Pathology’s Illicit Drugs Analysis Unit works every day to keep the community safe by conducting tests on drugs seized by police.

Their work supports the health and justice systems and contributes to public health alerts and drug warnings like this one.

Boosting organ donations through lifesaving screening

November 15, 2023 by Shannon Ramadge Leave a Comment

NSW Health Pathology’s Nucleic Acid Testing Laboratory has won a NSW Premier’s Award for a unique collaboration that provides 24/7 screening of donor organs for infectious diseases.

The team was last night presented with the NSW Premier’s Award for Highest Quality Healthcare.

When it comes to organ donation, timing is everything.

The ability to screen donor organs for infectious diseases and compatibility in just a few hours means the difference between life and death for patients awaiting transplant.

With a shortage of organs, more types of donors are being accepted following development of new screening methods for infections.

Only one team in NSW does this lifesaving work: the NSW Organ and Tissue Donation Service (OTDS) and the NSW Health Pathology Nucleic Acid Testing (NSWHP NAT) Laboratory at Prince of Wales Hospital in Sydney.

Our dedicated clinical pathologists, laboratory scientists and donation specialists work a 24/7 roster to respond whenever a donor organ becomes available, delivering results within a critical 8‑hour timeframe.

The lab now tests around 150 organ transplant donors – including 50 high-risk donors – and 650 tissue donors each year, ensuring safer, healthy organs for transplant.

The team provides virological screening for pathogens important in transplantation, including:

Human Immunodeficiency Virus type 1 (HIV‑1)
Hepatitis B (HBV)
Hepatitis C (HCV)
Cytomegalovirus (CMV)
Epstein-Barr virus (EBV)
Toxoplasma, and
Strongyloides.

There are approximately 1,650 people on organ transplant waiting lists in Australia at any one time. For these chronically ill people of all ages, access to a viable organ and tissue donor can lead to a longer, healthier life.

Currently there are more patients on transplantation lists than there are available organ and tissue donors. This was compounded during the COVID-19 pandemic which saw a 30% decrease in transplants.

But numbers are increasing to pre-pandemic levels and higher now with concerted donation drives led by DonateLife and the NSW Organ and Tissue Donation Service.

The small but dedicated team is committed to helping more people requiring transplants to access safe organ and tissue donations and to saving lives.

Leading melanoma pathologist named joint NSW Australian of the Year

November 14, 2023 by Liz Farquhar Leave a Comment

NSW Health Pathology’s Professor Richard Scolyer AO and his colleague, oncologist Professor Georgina Long AO will share the title of 2024 NSW Australian of the Year.

“Wow, still can’t believe the amazing honour of last night being named NSW 2024 Australian of the Year alongside my incredible colleague and friend Prof Georgina Long AO,” Richard wrote on social media after the ceremony.

“A tribute to all melanoma patients and their families, and brain cancer patients, as well as the amazing Melanoma Institute team.”

Prof Scolyer and Prof Long are co-medical directors of Melanoma Institute Australia and have worked together over many years to save thousands of lives from the deadly skin cancer. Now, they have teamed up for a very different challenge.

They have been treating melanoma using immunotherapy, which works by activating the patient’s own immune system.

In June this year Richard was diagnosed with glioblastoma, an incurable grade 4 brain cancer.

Richard has now become the world’s first brain cancer patient to have combination immunotherapy, before undergoing surgery to remove the tumour in his brain.

The experimental treatment brought with it the risk that his life expectancy would be further shortened, but he recently spoke of his gratitude at being able to advance the understanding of brain cancer for the benefit of future patients.

Richard has shared his cancer journey openly on social media, documenting his progress and his relentlessly positive outlook with a world-wide audience of supporters.

National Australia Day Council CEO Mark Fraser AO CVO congratulated all the NSW award recipients.

“The award recipients for NSW are an inspiring group of people devoted to helping others,” said Mark.

“The breakthrough work being done by Richard and Georgina, and Richard’s personal sacrifice, is simply extraordinary.”

The pair will be in the running to win 2024 Australian of the Year, when NSW’s recipients will join those from other states and territories for the national awards ceremony in Canberra on Thursday, 25 January 2024.

Construction starts on Dubbo pathology laboratory

November 14, 2023 by Liz Farquhar Leave a Comment

The Dubbo community is a step closer to a new, expanded NSW Health Pathology laboratory, with construction work now underway on the $6 million facility.

The project will deliver a larger, more modern pathology department to meet the growing health needs of the Dubbo community.

The new laboratory will ensure NSW Health Pathology staff can access fit-for-purpose facilities, including modern, automated testing platforms.

As part of NSW Health Pathology’s commitment to environmental sustainability, the Dubbo laboratory has also been selected for a pilot project to install sensor taps to conserve water and support energy efficiency.

Laboratory Manager Monique Mintern said the sustainability pilot project will be a welcome addition.

“The sustainability of sensor taps is significant,” Ms Mintern said.

“They create a hygienic and safe environment, reducing the chances of cross-contamination in the laboratory while also conserving water.

“Our local community here in Dubbo has lived through many years of drought and we appreciate how precious our local water supply is.”

NSW Health Pathology has awarded the $6 million contract to North Construction and Building following a competitive tender process.

North Managing Director Matthew Cook said North will work alongside NSW Public Works to refurbish the former ambulatory care section of the hospital which will house the new pathology laboratory.

“North has a long history of not only delivering essential medical facilities for NSW Health but also working collaboratively with NSW Public Works to bring these, and other, projects to fruition throughout regional NSW,” Mr Cook said.

“Our local team of experts is looking forward to completing these much-needed upgrades for the staff, patients and broader community.”

Construction work is due to be completed in late 2024. The existing pathology laboratory will continue to operate while the new laboratory is built.

Training the next generation of pathology collectors

November 13, 2023 by Liz Farquhar Leave a Comment

Meet Claire Padgett. A pathology collections trainer who works on the NSW Central Coast, ensuring our collectors are providing the best possible care.

Claire has worked for NSW Health Pathology as a collections trainer since 2002 and says she loves facilitating learning and the interaction it brings.

A Central Coast local, Claire works mostly at Gosford Hospital, but her job can take her all around the region from Umina to Wyong.

“I had previously worked as a paramedic for NSW Ambulance for 15 years,” she explains.

“I decided to work in pathology after realising I had a strong desire to remain within a health care role.”

Claire has a Diploma in Paramedical Science, a Cert IV in Training and Assessment and a Cert III in Pathology Collections.

She says training collectors sometimes requires her to think outside the box.

“You need to be creative when designing learning tools to keep it fun and your audience engaged,” she said.

“We all have different learning styles and learn at different rates, so patience is definitely required to be a collections trainer and facilitate effective learning.”

Claire gets a lot of joy from her work, particularly when it comes to inspiring young people to consider a career in pathology.

“I attend a careers expo each year and I love seeing the excited faces of all the school leavers,” she says.

“I take the manikin arm up to the expo, and one of our scientists takes along a microscope and slides.

“Together we spruik a career within NSW Health Pathology, it’s a very rewarding experience.”

She says she practices mindfulness to tackle the challenges of juggling multiple roles at work.

Claire’s hobbies away from work include bushwalking, reading, and baking.

Thanks Claire, for helping our collectors here at NSW Health Pathology to be the best they can be.

How COVID challenged us and what lies ahead

November 8, 2023 by Liz Farquhar Leave a Comment

On International Pathology Day, NSW Health Pathology’s A/Director of Public Health Pathology Dr Catherine Pitman and her colleagues consider the impact of climate change on the spread of disease and the implications for public pathology services.

As we know, 70 per cent of all clinical decisions are based on pathology results and most cancer diagnoses start with pathology.

NSW Health Pathology is the largest public pathology provider in the country and has more than 60 laboratories and over 150 collection centres located throughout New South Wales.

Australia and its citizens have access to one of the best pathology services in the world, partly due to the legislated high accreditation standards of NATA, the National Association of Testing Authorities (a not-for profit accrediting body) and the requirements of the RCPA, Royal College of Pathologists of Australasia. It is envied by many nations.

The COVID-19 pandemic challenged us all on many fronts, but it also has given us the opportunity to do better with outbreaks, big and small and adapt to the highly changing environments that we are facing in Australia and globally.

The latest risk modelling from London-based disease forecaster Airfinity suggests there is a 27.5% chance that a pandemic as deadly as COVID-19 could occur by 2033.

An independent Australian review of the COVID-19 pandemic outlined four areas where we as a country could have done better, five overarching lessons and six recommendations to improving our response to the next health crisis in Australia.

Those recommendations are:
– Strengthen crisis preparation
– Establish an expert body and trusted voice eg: an Australian Centre for Disease Control and Prevention
– Improve government decision-making
– Enhance public service collaboration, capability and communication
– Modernise how governments use data
– Build a culture of real-time evaluation and learning in the public sector

The first cases of COVID-19 in Australia were detected on 25 January 2020, concurrently in Victoria (one case) and NSW (three cases) on four returned travellers from Wuhan. The first known cases of community transmission in Australia were detected on 2 March 2020 in NSW.

The first SARS-CoV‑2 genomic sequence was released internationally on 10 January 2020 (ref 1 & 2) enabling the pathway for the development of in-house COVID-19 PCR assays across the world.

How NSW Health Pathology responded

On 22 January 2020, NSW Health Pathology’s Institute of Clinical Pathology and Medical Research at Westmead commenced COVID-19 PCR testing using an in-house PCR test, and the first NSW case was diagnosed on 25 January 2020. The first few PCR-positive cases of SARS-CoV‑2 were retested and confirmed at the VIDRL (Victorian Infectious Diseases Reference Laboratory).

Our Public Health Pathology Service co-ordinated the development of NSWHP testing capabilities under the leadership of then Chief Executive Tracey McCosker and Incident Management Controller Dr Stephen Braye in early 2020. The development of the COVID-19 PCR assays required a fully secure virus isolation facility, virus whole genome sequencing and SARS-CoV-2-specific serology as cases expanded in NSW.

Without these NSW Health Pathology facilities, the development of some of the first pathology assays in Australia would not have been possible. In the first 10 weeks of the pandemic, all testing was provided by the public pathology sector.

NSW Health Pathology was able to provide reliable, scalable, and prompt diagnostic services for COVID-19 diagnostics and has been instrumental in offering unique and public health-related laboratory advice to NSW Health. A unique collaboration with the world-renowned biosecurity facility at the Elizabeth Macarthur Agricultural Institute (EMAI) assisted with the expansion of COVID-19 during surges in 2020 and 2021.

What’s next?

When will the next major public health challenge be? Creating foundational capacity in pathology laboratories is critical to being able to rapidly and effectively contain the next health crisis.

The unpredictability of a changing climate will be a significant challenge. Climate change will not only lead to increased risk of mosquito-borne diseases but also extreme weather, including storm events, flooding, and bushfire. These could all impact health and result in new and changing diseases, which will require agile surveillance and response programs.

We now have new viruses that were not present in Australia before the COVID pandemic, such as Japanese Encephalitis Virus (JEV). With now more than 45 known cases of the disease and seven fatalities in Australia, the outbreak and presence of JEV has had a significant impact on health, as well as significant economic impacts on the Australian pork industry.

Similarly, the global outbreak of Mpox in 2022–2023, required new pathology assays and the capacity to monitor to help protect community health and safety.

Confronting our rapidly changing environments and diseases will require collaboration and commitment by all Australian citizens and organisations. Australia will be in a better position to meet the difficult and complex health challenges ahead if we continue to invest in the first-class pathology services of Australia and embed the learnings from the COVID-19 pandemic.

Authors: Dr Catherine Pitman, A/Director NSWHP Public Health Pathology, Vishal Ahuja, NSWHP Project Officer Public Health Pathology and Prof Dominic Dwyer, NSWHP medical virologist and infectious diseases physician.

References
1) Wu, F. et al. (2020) ‘A new coronavirus associated with human respiratory disease in China’, Nature, 579(7798), pp. 265–269. doi:10.1038/s41586-020‑2008‑3.
2) Lu, R. et al. (2020) ‘Genomic characterisation and epidemiology of 2019 novel coronavirus: Implications for virus origins and receptor binding’, The Lancet, 395(10224), pp. 565–574. doi:10.1016/s0140-6736(20)30251–8.