Severe cutaneous reaction to the messenger RNA (mRNA) BNT162b2 (Pfizer-BioNTech) vaccine.

The pathway out of the COVID-19 pandemic has been reliant on uptake of vaccination. In New Zealand, we have access to the messenger RNA (mRNA) BNT162b2 (Pfizer-BioNTech) vaccine. In this case report we discuss a patient who presented to an acute general medical service with a severe cutaneous adverse reaction (SCAR) after the vaccine with features of both Stevens-Johnson syndrome and acute generalised pustulosis. Early recognition and management of SCARs is required to prevent morbidity and mortality.

Patch testing in New Zealand: Barriers to evidence-based care.

Allergic contact dermatitis is a disabling condition, significantly impacting on quality of life, which can only be alleviated by identification and avoidance of a relevant allergen. Patch testing remains the gold standard diagnostic test for allergic contact dermatitis. The consistency with which patch testing is used varies throughout the world. The purpose of this study was to look at the adequacy of current patch testing practice in New Zealand. We undertook literature review of current guidance regarding patch testing and created a web-based survey to evaluate use of patch testing in New Zealand. This was sent to all 75 vocationally registered New Zealand dermatologists. Of respondents, 46% do not perform patch testing. The most commonly cited barriers were lack of nursing support, poor remuneration, time pressure and lack of facilities. 23% noted that public patch testing services are not available in their region. The majority do not record patch test results in a database. Access to and utilisation of patch testing in New Zealand is suboptimal. Increasing services in the public sector requires investment by health boards, as there remains a dermatology workforce shortage in New Zealand. In private practice, patients often find it unsatisfactory to pay for negative tests, and adequate remuneration of patch testing by private insurers is necessary. Surveillance of patch test results at a national level is lacking, and the development of a centralised database to identify common allergens affecting our population is recommended.

'Real-time' burden of community and healthcare-related infections in medical and rehabilitation patients in a public hospital in Auckland, New Zealand.

AIMS: To determine the prevalence and spectrum of infections on admission, or acquired during hospitalisation (HAI) at Waitakere Hospital, Auckland. METHODS: A questionnaire was completed on two separate days for all adult in-patients admitted to medical and rehabilitation wards for greater than 24 hours. Information obtained included patient characteristics, the presence and type of infection on admission or acquired during hospitalisation, as well as information on indwelling devices. RESULTS: Infection was the admitting diagnosis in 81 (41%) of 195 patients reviewed, with lower respiratory tract infection (LRTI) diagnosed in 50%, urine infections in 22% and cellulitis 18%. Only 40% LRTIs were supported by radiology or microbiological criteria. Twenty-five HAIs occurred in 21 patients (cumulative and point prevalence of 10.7% and 5.0% respectively). Urinary tract infection (UTI) was the most common HAI in 13 patients (62%), including 4 catheter-related infections. Patients with HAI were older and appeared to have had longer hospital stays, and higher urinary catheter usage. CONCLUSIONS: This study highlights the ongoing high burden of infections contributing to hospitalisation of adult patients in a developed country. The prevalence of HAI, patient characteristics and risk factors are comparable to previous studies in similar settings.