Head and neck tics can lead to serious injury

People with severe forms of Tourette syndrome or chronic tic disorder (TS/CTD) are at increased risk of cervical spine disorders.

A Swedish study, matching almost 7,000 people with TS/CTD to 68,000 unexposed people, found the repeated head jerking and neck movement was associated with a 39% increased risk of any cervical spine disorder (aHR 1.39).

The adjusted HR was 1.57 for cervical vascular disorders and 1.38 for nonvascular disorders.

“Considering that some of these disorders, such as cerebrovascular events and spine injuries with myelopathy, have the potential to cause severe long-term disabilities, our results suggest that cervical spine disorders are not just isolated events in TS/CTD but a phenomenon that requires awareness and vigilance,” the study said.

They noted events such as cerebral arterial dissection with a resulting ischaemic stroke in children was rare but potentially fatal.

“Physicians working in paediatric neurology settings should be aware that severe neck tics could be a risk factor for such medical complications.”

JAMA Neurology

Guillain-Barre Syndrome (GBS) warning for AZ vaccine

A warning about Guillain-Barre Syndrome (GBS) has been added to the Product Information for the AstraZeneca (Vaxzevria) Covid-19 vaccine.

The TGA said the update was a precautionary measure for a possible rare adverse effect after it received 89 reports mentioning GBS occurring after vaccination with the AstaZeneca vaccine.

“Following an investigation, the TGA, along with other international drug regulators, have so far been unable to establish a clear link between GBS and Vaxzevria (AstraZeneca),” it said.

“These cases will be considered as part of our ongoing monitoring of this signal.”

The warning statement reads: “Very rare events of demyelinating disorders, such as Guillain-Barré Syndrome (GBS), have been reported following vaccination with Vaxzevria. A causal relationship has not been established. Healthcare professionals should be alert of signs and symptoms of demyelinating disorders to ensure correct diagnosis, in order to initiate adequate supportive care and treatment, and to rule out other causes.”

The TGA advisory statement notes that GBS has been associated with other types of immunisations, such as influenza vaccines(link is external) and in many cases symptoms resolves within months but can sometimes take up to 2 years.

“We encourage people to seek medical attention if they experience symptoms that could suggest GBS as early medical care can reduce severity and improve outcomes. Symptoms to look out for include weakness and paralysis in the hands or feet that can progress to the chest and face over a few days or weeks.

COVID-19 vaccination now mandatory for healthcare workers in NSW

NSW has become the first state to introduce mandatory vaccination against against COVID-19 for al healthcare staff working in public and private hospitals.

Under a new Public Health Order, health staff must have a first dose of vaccine by 30 September 2021 and be fully vaccinated by 30 November 2021, or at least have their second appointment booked to continue working.

Staff will be required to provide evidence they have received their first dose to their employer by 30 September 2021 or they will be excluded from the workplace.

Health Minister Brad Hazzard said 80% of staff already vaccinated and the new requirement was similar to existing mandatory vaccination requirements for frontline health staff for influenza, chicken pox, measles and pertussis.

“National Cabinet agreed in June to mandate COVID-19 vaccination for aged care workers, and NSW will now ensure the same protections exist for all our health workers,” he said.

“It will also ease pressure on our health system during this challenging time. More than 1,200 healthcare workers have been in isolation each day over the past seven days and we cannot afford that right now. Vaccinations will help ensure our fantastic staff can continue to care for patients.