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National Infection Prevention and Control Manual

National Infection Prevention and Control Manual

A-Z Pathogens

The A-Z is under development and provides disease specific guidance for infectious agents for NHSScotland,

The A-Z is being developed to provide a description of pathogen, incubation period and infectivity along with transmission routes, notifiable status and alert organisms for diseases associated with the pathogen.   Guidance and supporting materials for the disease/pathogen are also included giving the current Scottish, UK and International guidance to be followed in that order.

Appendix 11 of the NIPCM can be used alongside the A-Z and includes additional information including optimal patient placement and respiratory and facial protection for a range of pathogens.

Download print quality poster (A3 size) PDF document

 

 

A

Acinetobacter baumanii

An environmental organism that typically causes infection in immunocompromised hosts, may be transmitted from an environmental point source via droplets or aerosols and may spread via either direct (person to person) or indirect (contaminated medical devices or surfaces) contact.

Disease : Pneumonia, bacteraemia, skin and soft tissue infections

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : No

Main route of transmission :

Adenovirus

Adenoviruses are members of the family of viruses Adenoviridae. Infections commonly affect the respiratory system; but may also cause various other illnesses and presentations, including cold-like symptoms, sore throat, bronchitis, pneumonia, diarrhoea, and conjunctivitis.

Incubation Period :

For respiratory infection this is 2-14 days, with symptoms usually lasting 3-5 days. For Adenoviral conjunctivitis this is from 4 to 12 days, with symptoms lasting 4 to 6 weeks.

Period of Infectivity :

The virus is shed during the initial 2 weeks of symptoms with Infectious particles able to survive on fomites for up to 2 months. Adenovirus infection can occur in any age group, but infants and immunocompromised individuals are more likely than others to develop severe illness from adenoviruses.

Disease : Upper +/- lower respiratory tract infection

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : No

Main route of transmission :

Droplet

Disease : Conjunctivitis

Notifiable

  • On the HPS alert organism list 2017 : No
  • Notifiable under Public Health (Scotland) Act 2008 : No

Main route of transmission :

Contact
Anthrax

See Bacillus anthracis

Aspergillus spp

Aspergillus spp. a common fungi that can be found in environment. Aspergillus fungi can often be found around plants and trees, including rotting leaves and compost; but also in air conditioning and heating systems, insulation material or dust. 

It causes a disease called aspergillosis. Symptoms of aspergillosis vary, depending on the type and the part of the body that's affected. Aspergillosis is not infectious and cannot be transmitted from person to person but occurs if an individual inhales tiny particles of the aspergillus fungi that hang in the air when the environment becomes disturbed.

Spore levels are increased during hospital building or renovation activities, with severely immunocompromised patients more at risk of developing aspergillosis.

Invasive pulmonary aspergillosis (IPA) is the most serious type and usually only affects those who are immunocompromised. Symptoms often include cough, chest pain or breathlessness.

Incubation Period :

Varies widely, from days to months.

Disease : Invasive Pulmonary Aspergillosis

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : No

Main route of transmission :

Contact / Airborne

Guidance and supporting materials

Scottish

Aspergillus Information for Staff
http://www.hps.scot.nhs.uk/haiic/ic/resourcedetail.aspx?id=1591

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B

Bacillus anthracis (anthrax)

Anthrax is usually a disease of herbivorous mammals and is caused by the bacterium Bacillus anthracis. Anthrax is contracted through environmental exposure and cannot be transmitted from person to person. 

In humans, anthrax can be contracted through direct or indirect contact with infected animals, including handling meat, hides, hair and wool. There are also concerns about the use of anthrax as a bioterrorism agent.

The symptoms of anthrax depend on route of infection and take four main forms: Inhalation, gastrointestinal, cutaneous and injection.

  • Inhalation anthrax can occur when a person inhales spores that are in the air (aerosolized) during the industrial processing of contaminated materials, such as wool, hides, or hair.
  • Cutaneous anthrax can occur when workers who handle contaminated animal products get spores in a cut or scrape on their skin.
  • Injection anthrax is a novel form of infection seen in heroin users and most likely contracted from using heroin contaminated with anthrax spores.

All types of anthrax have the potential, if untreated, to spread throughout the body and cause severe illness and even death.

Symptoms may include:

  • Cutaneous: (>90% cases) entry through a skin lesion leads to the development initially of a pimple which, within two to three days, develops to form a dry, black firmly adherent scab from two to several cm in diameter across. The lesion rarely causes much pain, but there is nearly always considerable oedema which may spread a long way from the site of the lesion and may take up to six weeks to resolve.
  • Pulmonary – Following inhalation of spores, time to onset of symptoms is dependent on the number of spores inhaled. Symptoms may include mild pyrexia and malaise lasting a few days; followed by a flu-like illness, leading quickly to shock, collapse and death.
  • Intestinal – entry is through ingestion of spores and leads to severe gastrointestinal disease with nausea, vomiting, anorexia and fever leading to shock, collapse and death.
  • Injection: Fever and chills, small blisters/ bumps at the injection site which change to a painless skin sore with a black centre, swelling around the sore often accompanied with abscesses at the injection site.

Incubation Period :

Cutaneous: One to 7 days (rarely up to 7 weeks)
Pulmonary: One to 7 days (usually 48 hours)*
Intestinal: One to 7 days.

Disease : Anthrax

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : Yes

Main route of transmission :

Contact / Airborne

Guidance and supporting materials

Scottish

HPS Anthrax web page http://www.hps.scot.nhs.uk/giz/anthrax.aspx

Guidelines for the public health management of tetanus, botulism or anthrax among people who use drugs, 2017
http://www.hps.scot.nhs.uk/giz/resourcedetail.aspx?id=3190

UK

Anthrax: Guidance, data and analysis
https://www.gov.uk/government/collections/anthrax-guidance-data-and-analysis

Anthrax: the green book, chapter 13
https://www.gov.uk/government/publications/anthrax-the-green-book-chapter-13

International

Guidelines for the surveillance and control of anthrax in humans and animals
http://www.who.int/csr/resources/publications/anthrax/WHO_EMC_ZDI_98_6/en/

Bacillus cereus

B. cereus in particular is a frequently recognised cause of toxin-induced acute gastroenteritis, however this genus may also cause sepsis, pneumonia, endocarditis, central nervous system (CNS) and ocular infections.

Symptoms often include abdominal pain, nausea, vomiting and diarrhoea.

Bacillus cereus is known to cause bacteraemia in immunocompromised individuals.

B. cereus cannot be transmitted from person to person; it is transmitted by contaminated cooked foods, especially rice, pastas and vegetables, as well as raw milk and meat products.

Airborne dissemination of the organisms from environmental sources is considered to further facilitate contamination, environmental sources include: soil, sediments, vegetation.

Dust and contaminated laundry have been implicated in the healthcare environment. The risk of person-to-person transmission is typically considered to be low.

 

Incubation Period :

1-24 hours.

Disease : Gastroenteritis

Notifiable

  • On the HPS alert organism list 2017 : No
  • Notifiable under Public Health (Scotland) Act 2008 : Yes

Main route of transmission :

Contact / Airborne

Guidance and supporting materials

Body Lice

Body lice are parasitic insects that live on clothing and bedding used by an infested person. Body lice frequently lay their eggs on or near the seams of clothing. Body lice must feed on blood and usually only move to the skin to feed. Body lice can also spread diseases such as epidemic typhus, trench fever, and louse-borne relapsing fever.

They spread rapidly under crowded living conditions where hygiene is poor. Body lice are spread through direct physical contact with a person who has body lice or through contact with articles such as clothing, beds, bed linens, or towels that have been in contact with an infested person.

As long as an individual remain infested they can infect others, treatment can take the form of improved hygiene and/or treatment with a pediculicide.

Incubation Period :

Lice eggs (nits) hatch within 1 to 2 weeks after they're laid. After hatching, the remaining shell looks white or clear and stays firmly attached to the hair shaft.

Disease : Body Lice

Notifiable

  • On the HPS alert organism list 2017 : No
  • Notifiable under Public Health (Scotland) Act 2008 : No

Main route of transmission :

Contact
Bordetella pertussis (Whooping cough)

Pertussis is caused by the bacterium Bordetella pertussis. The initial symptoms (catarrhal stage) include: runny nose, fever, cough and apnea (in babies). Later symptoms (paroxysmal stage) include: paroxysms of many rapid coughs in children this is followed by a high-pitched "whoop", often accompanied with vomiting and exhaustion after coughing fits.

Adults do not exhibit the ‘whoop’ but present with a persistent cough which can last several weeks and may act as a reservoir for B. pertussis during this period.

Unvaccinated children under 2 years of age are most at risk of complications.

Incubation Period :

Between 4–21 days

Period of Infectivity :

Pertussis is highly communicable. Individuals with pertussis are most infectious during the catarrhal period and the first 2 weeks after cough onset (i.e., approximately 21 days). Antibiotic therapy will shorten the period of infectivity.

Disease : Pertussis/Whooping Cough

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : Yes

Main route of transmission :

Droplet

Guidance and supporting materials

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C

Campylobacter

Campylobacter are genus of bacteria that commonly cause food poisoning associated with raw or undercooked meat in particular poultry; the two most common species implicated in human disease are C. jejuni and C. coli.

Symptoms can include diarrhoea (sometimes bloody), nausea and vomiting, abdominal pain, malaise and fever, with symptoms lasting from 2-10 days.

Sequelae can include Guillain-Barré syndrome.

Incubation Period :

Usually 1 to 5 days, but can range up to 11 days

Period of Infectivity :

While symptomatic and for a further 48 hours after the cessation of symptoms.

Period of Exclusion: Whilst symptomatic and 48 hours after cessation of symptoms

Disease : Campylobacter Gastroenteritis

Notifiable

  • On the HPS alert organism list 2017 : No
  • Notifiable under Public Health (Scotland) Act 2008 : Yes

Main route of transmission :

Foodborne / Contact (faecal/oral)

Guidance and supporting materials

*This is rarely reported in the care environment where the main route of transmission is through contact

Carbapenemase producing Enterobacteriaceae (CPE)

Enterobacteriaceae are part of large family of Gram-negative, rod-shaped bacteria which include (amongst others) Escherichia coli, Klebsiella spp and Proteus spp.. Many types of Enterobacteriaceae are a part of the normal range of bacteria found in the gut, though they can cause infections such as bacteraemia, urinary tract infections and intra-abdominal infections.

Carbapenemase-producing Enterobacteriaceae (CPE) are a type of Enterobacteriaceae that are extremely resistant to antibiotics.

These bacteria carry a gene for a carbapenemase enzyme that breaks down carbapenem antibiotics. Carbapenems are a class of very broad-spectrum intravenous antibiotics which are used to treat serious infections or conditions where other therapeutic options have failed.

CPE are predominantly healthcare associated, with immunocompromised patients and those with prolonged hospital stays most at risk of developing an infection.

Infections caused by CPE are difficult to treat and are associated with high rates of morbidity and mortality. Risk factors for colonisation include receiving healthcare out with Scotland and close contact with someone infected or colonised with CPE.

Incubation Period :

N/A

Period of Infectivity :

N/A

Disease : Carbapenemase-producing Enterobacteriaceae infection or colonisation

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : No

Main route of transmission :

Contact

Guidance and supporting materials

Scottish

Patient Screening for Carbapenemase Producing Enterobacteriaceae (CPE) - Leaflets for Healthcare Workers and Patients http://www.hps.scot.nhs.uk/guidelines/detail.aspx?id=1661

Toolkit for the early detection, management and control of carbapenemase-producing Enterobacteriaceae in Scottish Acute Settings http://www.hps.scot.nhs.uk/guidelines/detail.aspx?id=478

Toolkit for managing carbapenemase-producing Enterobacteriaceae (CPE) in Scottish non-acute care settings.
http://www.hps.scot.nhs.uk/haiic/amr/resourcedetail.aspx?id=3347

 

International

CRE Toolkit
http://www.cdc.gov/hai/organisms/cre/cre-toolkit/index.html

Risk assessment on the spread of carbapenemase-producing Enterobacteriaceae (CPE) through patient transfer between healthcare facilities, with special emphasis on cross-border transfer https://ecdc.europa.eu/en/publications-data/risk-assessment-spread-carbapenemase-producing-enterobacteriaceae-cpe-through

Chickenpox

See Varicella virus

Chlamydia pneumoniae

Disease : Pneumonia

Notifiable

  • On the HPS alert organism list 2017 : No
  • Notifiable under Public Health (Scotland) Act 2008 : No

Main route of transmission :

Droplet
Clostridium difficile (CDI)

Clostridium difficile infection (CDI) is a major cause of infectious diarrhoea due to the spore-forming bacterium, Clostridium difficile. It is predominantly healthcare associated and accounts for about 20% of cases of antibiotic-associated diarrhoea.

Disease is mediated by the production of toxins, and symptoms include watery diarrhoea, fever, nausea, and abdominal pain, which may lead to serious complications including pseudomembranous colitis, toxic megacolon, and death.

Treatment with antibiotics or invasive surgical procedures, which disturb the normal intestinal flora, may lead to overgrowth of C. difficile, resulting in either asymptomatic colonisation or infection.

Those at most risk of developing CDI include elderly people and immunocompromised patients. A small proportion of healthy adults may carry C. difficile as part of the normal gut flora.

Incubation Period :

The precise incubation period is not well defined. C. difficile is transmitted via spores that are picked up from the environment either by direct contact with an infected (or colonised) person or by indirect contact with a contaminated surface.

Period of Infectivity :

While symptomatic and as a general principle until at least 48 hours after cessation of symptoms. Note: Shedding of the virus can occur for much longer durations in persons that are no longer symptomatic.

Exclusion period:Whilst symptomatic and 48 hours after cessation of symptoms.

Disease : Clostridium difficile infection

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : Yes

Main route of transmission :

Contact

Guidance and supporting materials

Scottish

Information leaflets

Tools

Surveillance

 

Coronavirus

Coronaviruses are species of virus belonging to the subfamily Coronavirinae.

Coronaviruses primarily infect the upper respiratory and gastrointestinal tract and are believed to cause a significant proportion of common colds in human adults. Occasionally, coronaviruses are able to cause more significant lower respiratory tract infections in humans with pneumonia; this is more likely in immunocompromised individuals, people with cardiopulmonary illnesses, as well as elderly people and young children.

 

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is a novel coronavirus that recently emerged in the Middle East that causes severe viral respiratory disease.

Symptoms include fever and cough that commonly progresses to a severe pneumonia, sometimes requiring mechanical ventilation (pneumonia is more likely in immunocompromised individuals, people with cardiopulmonary illnesses, as well as the elderly and young children). In some cases, a diarrheal illness has been the first symptom to appear.

Those at risk of contracting MERS-CoV include travellers to the Arabian Peninsula (or those in close contact with travellers to this region). The camel is a host species for the virus and those in contact with camels or camel products may also be at risk of contracting the disease.

Incubation Period :

5 - 14 days

Period of Infectivity :

Very limited data are available on hte duration of respiratory and extrapulmonary shedding of MERS-CoV, although it has been reported up to 32 days after onset of symptoms.

Disease : Coronavirus infection (non-MERS-CoV)

Notifiable

  • On the HPS alert organism list 2017 : No
  • Notifiable under Public Health (Scotland) Act 2008 : No

Main route of transmission :

Droplet

Disease : Novel coronavirus (MERS-CoV) infection

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : No

Main route of transmission :

Contact / Droplet

Guidance and supporting materials

Scottish

International

Corynebacterium diphtheriae

Disease : Diphtheria - Cutaneous

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : Yes

Main route of transmission :

Contact
Corynebacterium ulcerans

Disease : Diphtheria - Pharyngeal toxigenic strains

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : Yes

Main route of transmission :

Droplet
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D

Diphtheria

Diphtheria is an acute bacterial disease resulting from toxigenic C. diphtheriae or C.ulcerans infection of the upper respiratory tract and occasionally the skin. Most complications of diphtheria are attributable to effects of the toxin produced by the bacteria during infection. Depending on the tissues involved there are two main types of clinical diphtheria: pharyngeal and cutaneous.  

Pharyngeal diphtheria mainly affects the pharynx and the tonsils. Early symptoms include malaise, sore throat, swollen (bull) neck, anorexia, and low-grade pyrexia. Severe complications can include respiratory failure, toxin-induced myocarditis and peripheral neuritis, and may lead to death.  

Cutaneous diphtheria usually affects the skin on legs, hand and feet although rare reports of stoma-associated infection have been recorded. Pus-filled spots develop and eventually form into large ulcers surrounded by a red patch of discoloured skin. Ulcers usually heal within two to three months.

Diphtheria is a vaccine preventable disease and is part of the routine childhood immunisation schedule.

Incubation Period :

The incubation period of diphtheria is 2–5 days, with a range: 1–10 days

Period of Infectivity :

2-4 weeks after onset of symptoms, chronic carriers may shed bacteria for up to six months

Exclusion period Exclusion is essential. Family contacts must be excluded until cleared to return by your local HPT.

Disease : Diphtheria - Pharyngeal

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : Yes

Main route of transmission :

Droplet

Disease : Diphtheria - Cutaneous

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : Yes

Main route of transmission :

Contact

Guidance and supporting materials

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E

Enterovirus D68

EV-D68 is one of more than 100 enteroviruses, and belongs to the viruses of the family Picornaviridae genus Enterovirus.

EV-D68 can cause mild to severe respiratory illness. Symptoms may include rhinorrhoea, cough and myalgia, and in severe cases wheezing and difficulty breathing, resulting in hospitalisation.

In addition, EV-D68 has been associated with neurological symptoms such as aseptic meningitis, acute flaccid myelitis (AFM), and potentially Guillain-Barré syndrome in adults. EV-D68 is spread via infectious respiratory secretions, such as saliva, nasal mucus and sputum. Vulnerable groups include children, teenagers and immunocompromised adults.

 

Incubation Period :

3 to 5 days

Period of Infectivity :

While symptomatic (has been reported up to 21 days)

Disease : Severe respiratory illness

Notifiable

  • On the HPS alert organism list 2017 : No
  • Notifiable under Public Health (Scotland) Act 2008 : No

Main route of transmission :

Droplet

Disease : Acute flaccid myelitis (AFM)

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : No

Main route of transmission :

Droplet
Escherichia coli O157 (STEC)

Escherichia coli O157, also known as Shigatoxigenic Escherichia coli (STEC, previously known as verotoxigenic or VTEC), is a serogroup of the family of bacteriaEscherichia coli. STEC infection is a relatively rare cause of gastrointestinal illness. E. coli O157 is found in the gut and faeces of many animals, particularly cattle.

Symptoms can range from mild gastroenteritis through to severe bloody diarrhoea and in rare cases develop serious conditions including haemolytic uraemic syndrome (HUS) and thrombotic thrombocytopaenic purpura (TTP). Children and the elderly are most at risk of developing serious complications.

Incubation Period :

Usually 3-4 days, but can range from 1 to 14 days.

Period of Infectivity :

Symptoms can last up 14 days. Transmission from person-to-person is via the contact (faecal oral) route: from any food, water, or environmental source contaminated by the excreta of an animal or human case (including asymptomatic cases).

Period of Exclusion:Whilst symptomatic and 48 hours after cessation of symptoms, and until microbiologicaly clear (see additional guidance: http://www.hps.scot.nhs.uk/resourcedocument.aspx?id=1172

Disease : Escherichia coli Gastroenteritis

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : Yes

Main route of transmission :

Foodborne / Contact (faecal/oral)

Guidance and supporting materials

*This is rarely reported in the care environment where the main route of transmission is through contact

Scottish

Guidance for the Public Health Management of Infection with Verotoxigenic Escherichia coli (VTEC)

http://www.hps.scot.nhs.uk/resourcedocument.aspx?id=1170

 

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F

No Pathogens

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G

No Pathogens

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H

Haemophilus influenzae type b

Disease : Epiglottitis

Notifiable

  • On the HPS alert organism list 2017 : No
  • Notifiable under Public Health (Scotland) Act 2008 : No

Main route of transmission :

Droplet

Disease : Meningitis

Notifiable

  • On the HPS alert organism list 2017 : No
  • Notifiable under Public Health (Scotland) Act 2008 : Yes

Main route of transmission :

Droplet

Guidance and supporting materials

UK

Hepatitis A virus (HAV)

Hepatitis A is a member of Picornaviridae family of viruses and causes infectious hepatitis.

Those infected (especially children) may be asymptomatic, or can range in severity from non specific nausea and vomiting, through to hepatitis (liver inflammation, jaundice, or icterus); and in rare cases to liver failure.

Symptoms can last 1-2 weeks in the case of mild disease and up to a year in the case of severe disease.

Hepatitis A is transmitted from person to person, or though contact with contaminated food, water, contaminated surfaces or objects.

Certain groups are at increased risk of acquiring Hep A including travellers to parts of the world with poor levels of sanitation, men who have sex with men, and people who inject drugs.

Incubation Period :

Typically the incubation period is 28–30 days, however in some instances it can range from 15 to 50 days

Period of Infectivity :

During the latter half of incubation (1- 2 weeks before onset of symptoms) and up to few days after the onset of jaundice.

Exclusion period: Exclude from work, school or nursery until 7 days post onset of jaundice or in absence of jaundice, from the onset of compatible symptoms (such as fatigue, nausea or fever

Disease : Infectious hepatitis

Notifiable

  • On the HPS alert organism list 2017 : No
  • Notifiable under Public Health (Scotland) Act 2008 : Yes

Main route of transmission :

Contact

Guidance and supporting materials

Route of transmission is contact/foodborne

 

UK

Hepatitis A infection: prevention and control guidance
https://www.gov.uk/government/publications/hepatitis-a-infection-prevention-and-control-guidance

Vaccination information
https://www.gov.uk/government/publications/hepatitis-a-the-green-book-chapter17

Hepatitis E

Disease : Hepatitis E

Main route of transmission :

Guidance and supporting materials

UK

Hepatitis E, symptoms, transmission, prevention and treatment
https://www.gov.uk/government/publications/hepatitis-e-symptoms-transmission-prevention-treatment

Herpes zoster (varicella zoster)

The varicella-zoster virus establishes latency after initial infection and may be re-activated, usually in later life, as herpes zoster (shingles). This often occurs when the immune system is weakened.

The virus can be spread through direct contact with fluid from the rash blisters caused by shingles andit is therefore possible to catch chickenpox from someone with shingles, although it is not possible to catch shingles from someone with chickenpox.

Incubation Period :

Reactivation can occur many years after initial infection

Period of Infectivity :

Infective while the rash oozes fluid

Exclusion period Exclude only if rash is weeping and cannot be covered

Disease : Shingles (vesicle fluid)

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : No

Main route of transmission :

Contact

Disease : Shingles (lesions in the respiratory tract)

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : No

Main route of transmission :

Droplet / Airborne

Guidance and supporting materials

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I

Influenza virus (Endemic strains)

Disease : Influenza

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : Yes

Main route of transmission :

Droplet

Guidance and supporting materials

Scottish

Cribcard for influenza
http://www.documents.hps.scot.nhs.uk/hai/infection-control/toolkits/flu-crib-card-2015-09.pdf

Influenza Outbreak control measure trigger tool for hospitals
http://www.hps.scot.nhs.uk/haiic/ic/resourcedetail.aspx?id=1596

Influenza Outbreak Trigger tool for Care homes
http://www.hps.scot.nhs.uk/haiic/ic/resourcedetail.aspx?id=1684

Guidance on outbreaks of Influenza in Care Homes and Hospitals (Poster)
http://www.hps.scot.nhs.uk/haiic/ic/resourcedetail.aspx?id=1595

Interim infection control precautions to minimise transmission of respiratory tract infections (RTIs)
http://www.hps.scot.nhs.uk/resp/resourcedetail.aspx?id=1586

UK Influenza Pandemic Preparedness Strategy
http://www.scotland.gov.uk/Publications/2011/11/e3135711/link

UK

Influenza: the green book, chapter 19
https://www.gov.uk/government/publications/influenza-the-green-book-chapter-19

 

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J

No Pathogens

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K

No Pathogens

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L

Legionella

Disease : Legionnaire's disease, legionellosis, pontiac fever

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : Yes

Main route of transmission :

Guidance and supporting materials

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M

Measles virus (Rubeola)

Measles is a highly infectious acute viral disease resulting from infection with measles virus.

Initial symptoms include fever, conjunctivitis, cough, runny nose and sneezing. This is followed by small grey/white spots, called Koplik’s spots, on the inside of the mouth 1–2 days before rash onset which may last for 2-4 days.

Measles rash appears red and blotchy, developing 2–4 days after the onset of fever, and spreading from the head to the body over the next 3–4 days.

Vulnerable groups include unvaccinated children/pregnant women, immunocompromised patients and the chronically ill. These groups are more at risk of developing severe complications including pneumonia/bronchitis, convulsions, diarrhoea, meningitis/encephalitis, immune thrombocytopenic purpura (ITP), late onset subacute sclerosing panencephalitis (SSPE).

Incubation Period :

Usually 10-12 days before the beginning of symptoms and 14 days after appearance of rash.

Period of Infectivity :

Individuals are usually infectious 5 days before to 4 days after rash onset. Measles is transmitted via respiratory droplets, or direct contact with nasal/throat secretions of infected individuals.

Exclusion period 4 days after onset of rash

Disease : Measles (Rubeola)

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : Yes

Main route of transmission :

Droplet / Airborne

Guidance and supporting materials

Scottish

Guideline for the control of measles incidents and outbreak in Scotland, 2014
http://www.hps.scot.nhs.uk/guidelines/detail.aspx?id=196

Infection Prevention and Control in Childcare Settings
http://www.hps.scot.nhs.uk/resourcedocument.aspx?id=5761

Measles, Clinical signs and symptoms. HPS Presentation.
https://www.hps.scot.nhs.uk/resourcedocument.aspx?id=490

 

UK

National measles Guidance (10 August 2017)
https://www.gov.uk/government/publications/national-measles-guidelines

Measles: Post exposure prophylaxis
https://www.gov.uk/government/publications/measles-post-exposure-prophylaxis

Measles: symptoms, diagnosis, complications, treatment
https://www.gov.uk/government/publications/measles-symptoms-diagnosis-complications-treatment

NICE: Clinical Knowledge Summary
https://cks.nice.org.uk/measles#!topicsummary

 

Meticillin resistant Staphylococcus aureus (MRSA)

See Staphylococcus Aureus

Middle East Respiratory Syndrome Coronavirus (MERS-CoV)

See Coronavirus

Mumps virus

Mumps is a disease caused by a paramyxovirus.

The symptoms include swelling of the parotid glands (Parotitis) which may be painful, causing difficulty with swallowing. Parotitis may be preceded by several days of non-specific symptoms such as fever, headache, malaise, nausea, myalgias and anorexia; although asymptomatic mumps infection is common, particularly in children.

Common complications may include swelling of the ovaries (oophoritis), swelling of the testes (orchitis), pancreatitis and viral meningitis. Rare complications include encephalitis and permanent hearing loss; Mumps is rarely fatal.  

Mumps is a vaccine preventable disease and is part of the normal childhood vaccination schedule.

Incubation Period :

The incubation period is 17 days, with a range of 14 to 25 days.

Period of Infectivity :

Several days before the parotid swelling starts until several days afterwards.

Exclusion period: Exclude for five days after onset of swelling.

Disease : Mumps (infectious parotitis)

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : Yes

Main route of transmission :

Droplet

Guidance and supporting materials

Mycobacterium tuberculosis

Tuberculosis (TB) is a disease caused by Mycobacterium tuberculosis, M. bovis, M. africanum, M. canetti or M. microti, which together form the Mycobacterium tuberculosis complex. There are two forms of tuberculosis:

  • TB affecting the lungs; and
  • TB causing infection elsewhere in the body, including the glands, bones and nervous system.

Typical symptoms of TB can include: extreme tiredness/fatigue, loss of appetite/weight, night sweating and fever.

Additional symptoms for pulmonary TB include increasing breathlessness and a persistent productive cough lasting more than 3 weeks, which may be bloody.

Additional symptoms of extrapulmonary TB vary but may include: persistently swollen glands, abdominal pain, pain and loss of movement in an affected bone or joint, confusion, persistent headache and seizures.

TB is treated with antibiotics, however resistance to the antibiotics used for treatment is an increasing problem:

  • Multidrug-resistant tuberculosis (MDR TB)

Multidrug-resistant TB (MDR TB) is caused by an organism that is resistant to at least isoniazid and rifampin, the two most potent TB drugs that are used in all cases for treatment.

  • Extensively drug resistant tuberculosis (XDR TB)

Extensively drug resistant TB (XDR TB) is a rare type of MDR TB that is resistant to isoniazid and rifampin, plus any fluoroquinolone and at least one of three injectable second-line drugs (i.e., amikacin, kanamycin, or capreomycin). Because XDR TB is resistant to the most potent TB drugs, patients are left with treatment options that are much less effective. XDR TB is of particular concern for persons with HIV infection or other conditions that can weaken the immune system.

Transmission of TB is normally by inhalation of infected droplets and requires prolonged close contact (e.g. sharing sleeping quarters) with an infected individual. In some cases after infection the bacteria can remain latent in the body for a long time (even lifelong), causing no symptoms of disease. People with latent TB infection (LTBI) are not infectious; however under favourable conditions i.e. immunosuppressed, the bacteria can start multiplying (reactivate) and cause clinical disease.

Vulnerable groups include:those in close contact with a person with infectious TB disease; those who have immigrated from areas of the world with high rates of TB; children younger than 5 years of age who have a positive TB test; and groups with high rates of TB transmission, such as homeless persons, injection drug users, persons with HIV infection and persons who work or reside with people who are at high risk of contracting TB.

The TB vaccine (BCG) is recommended for certain at risk groups.

Incubation Period :

Normally 2 to 10 weeks, however, immunocompromised patients may have a shorter incubation period, while those with latent TB infections may never develop TB disease.

Period of Infectivity :

While symptomatic and for 2-4 weeks after antibiotic treatment commences, and while viable bacilli are discharged in sputum.

Disease : Extrapulmonary Tuberculosis

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : Yes

Main route of transmission :

Contact

Disease : Pulmonary or laryngeal Tuberculosis

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : Yes

Main route of transmission :

Airborne

Guidance and supporting materials

Scottish

Tuberculosis:Clinical diagnosis and management of tuberculosis, and measures for its prevention and control in Scotland http://www.hps.scot.nhs.uk/resp/guidelinedetail.aspx?id=40817

A TB Action plan for Scotland
http://www.scotland.gov.uk/Publications/2011/03/18095603/0

 

International

ECDC Tuberculosis webpage
https://ecdc.europa.eu/en/tuberculosis

CDC Tuberculosis webpage
https://www.cdc.gov/tb/default.htm

Mycoplasma pneumoniae

Disease : Pneumonia

Notifiable

  • On the HPS alert organism list 2017 : No
  • Notifiable under Public Health (Scotland) Act 2008 : No

Main route of transmission :

Droplet
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N

Neisseria meningitides

Disease : Meningitis - meningococcal (or presentation of clinical meningitis of unknown origin)

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : Yes

Main route of transmission :

Droplet
Nontuberculous mycobacteria (NTM)

Nontuberculous mycobacteria (NTM) are mycobacteria which do not cause tuberculosis or leprosy. NTM infections are most frequently located in the lungs, but may also be found in lymph nodes, skin, soft tissue, and joint and bones. NTM cause pulmonary diseases that resemble tuberculosis: symptoms may include fever, tiredness, nausea/vomiting, night sweats, cough and weight loss, with the more severe cases required antibiotic and steroid therapy.

NTM comprise a multispecies group of organisms common throughout the environment, and rarely associated with outbreaks in care settings. NTM is not considered contagious and is spread via environmental sources, typically water, but also contaminated medical equipment/devices.

Fifteen species are recognized as pathogenic to humans, with some species showing high levels of antimicrobial resistance: particularly M. abscessus.

  • M. abscessus: Healthcare-associated infections due to this bacterium are usually of the skin and the soft tissues under the skin, which usually become red, warm, tender to the touch, swollen, and/or painful. Infected areas can also develop boils or pus-filled vesicles. M. abscessus is also a cause of serious lung infections in persons with chronic lung diseases, such as cystic fibrosis. Infection with M. abscessus is usually caused by injections of substances contaminated with the bacterium or through invasive medical procedures employing contaminated equipment or material. Infection can also occur after accidental injury where the wound is contaminated by soil.
  • M. avium and M. fortuitum have been linked to hot tubs or spa baths, with NTM found in spa bath water and/or in the air of the homes of the people diagnosed with NTM infection. Infection may occur in the skin or soft tissues following trauma or surgery.
  • M. chimaera which belongs to the M. avium complex, has been recognised as a cause of endocarditis, severe disseminated infection and chronic sternal wound infection in patients who have undergone cardiothoracic surgery. This is likely to be transmitted from the heater cooler units of cardiopulmonary bypass equipment. M. chimaera may manifest many years after surgery. Vulnerable groups include HIV infected and immunocompromised persons, cystic fibrosis (CF) patients, and those who have had open heart surgery since January 2013.

Incubation Period :

Varies widely from days to years

Period of Infectivity :

Transmitted from environmental sources

Disease : Mycobacteriosis

Notifiable

  • On the HPS alert organism list 2017 : No
  • Notifiable under Public Health (Scotland) Act 2008 : No

Main route of transmission :

Contact / Droplet

Guidance and supporting materials

Scotland

Guidance on Mycobacterium chimaera infections associated with heater cooler units used in cardiopulmonary bypass.
http://www.hps.scot.nhs.uk/haiic/sshaip/resourcedetail.aspx?id=3169

 

UK

Mycobacterium chimaera infections: guidance for secondary care
https://www.gov.uk/government/publications/mycobacterium-chimaera-infections-guidance-for-secondary-care

 

International

Mycobacterium abscessus in Healthcare Settings https://www.cdc.gov/hai/organisms/mycobacterium.html


Norovirus (winter vomiting disease, norwalk-like viruses)

Norovirus, also known as ‘winter vomiting disease’, belongs to the Caliciviridae family of viruses and is a common gastrointestinal infection.

Symptoms include acute onset of non-bloody watery diarrhoea and / or vomiting, often accompanied with abdominal cramps, myalgia, headache, malaise and low grade fever. Noroviruses are highly infectious and transmitted easily from person to person, contaminated food or water or by contact with contaminated surfaces or objects.

Outbreaks are common in semi-enclosed areas such as hospitals, care homes, educational establishments and prisons due to population proximity. Although norovirus gastroenteritis is generally mild and of short duration, the illness can be severe among vulnerable population groups such as young children and the elderly.

Incubation Period :

Typically between 12-48 hours

Period of Infectivity :

Whilst individuals are symptomatic and for a further 48 hours after the cessation of symptoms. Prolonged shedding of the virus can occur in persons that are immunocompromised and young children.

Exclusion Period: Whilst symptomatic and 48 hours after cessation of symptoms.

Disease : Norovirus gastroenteritis

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : No

Main route of transmission :

Contact

Guidance and supporting materials

Scottish

General information to prepare for and manage norovirus in care settings
http://www.hps.scot.nhs.uk/haiic/ic/resourcedetail.aspx?id=165

Norovirus Tracker: monthly and seasonal
http://www.hps.scot.nhs.uk/haiic/ic/resourcedetail.aspx?id=1685

Guidance on outbreaks of norovirus in care homes poster
http://www.documents.hps.scot.nhs.uk/hai/infection-control/norovirus/noro-poster-care-home-2015.pdf

Norovirus: Information for patients and their relatives and carers
http://www.hps.scot.nhs.uk/haiic/ic/resourcedetail.aspx?id=596

The Identification and Management of Outbreaks of Norovirus Infection in Tourists and Leisure Industry Settings. Guide for NHS boards and local authorities.
http://www.hps.scot.nhs.uk/enviro/resourcedetail.aspx?id
=889

Norovirus Campaign materials
http://www.healthscotland.com/resources/campaigns/norovirus.aspx

Stay at home: Norovirus the winter vomiting bug. Keep it to yourself. Advice for everyone
http://www.healthscotland.com/documents/24074.aspx

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O

No Pathogens

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P

Panton Valentine Leukocidin (PVL) -positive Staphylococcus aureus

See Staphylococcus aureus

Parainfluenza virus

Disease : Upper +/- lower respiratory tract infection

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : No

Main route of transmission :

Droplet
Parvovirus B19 - (Erythema infectiosum - Erythrovirus B19)

Disease : Slapped cheek syndrome

Notifiable

  • On the HPS alert organism list 2017 : No
  • Notifiable under Public Health (Scotland) Act 2008 : No

Main route of transmission :

Droplet
Pneumocystis jirovecii

Disease : Pneumonia

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : No

Main route of transmission :

Guidance and supporting materials

Scottish

PcP: Patient information leaflet
http://www.hps.scot.nhs.uk/pubs/detail.aspx?id=3075

Pseudomonas aeruginosa

Disease : Pneumonia, bacteraemia, wound or surgical infections, catheter-associated urinary tract infections, conjunctivitis in neonates

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : No

Main route of transmission :

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Q

No Pathogens

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R

Rabies virus

The rabies virus is a member of the family of Rhabdoviridae. The most common mode for rabies transmission is from virus-laden saliva of an infected animal following an animal bite or scratch (in particular dogs) has also been found in bats.  

The onset of illness is insidious. Early symptoms may include paraesthesiae around the site of the wound, fever, headache and malaise. The disease may then present with hydrophobia, hallucinations and maniacal behaviour progressing to paralysis and coma, or as an ascending flaccid paralysis and sensory disturbance.

Rabies is almost always fatal, death resulting from respiratory paralysis. Early intervention, including vaccination, is essential to prevent progression to later stages of infection which include acute nervous system dysfunction with muscle weakness, frothing saliva, general paralysis, convulsions and latterly death.

Incubation Period :

Highly variable: The incubation period for rabies depends upon the size of the inoculum and the distance of the inoculum from the victim’s central nervous system. The incubation period has been reported to be as short as a few days, and as long as a few years

Period of Infectivity :

Normally 3 to 7 days, before onset of clinical signs and throughout the course of the disease.

Disease : Rabies

Notifiable

  • On the HPS alert organism list 2017 : No
  • Notifiable under Public Health (Scotland) Act 2008 : Yes

Main route of transmission :

Contact

Guidance and supporting materials

Respiratory synctial virus (RSV)

Respiratory syncytial virus (RSV) is a single stranded RNA paramyxovirus, which belongs to the Pneumovirus genus. RSV usually causes mild, cold-like symptoms, but may cause severe breathing problems and bronchiolitis or pneumonia in babies. Vulnerable groups include:premature infants, young children and elderly people with heart or lung disease and immunocompromised people.  

 

Incubation Period :

2-8 days

Period of Infectivity :

Usually 3 to 8 days. However, infants and people with weakened immune systems can continue to spread the virus for as long as 4 weeks after they stop showing symptoms.

Disease : RSV Infection

Main route of transmission :

Contact / Droplet

Guidance and supporting materials

Rhinovirus

Disease : Upper +/- lower respiratory tract infection

Notifiable

  • On the HPS alert organism list 2017 : No
  • Notifiable under Public Health (Scotland) Act 2008 : No

Main route of transmission :

Droplet
Rotavirus

Rotavirus belongs to the Reoviridae family of viruses and is a common cause of infectious gastroenteritis in infants and young children, and less frequently in adults.

Symptoms last 4-6 days and include: severe vomiting and diarrhoea, accompanied by stomach cramps; in rare occasions it can cause severe dehydration and death in young children.

Rotavirus is transmitted from person to person, or though contact with contaminated food, water, contaminated surfaces or objects.

Incubation Period :

24-72 hours

Period of Infectivity :

While symptomatic, and for a further 48 hours after the cessation of symptoms. . Prolonged shedding of the virus can occur in persons that are immunocompromised.

Exclusion Period: Individuals should be considered infectious for 48 hours after cessation of symptoms.

Disease : Rotavirus gastroenteritis

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : No

Main route of transmission :

Contact / Droplet

Guidance and supporting materials

Rubella virus

Disease : German measles

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : Yes

Main route of transmission :

Droplet

Guidance and supporting materials

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S

Salmonella (non-typhoidal)

Salmonella spp. is a ubiquitous bacterium of which more than 2000 serotypes have been identified. Salmonella can cause food poisoning with most disease caused by two serotypes, S. Enteritidis and S.Typhimurium.

Transmission occurs by the ingestion of contaminated food (most commonly poultry, red meat, raw eggs and dairy products and salad products) or via faecal contamination from an infected person or animal.

Symptoms include diarrhoea, stomach cramps and sometimes vomiting and fever.

Incubation Period :

12 - 72 hours

Period of Infectivity :

4–7 days

Exclusion period:Whilst symptomatic and 48 hours after cessation of symptoms
Serratia marcescens

Disease : Pneumonia, bacteraemia, urinary tract infections, wound infections

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : No

Main route of transmission :

Shigella

Shigella, also known as bacillary dysentery, is a genus of bacteria of which four species cause disease in humans: Shigella dysenteriae, Shigella flexneri, Shigella boydii, Shigella sonnei.

Symptoms include: diarrhoea, often containing blood and mucus (dysentery), nausea, vomiting and fever. 

Sequelae include toxaemia and toxic megacolon.

Shigella is highly infectious and is transmitted easily from person to person, through contaminated food or water or by contact with contaminated surfaces or objects.

Incubation Period :

Usually 1 - 3 days, but can range from 12 - 96 hours and up to 1 week for Sh.dysenteriae

Period of Infectivity :

During acute infection, and up to 4 weeks after cessation of symptoms

Exclusion period:
Individuals should be considered infectious for 48 hours after cessation of symptoms. * *Some groups may need to be excluded until clear of the infecting organism, for details see: http://www.hps.scot.nhs.uk/resourcedocument.aspx?id=1053

Disease : Bacillary dysentery (Shigellosis)

Notifiable

  • On the HPS alert organism list 2017 : No
  • Notifiable under Public Health (Scotland) Act 2008 : Yes

Main route of transmission :

Contact

Guidance and supporting materials

Main route of transmission is Contact/foodborne*

*This is rarely reported in the care environment where the main route of transmission is through contact

Staphylococcus aureus

Staphylococcus aureus is a bacterium that commonly colonises human skin and mucosa.

Normally the bacteria cause no harm and those colonised with S. aureus remain asymptomatic. S. aureus can however lead to serious infections when bacteria spread to the bloodstream, this may occur when then skin is broken, for example following surgery or a medical procedure.S. aureus may cause a range of illness including skin and wound infections, infected eczema, abscesses or joint infections, endocarditis, pneumonia, osteomyelitis, urinary tract infections and bacteraemia.

S. aureus can be spread from close contact with infected people, or touching surfaces or objects contaminated with S. aureus. Vulnerable groups include people with chronic conditions such as diabetes, cancer, vascular disease, eczema, lung disease and the immunocompromised. 

 

Meticillin-Resistant Staphylococcus aureus (MRSA)

Most strains of S. aureus are treated with the more commonly used antibiotics, however some S. aureus bacteria are resistant to the antibiotic meticillin, these are termed meticillin-resistant Staphylococcus aureus (MRSA).

 

Panton Valentine Leukocidin (PVL) positive Staphylococcus aureus

Panton-Valentine leukocidin (PVL) is a cytotoxin produced by some strains of Staphylococcus aureus that causes leukocyte destruction and tissue necrosis. Infection with PVL S. aureus causes a variety of skin and soft tissue infections including boils, cellulitis, purulent eyelid infection, tissue necrosis and abscesses. Invasive infections include necrotising/ haemorrhagic pneumonia, necrotising fasciitis, osteomyelitis, septic arthritis, and bacteraemia. PVL S. aureus is associated with increased morbidity and mortality, although fatalities remain rare.

Incubation Period :

N/A

Period of Infectivity :

While colonised/infected

Exclusion period:Hospitalised patients should be placed in single en-suite room while colonised infected with MRSA and/or PVL-S.aureus . Advice from Human Resources and Occupational Health must be sought when dealing with screening or exclusion of staff from work during an outbreak

Disease : MRSA infection

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : Yes

Main route of transmission :

Contact

Disease : PVL-S.aureus infection

Notifiable

  • On the HPS alert organism list 2017 : Yes

Main route of transmission :

Contact

Guidance and supporting materials

Scottish

Protocol for Enhanced Staphylococcus aureus bacteraemia surveillance
http://www.hps.scot.nhs.uk/haiic/sshaip/resourcedetail.aspx?id=1732

Protocol for the Scottish Mandatory Surveillance Programme for Staphylococcus aureus bacteraemia
http://www.hps.scot.nhs.uk/haiic/sshaip/resourcedetail.aspx?id=677

Interim advice for the diagnosis and management of PVL-associated Staphylococcus aureus infections (PVL-S. aureus)
http://www.hps.scot.nhs.uk/resourcedocument.aspx?id=1189

 

UK

Staphylococcus aureus: guidance, data and analysis
https://www.gov.uk/government/collections/staphylococcus-aureus-guidance-data-and-analysis  

Guidelines for the control and prevention of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities, Journal of Hospital Infection (2006) http://www.journalofhospitalinfection.com/article/S0195-6701(06)00002-8/abstract

Stenotrophomonas maltophilia

Disease : Bacteraemia, respiratory infections, urinary infections and surgical-site infections

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : No

Main route of transmission :

Streptococcus pneumoniae

Disease : Pneumonia Meningitis

Notifiable

  • On the HPS alert organism list 2017 : No
  • Notifiable under Public Health (Scotland) Act 2008 : Yes

Main route of transmission :

Droplet

Disease : Bacteraemia, meningitis, wound ie. blood, cerebrospinal fluid or other normally sterile site

Notifiable

  • On the HPS alert organism list 2017 : No
  • Notifiable under Public Health (Scotland) Act 2008 : Yes

Main route of transmission :

Contact
Streptococcus pyogenes (Group A Strep)

Disease : Respiratory

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : No

Main route of transmission :

Droplet

Disease : Bacteraemia meningitis, wound i.e blood, cerebrospinal fluid or other normally sterile site

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : Yes

Main route of transmission :

Contact
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T

Transmissible Spongiform Encephalopathies (TSEs)

Transmissible spongiform encephalopathies (TSEs), or prion diseases, are a group of rare and invariably fatal neurodegenerative disorders.

Three types of TSE can affect humans: idiopathic TSEs (e.g. sporadic Creutzfeldt-Jakob disease [CJD]), familial TSEs and acquired TSEs (e.g. iatrogenic CJD).

Variant CJD (vCJD) is an acquired TSE caused by transmission of the agent responsible for bovine spongiform encephalopathy (BSE) in cattle. Whereas sporadic CJD is most common in people over 50 and accounts for 85% of CJD cases, vCJD has an age of onset in the late 20s. Sporadic CJD presents as rapidly progressive dementia with a range of neurological signs and symptoms, including ataxia, myoclonus, visual disturbances and movement disorders. In vCJD, this presentation is often preceded by psychiatric symptoms, such as anxiety and depression. People with vCJD tend to live for an average of 14 months after symptom onset, while survival for sporadic CJD is frequently only a few months.

Incubation Period :

Incubation periods for iatrogenic CJD vary widely and range from 1–2 years for transmission by contaminated neurosurgical instruments to over 30 years for transmission via human-derived pituitary hormones.

Main route of transmission Period of Iatrogenic transmission from cases of sporadic CJD can occur in association with specific medical interventions, including: receipt of hormones derived from human pituitary glands (i.e. growth hormone and gonadotrophin), organ or tissue transplants (i.e. dura mater grafts and corneal transplantation), and neurosurgical procedures using contaminated instruments. With the exception of neurosurgical procedures, these interventions are no longer performed in the UK. Abnormal prion proteins can remain infective on instruments after steam sterilisation and are highly resistant to both chemical disinfectants and radiation. Iatrogenic transmission from cases of vCJD can occur via blood transfusion or receipt of blood products (e.g. clotting factors).

Disease : TSEs, Creutzfeldt-Jakob Disease (CJD)

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : No

Main route of transmission :

Guidance and supporting materials

Although not notifiable, the CMO mandates that all suspected cases must be reported to the local health protection team and the National CJD Research & Surveillance Unit.

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U

No Pathogens

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V

Vancomycin-resistant Enterococci (VRE)

Enterococci are a group of gram-positive bacteria that are naturally present in the human intestine, known as commensals.  They are normally harmless with colonisation occurring more frequently than infection, but can be pathogenic and cause bacteraemia, urinary tract infections, and wound and surgical site infections. Most infections are due to E. faecalis (around 90%), though cases of E. faecium are rising.

Vancomycin-resistant Enterococci (VRE) are enterococci that are resistant to the antibiotic vancomycin making them more difficult treat. Vancomycin resistance occurs in approximately 1% of E. faecalis and 34% of E. Faecium strains. They are sometimes referred to as Glycopeptide-resistant Enterococci (GRE). Most vancomycin-resistant Enterococcal infections are healthcare associated with high risk groups including patients with a history of antibiotic use (particularly vancomycin), presence of an invasive medical device and being immunocompromised.

Disease : Vancomycin-resistant enterococcal infection or colonisation

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : No

Main route of transmission :

Contact

Guidance and supporting materials

Scottish

Vancomycin-resistant enterococci (VRE): Information for healthcare workers http://www.documents.hps.scot.nhs.uk/hai/infection-control/publications/leaflets/vre-leaflet-hcw-2016-01.pdf

 

UK

Guidance: Enterococcus species and glycopeptide-resistant enterococci (GRE) https://www.gov.uk/guidance/enterococcus-species-and-glycopeptide-resistant-enterococci-gre

Guidelines for the control of glycopeptide-resistant enterococci in hospitals

https://www.his.org.uk/resources-guidelines/his-guidelines/

 

International

VRE in Healthcare Settingshttps://www.cdc.gov/hai/organisms/vre/vre.html

 

Varicella virus

Chickenpox (varicella) is an acute, generalised viral disease resulting from primary infection with varicella-zoster virus (VZV).

The symptoms are fever and malaise prior to onset of the itchy vesicular rash. In children the rash is often the first sign of disease. Successive crops of lesions can appear, drying to a granular scab five or six days after the rash began.

Chickenpox is generally not a serious infection, but complications including encephalitis, pneumonia and secondary bacterial infection can occur in previously healthy individuals.

Chickenpox is most serious for pregnant women, immunocompromised individuals and exposed neonates; who are at risk of severe, disseminated disease. Vaccination is available to children and adults who are particularly vulnerable to chickenpox complications.

 

Incubation Period :

1-3 weeks

Period of Infectivity :

1-2 days before the rash appears up until the vesicles become dry.

Exclusion Period Until all vesicles have crusted over, usually around 5-6 days

Disease : Chickenpox

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : Yes

Main route of transmission :

Droplet / Airborne

Guidance and supporting materials

Scotland

HPS Chickenpox web page
http://www.hps.scot.nhs.uk/immvax/chickenpox.aspx

UK

Varicella: the green book, chapter 34 
https://www.gov.uk/government/publications/varicella-the-green-book-chapter-34

Chickenpox and shingles: infection control in prisons and other places of detention
https://www.gov.uk/government/publications/chickenpox-and-shingles-infection-control-in-prisons-and-other-places-of-detention

NICE: Clinical Knowledge Summary - Chickenpox
https://cks.nice.org.uk/chickenpox#!topicsummary

Vero cytoxin-producing Escherichia coli (VTEC)

Disease : Gastroeneteritis, haemolytic uremic syndrome, thrombotic thrombocytopaenic purpura

Notifiable

  • On the HPS alert organism list 2017 : Yes
  • Notifiable under Public Health (Scotland) Act 2008 : Yes

Main route of transmission :

Contact
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W

Whooping cough

See Bortedella pertussis

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X

No Pathogens

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Y

No Pathogens

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Z

No Pathogens

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Footnotes

A-Z of Pathogens