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National Infection Prevention and Control Manual

National Infection Prevention and Control Manual

A-Z Pathogens

The A-Z provides a description of pathogen, incubation period and infectivity along with transmission routes, notifiable status and alert organisms for diseases associated with the pathogen.  

The A-Z also contains links to external UK/International guidance documents (non-Scottish); Health Protection Scotland is not responsible for the content of these guidance documents.  Unless explicitly stated, external guidance has not been assessed and/or approved for use in Scottish care settings.  External UK/International guidance should not override or replace HPS-approved guidance.

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 table (February 2018) PDF document

 

 

A

Acinetobacter baumanii

Acinetobacter baumannii is a gram-negative bacterium that is found in the environment including drinking water, soil and sewage. It can also be found on the skin of some healthy individuals. A.baumannii infections in the community are very rare and almost exclusively occur in the hospital setting. It is an opportunistic pathogen affecting those with underlying health problems and infection is often associated with invasive or indwelling medical devices.

A.baumannii can cause pneumonia, bloodstream infections, meningitis, urinary tract infections and surgical site infections including necrotising fasciitis. At risk groups include patients who are immunocompromised, have chronic lung disease, diabetes, or burn injuries. Infections can be very difficult to treat as A.baumannii is intrinsically resistant to many antimicrobial agents and can acquire resistance easily. This includes increasing resistance to the carbapenem class of antibiotics which are often the last resort for treatment.

Incubation Period :

N/A

Period of Infectivity :

Transmission is possible from contact with colonised environmental sources or the skin of colonised individuals.

Disease : Acinetobacter baumannii 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

**On alert organisms list if found in high risk units e.g. ICU/oncology/NNU etc

UK

Acinetobacter species Guidance https://www.gov.uk/guidance/acinetobacter-species

International

Acinetobacter in Healthcare Settings https://www.cdc.gov/hai/organisms/acinetobacter.html

Rapid risk assessment: Carbapenem-resistant Acinetobacter baumannii in healthcare settings https://ecdc.europa.eu/en/publications-data/rapid-risk-assessment-carbapenem-resistant-acinetobacter-baumannii-healthcare

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 : Conjunctivitis

Notifiable

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

Main route of transmission :

Contact

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
Anthrax

See Bacillus anthracis

Aspergillus spp

Aspergillus spp. a common fungi that can be found in the 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

International

Aspergillosis guidance, Health Protection Surveillance Centre, Ireland
http://www.hpsc.ie/a-z/respiratory/aspergillosis/guidance/

 

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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

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

 

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 (Pediculus humanus humanus or sometimes called Pediculus humanus corporis) are a type of tiny parasite. Infestations of body lice are known as Pediculosis corporis, Pediculosis vestimenti or Vagabond’s disease.

The lice lay eggs in the seams of clothing, usually only moving onto skin to feed on blood via biting. Infestations with body lice can cause severe itch on the parts of the body affected and sometimes a rash caused by an allergic reaction to the bites can occur.

Body lice are less common than head and pubic lice infestations, usually only occurring in vulnerable groups such as people who are homeless.

Prolonged direct contact with infested individual or their clothing/bed linens is required for transmission. Outbreaks can occur in situations that prevent the regular laundering of clothing or maintenance of good hygiene. However, unlike head and pubic lice, infestations with body lice can lead to more serious conditions as the lice can be a vector for diseases such as typhus, trench fever, louse-borne relapsing fever.

Management of body lice involves regular bathing and laundering of clothes and bedding material at high temperatures to prevent re-infestation. Treatment with a pediculicide is only required if good hygiene practices cannot be introduced.

Incubation Period :

Lice hatch from eggs (‘nits’) 1-2 weeks after being laid

Period of Infectivity :

While live lice are present in clothing, bedding or towels.

Exclusion period: Whilst undergoing treatment, individuals should not have prolonged physical contact with others or share bedding or other linens.

Disease : Body lice infestation/ Pediculosis corporis/ Pediculosis vestimenti/ Vagabond’s disease

Notifiable

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

Main route of transmission :

Contact

Guidance and supporting materials

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

Burkholderia cepacia complex

Burkholderia cepacia complex is a group of Gram-negative bacteria commonly found in soil and water and are opportunistic pathogens in hospital environments.

B. cepacia poses little risk to healthy people however people with weakened immune systems or chronic lung diseases such as cystic fibrosis are susceptible to infection.

Infection typically involves the respiratory tract, with symptoms including fever, cough, shortness of breath and wheezing. 
B. cepacia are often resistant to common antibiotics and treatment typically requires a combination of antibiotics.

B. cepacia can be transmitted to susceptible people by direct/indirect contact with contaminated surfaces and exposure to B. cepacia in the environment.

Disease : Burkholderia cepacia complex

Notifiable

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

Main route of transmission :

Contact
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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 :

Contact / Foodborne

Guidance and supporting materials

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

UK

Campylobacter guidance, data and analysis

https://www.gov.uk/government/collections/campylobacter-guidance-data-and-analysis

 

Candida auris

Candida auris is a recently identified species of yeast (a type of fungus) from the Candida genus. Most Candida species are harmless commensals, however they can be invasive and cause disease, known as candidiasis.

C. auris was first identified in 2009 and has been associated with prolonged outbreaks in healthcare settings as it is highly transmissible between patients and from contaminated environments. It can cause a wide range of infections, including blood stream infections (candidaemia), pericarditis, urinary tract infections (UTIs) and pneumonia.  It is hard to identify with standard laboratory methods and is multi-drug resistant making diagnosis and treatment difficult.

C. auris mainly affects critically unwell patients in a high dependency or intensive care settings. Those with severe underling co-morbidities and immunosuppression, including those with diabetes, chronic kidney disease, malignancies and Human Immunodeficiency Virus (HIV) are most at-risk.

Period of Infectivity :

While colonised or infected.

Exclusion period Patients with C. auris infections or colonisation should be managed in single rooms.

Disease : Candida auris 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

PHE Guidance for the laboratory investigation, management and infection prevention and control for cases of Candida auris (includes SHPN addendum) 

http://www.hps.scot.nhs.uk/pubs/detail.aspx?id=3413

 

 

Carbapenemase producing Enterobacteriaceae (CPE)

Enterobacteriaceae are part of a 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

Advice leaflets for contacts of a CPE carrier
https://www.hps.scot.nhs.uk/haiic/amr/resourcedetail.aspx?id=3424

Advice leaflet for the family of a person who is a carrier of carbapenemase-producing Enterobacteriaceae (CPE)
https://www.hps.scot.nhs.uk/haiic/amr/resourcedetail.aspx?id=3425

Advice leaflet for individuals receiving care at home or in the community who have an infection with, or are colonised by carbapenemase-producing Enterobacteriaceae (CPE)
https://www.hps.scot.nhs.uk/haiic/amr/resourcedetail.aspx?id=3423

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

ECDC - Rapid risk assessment: Carbapenem-resistant Enterobacteriaceae - first update
https://ecdc.europa.eu/en/publications-data/rapid-risk-assessment-carbapenem-resistant-enterobacteriaceae-first-update

Chickenpox

See Varicella virus

Chlamydia pneumoniae

Chlamydia pneumoniae (also known as Chlamydophila pneumoniae) is a gram negative bacterium that is common cause of community acquired pneumonia (CAP). C.pneumonia often only causes mild upper respiratory tract infections (e.g. sore throat), but may also cause lower respiratory tract infections such as pneumonia. Symptoms of C.pneumonia infection include rhinitis, fatigue, fever, laryngitis, sore throat, prolonged cough and headache. Symptoms can also continue for several weeks after they start. Preceding laryngitis is a common feature of pneumonia caused by C.pneumonia.

Vulnerable groups include those who live/work in crowded settings e.g. schools, military barracks, nursing homes, hospitals and prisons. Elderly people are at increased risk for developing pneumonia and other complications including exacerbation of asthma, encephalitis and myocarditis.

Incubation Period :

3-4 weeks

Period of Infectivity :

During incubation period and while symptomatic. Some individuals may also carry the bacteria in the nasopharynx for several months after illness.

Disease : Chlamydia pneumoniae pneumonia

Notifiable

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

Main route of transmission :

Droplet

Guidance and supporting materials

Clostridioides difficile

Clostridioides difficile infection (CDI) is a major cause of infectious diarrhoea due to the spore-forming bacterium, Clostridioides 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 : Clostridioides 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 the 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

UK

Corynebacterium diphtheriae

See Diphtheria

Corynebacterium ulcerans

See diphtheria

Creutzfeldt-Jakob Disease (CJD)

See Transmissible Spongiform Encephalopathies

Cryptococcus spp.

Cryptococcus spp. is a yeast commonly found in the environment in soil, decaying wood, and bird droppings. 

There are two Cryptococcus species that can cause disease in humans.  C. gattii is confined mainly to tropical and subtropical regions and can cause disease in healthy individuals.  C. neoformans is found worldwide but rarely infects healthy people; those who are immunocompromised are most at risk from infection. 

The lungs and the central nervous system are the most common infection sites, resulting in pneumonia and meningitis however any part of the body can be affected including the skin and eyes. 

Transmission from person to person is very rare.

Incubation Period :

Varies widely, from days to months.

Period of Infectivity :

Whilst colonised.

Disease : Cryptococcosis

Notifiable

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

Main route of transmission :

Airborne
Cryptosporidium

Cryptosporidium are protozoan parasites, with the species C. parvum and C. hominis causing the majority of cryptosporidium infections in humans. They can cause Cryptosporidiosis. The parasite is transmitted via microbial cysts (oocysts) that once ingested are released and result in infection. The most common route of infection is from contaminated material such as ingested unfiltered/untreated water or food, or contact with faeces from an infected person or animal.

Infections usually affect the gastrointestinal (GI) system. Symptoms of GI infections include: diarrhoea, fever, abdominal pain, nausea and vomiting. Respiratory infections are less common, but can cause fever, cough, and shortness of breath. Vulnerable groups include children, childcare workers, occupations with exposure to animals (e.g. farmers, vets) and those likely to be in contact with untreated water (e.g. fresh water swimmers, travellers). People who are immunocompromised are at greater risk of severe disease and infections can be fatal in this group.

Incubation Period :

7 - 10 days, but can be as long as 28 days

Period of Infectivity :

From onset and duration of symptoms. The parasite can be shed in faeces many weeks after symptoms have resolved.

Exclusion period: Until symptom free for 48 hours. Avoid swimming until 14 days after last diarrhoeal episode.

Disease : Cryptosporidiosis

Notifiable

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

Main route of transmission :

Contact (faecal/oral)

Guidance and supporting materials

UK

Cryptosporidiosis: guidance, data and analysis https://www.gov.uk/government/collections/cryptosporidiosis-guidance-data-and-analysis

International

Cryptosporidiosis:Toolkit for outbreak response and investigation https://ecdc.europa.eu/en/cryptosporidiosis

 

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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

 

Scottish

Infection Prevention and Control in Childcare Settings (Daycare and nursery)
http://www.hps.scot.nhs.uk/haiic/ic/resourcedetail.aspx?id=352

UK

Diphtheria - the Green book
https://www.gov.uk/government/publications/diphtheria-the-green-book-chapter-15

Diphtheria: public health control and management in England and Wales
https://www.gov.uk/government/publications/diphtheria-public-health-control-and-management-in-england-and-wales

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E

Ebola

See Viral Haemorraghic Fever

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 : 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

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

Guidance and supporting materials

Scottish

Information for staff on Enterovirus D68 (EV-D68)
http://www.hps.scot.nhs.uk/haiic/ic/resourcedetail.aspx?id=3156

UK

Guidance on the diagnosis, management and epidemiology of enterovirus infections
https://www.gov.uk/government/collections/enterovirus-infections

Enterovirus – D 68 Risk Assessment
https://www.gov.uk/government/publications/enterovirus-d-68-risk-assessment

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 bacteria Escherichia 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
*Foodborne transmission is rarely reported in the care environment where the main route of transmission is through contact

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

Scottish

Guidance for the Public Health Management of Escherichia coli O157 and other Shiga toxin-producing (STEC) infections
https://www.hps.scot.nhs.uk/giz/resourcedetail.aspx?id=180

E.coli O157 and other STEC infections - Public Information Leaflet
https://www.hps.scot.nhs.uk/giz/resourcedetail.aspx?id=793

UK

Shiga toxin-producing Escherichia coli: operational guidelines
https://www.gov.uk/government/publications/vero-cytotoxin-producing-escherichia-coli-operational-guidelines-for-public-health-management#history

Shiga toxin-producing Escherichia coli: how to avoid and treat
https://www.gov.uk/government/publications/vero-cytotoxin-producing-escherichia-coli-symptoms-how-to-avoid-how-to-treat

Shiga toxin-producing Escherichia coli: public health management
https://www.gov.uk/government/publications/vero-cytotoxin-producing-escherichia-coli-advice-for-public-health-management-teams

Shiga toxin-producing Escherichia coli (STEC): complications
https://www.gov.uk/government/publications/vero-cytotoxin-producing-escherichia-coli-vtec-complications

Extended-spectrum beta-lactamase (ESBL)

Extended-spectrum beta-lactamases (ESBLs) are enzymes produced by bacteria and confer resistance to a variety of beta-lactam antibiotics, such as penicillins and cephalosporins. Beta-lactam antibiotics are broad-spectrum and are used to treat a variety of infections. The genes coding for ESBL production can be spread between bacterial species and frequently carry genes that also encode resistance to other drug classes, therefore antibiotic options in the treatment of ESBL-producing organisms are limited. Carbapenem antibiotics are the treatment of choice for serious infections due to ESBL-producing organisms. However, carbapenem-resistant (primarily ertapenem resistant) isolates have been reported.

The most common types of ESBL-producing bacteria are Escherichia coli and Klebsiella spp. causing infections including urinary tract infections (UTI), pneumonia and blood stream infections. Vulnerable groups at risk for colonisation or infection with ESBL-producing organisms include people who are immunocompromised, elderly people, those with previous exposure to antibiotics and long durations of hospitalisation.

 

Period of Infectivity :

While colonised or infected

Disease : Extended-spectrum beta-lactamase (ESBL) bacterium 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

UK

Extended-spectrum beta-lactamases (ESBLs): guidance, data, analysis https://www.gov.uk/government/collections/extended-spectrum-beta-lactamases-esbls-guidance-data-analysis

 

 

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F

No Pathogens

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G

German measles

See Rubella

Giardia lamblia

Giardia lamblia is a flagellated parasite that colonises in the small intestine causing giardiasis (also known as giardia). Infection in humans usually occurs by ingestion of Giardia lamblia cysts (which can survive for months in cold water) from drinking contaminated water, such as from streams and ponds, as well as artificial lakes created by beaver dams hence its popular name “beaver fever”. It can also contaminate urban water supplies despite treatment, as the parasite cysts are resistant to conventional water treatment processes. Zoonotic transmission is also possible from contact with infected animals or ingestion of infected uncooked foods including meat products.

Symptoms of giardia infection include diarrhoea, abdominal pain, weight loss and vomiting, however infection can be asymptomatic. Vulnerable groups include children in childcare settings, backpackers/campers who drink untreated waters, swimmers in outdoor recreational waters and those in close contact with someone with giardiasis.

Incubation Period :

1-3 weeks

Period of Infectivity :

For as long as cysts persist in faeces which can be months whether or not symptomatic.

Disease : Giardiasis/Giardia

Notifiable

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

Main route of transmission :

Contact (faecal/oral)

Guidance and supporting materials

Group A Streptococcus

Group A Streptococcus (GAS; Streptococcus pyogenes) is a bacterium which can colonise the throat, skin and anogenital tract. It causes a diverse range of skin, soft tissue and respiratory tract infections, including: tonsillitis, pharyngitis, scarlet fever, pneumonia. In rare cases, patients may go on to develop post-streptococcal complications, such as rheumatic fever or glomerulonephritis.

In children aged 3 and younger respiratory disease caused by GAS rarely manifests as acute pharyngitis, but rather as mucopurulent rhinitis followed by fever, irritability, and anorexia (called “streptococcal fever” or “streptococcosis”). In contrast to typical acute group A strep pharyngitis, this presentation in young children is subacute and high fever is rare.

Invasive GAS (iGAS) is an infection where the bacteria are isolated from a normally sterile body site, such as the blood. Any GAS manifestation can be associated with development of streptococcal toxic shock syndrome, although patients with necrotising fasciitis are at highest risk. Vulnerable groups at risk from contracting iGAS infections include perinatal women, neonates, elderly people, persons with diabetes, and those who are immunocompromised.

Incubation Period :

2-5 days

Period of Infectivity :

While febrile and until 24 hours after therapeutic dose of antibiotic therapy commenced.

Exclusion period:
Impetigo: Until lesions are crusted or healed or 48 hours after commencing appropriate antibiotics.

Scarlet fever: 24 hours after commencing appropriate antibiotics

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

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

Group A Streptococcal infection - information for patients
https://www.hps.scot.nhs.uk/web-resources-container/group-a-streptococcal-infection-information-for-patients/

Group A Streptococcus - information for healthcare workers
https://www.hps.scot.nhs.uk/web-resources-container/group-a-streptococcus-information-leaflet-for-healthcare-workers/

 

UK

Group A streptococcal infections – infection control guidance
https://www.gov.uk/streptococcal-infections

 

 

Disease : Scarlet Fever

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

Scarlet fever symptoms diagnosis and treatment
https://www.gov.uk/government/publications/scarlet-fever-symptoms-diagnosis-treatment

Guidelines for the public health management of scarlet fever outbreaks in schools, nurseries and other childcare settings
https://www.gov.uk/government/publications/scarlet-fever-managing-outbreaks-in-schools-and-nurseries

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H

Haemophilus influenzae type b

Haemophilus influenzae is a Gram-negative anaerobic bacterium. Serotype b (Hib) is the most common and pathogenic. Hib may cause invasive disease, the most common being meningitis and bacteraemia, and it may also cause epiglottitis and pneumonia. Less common presentations include septic arthritis, osteomyelitis, cellulitis and pericarditis. There is a vaccine available against Hib which is part of the childhood immunisation schedule in Scotland.

H. influenzae bacteraemia can occur with or without pneumonia and symptoms include fever, fatigue, nausea, abdominal pain, difficulty breathing and confusion.

H. influenzae meningitis may be accompanied by H. influenzae bacteraemia and symptoms include fever, headache, stiff neck, vomiting, photophobia and confusion. It is serious condition that can be fatal (in approximately 5% of cases) and may cause long term sequelae including deafness, seizures and intellectual impairment.

H. influenzae epiglottitis is a life-threatening medical emergency. The infection causes the inflammation of the epiglottis and surrounding tissues leading to obstruction of the airway. Signs and symptoms include high fever, tachypnoea, stridor and excessive drooling. Intubation and tracheotomy may be required to prevent respiratory arrest and death.

Vulnerable groups for all types of H. influenzae infections are children under 5 years of age, elderly people and people who are immunocompromised, including those with sickle cell disease. Individuals who have had close contact with someone infected with Hib are also at increased risk of contacting the infection, and as such may require antibiotic chemprophylaxis.

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

Haemophilus influenzae: guidance, data and analysis https://www.gov.uk/government/collections/haemophilus-influenzae-guidance-data-and-analysis

Haemophilus influenzae type b (Hib): revised recommendations for the prevention of secondary cases https://www.gov.uk/government/publications/haemophilus-influenzae-type-b-hib-revised-recommendations-for-the-prevention-of-secondary-cases

Haemophilus influenzae type b (Hib): the green book, chapter 16 https://www.gov.uk/government/publications/haemophilus-influenzae-type-hib-the-green-book-chapter-16

 

 

Hantavirus

Hantavirus is a zoonotic infection caused by a group of viruses carried mainly by species of rodents such as rats, mice and voles.  Animal vectors become infected early in life and can shed the virus over prolonged periods although they rarely show signs of disease.

The virus is spread to humans when virus particles in the urine, faeces or saliva of infected rodents become aerosolised and are inhaled. 

Hantaviruses do not spread easily between people and there is a very low risk of transmission to the general population.  Those most at risk include people who keep pet rodents and people with occupational exposure to rodents i.e. farm workers and pest control workers.

Infection in humans can range from a mild flu-like illness, to severe disease.  Forms of severe disease include haemorrhagic fever and kidney failure (known as haemorrhagic fever with renal syndrome (HFRS)) as seen in Europe and Asia, and severe lung disease (known as hantavirus pulmonary syndrome (HPS)) as seen in North and South America.  Human hantavirus infections in the UK are very rare.

Symptoms of HFRS include fever, headache, nausea, vomiting and kidney failure.  There is no antiviral treatment.

Incubation Period :

Typically 2-4 weeks although can range from 2 days-8 weeks.

Disease : Haemorrhagic fever with renal syndrome (HFRS), Hantavirus pulmonary syndrome (HPS)

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

UK

Hantavirus: The characteristics, diagnosis, epidemiology of hantaviruses.
https://www.gov.uk/guidance/hantaviruses

Head Lice

Head lice, Pediculus humanus capitis, are tiny parasitic insects that live in hair. They can cause infestation of the scalp known as Pediculosis capitis.

Head lice hatch from eggs and the sacs left behind are known as ‘nits’ which attach firmly to the hair shaft. Nits are more visible to the naked eye than live lice.

Symptoms include itching, a tickling feeling in hair, difficulty sleeping and sores on the head secondary to scratching. They are spread by direct head-to-head contact and are a common problem particularly in children aged 4 to 11. Child care settings e.g. schools, nurseries are high risk areas for transmission.

Treatment with a pediculicide is recommended only in cases where live lice are seen.

Incubation Period :

Lice hatch from eggs (‘nits’) within 1 to 2 weeks after being laid

Period of Infectivity :

While live lice are present
Exclusion period: None

Disease : Head lice infestation - Pediculosis capitis

Notifiable

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

Main route of transmission :

Contact

Guidance and supporting materials

Scottish

National Guidance on Managing Head Lice Infection in Children  http://www.gov.scot/Publications/2003/03/16774/20132

Infection Prevention and Control in Childcare Settings (SHPN) http://www.hps.scot.nhs.uk/haiic/ic/resourcedetail.aspx?id=352

UK

Head Lice clinical knowledge summary  https://cks.nice.org.uk/head-lice#!topicsummary

 

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 / Foodborne

Guidance and supporting materials

Hepatitis B virus (HBV)

Hepatitis B Virus (HBV) is a virus that can cause chronic infection and affects the liver. It is transmitted through exposure to blood or other body fluids from an infected person. The initial acute infection may be asymptomatic, but can cause acute viral hepatitis (inflammation of the liver) with symptoms of nausea, vomiting, fever and jaundice which last for several weeks. Most people recover from this illness, but a few go on to develop fulminant hepatic failure. 90% of those infected with HBV at birth go on to develop chronic HBV infection, while less than 5% of those acutely infected as adults do. Chronic HBV infection may also be asymptomatic, but can be associated with chronic hepatitis which may lead to liver cirrhosis. It also increases the risk of the individual developing heptocellular carcinoma (HCC).

In countries where HBV is endemic, the commonest route of spread of HBV is vertical transmission from mother to child at birth. However, in low prevalence countries the most likely route of exposure is from parenteral exposure to infected blood or body fluids, such as from sharing injecting drug equipment or occupational exposure to blood products e.g. needlestick injuries. HBV can also be spread via sexual contact with an infected person with the most at-risk populations being men who have sex with men (MSM), heterosexuals with multiple sex partners or sex workers.

There is a vaccine available for HBV, as of August 2017 this vaccine is part of the routine childhood immunisation schedule in Scotland. The vaccine and hepatitis B immunoglobulin (HBIG) can used as post-exposure prophylaxis.

Incubation Period :

30-180 days (75 days average)

Period of Infectivity :

During active infection or if chronically infected

Disease : Hepatitis B Virus 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

Scotland

PHE Integrated guidance on health clearance of healthcare workers and the management of healthcare workers infected with bloodborne viruses (hepatitis B, hepatitis C and HIV) (includes SHPN addendum)
http://www.hps.scot.nhs.uk/pubs/detail.aspx?id=3409

UK

Bloodborne viruses (BBVs) in healthcare workers https://www.gov.uk/government/collections/bloodborne-viruses-bbvs-in-healthcare-workers

Hepatitis B: guidance, data and analysis https://www.gov.uk/government/collections/hepatitis-b-guidance-data-and-analysis

Hepatitis B: the green book, chapter 18 https://www.gov.uk/government/publications/hepatitis-b-the-green-book-chapter-18

Hepatitis B (chronic): diagnosis and management https://www.nice.org.uk/guidance/cg165

 

Hepatitis C Virus (HCV)

Hepatitis C Virus (HCV) is a virus that may causes chronic infection which can lead to liver disease of varying severity. Acute HCV infection is usually asymptomatic though it may cause a range of vague symptoms including decreased appetite, fatigue, nausea, myalgia and weight loss. In rare instances, individuals may develop acute liver failure.  Approximately 80% will go on to develop chronic HCV infection which may lead to cirrhosis of the liver or hepatocellular carcinoma (HCC) over a long period of time. Most people with chronic HCV infection are asymptomatic.

HCV can be transmitted through exposure to infected blood or body fluids. Those most at-risk are those who share drug injecting equipment, receive transfusion of blood or blood products (though uncommon in developed countries due to screening processes) or are occupationally exposed to infected blood/body fluids e.g. needlestick injury from an infected patient. HCV can also be contracted via sexual contact with an infected person and/or vertical transmission (from mother to child), but the risks are far less compared with direct blood exposure.

There is no vaccine or post exposure prophylaxis treatment for HCV. However, new advances in antiviral medications can cure up to 95% of those infected.

Incubation Period :

2 - 26 weeks

Period of Infectivity :

During active/chronic infection

Disease : Hepatitis C Virus 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

PHE Integrated guidance on health clearance of healthcare workers and the management of healthcare workers infected with bloodborne viruses (hepatitis B, hepatitis C and HIV) (includes SHPN addendum)
http://www.hps.scot.nhs.uk/pubs/detail.aspx?id=3409

National Clinical Guidelines for the treatment of HCV in adults http://www.hps.scot.nhs.uk/guidelines/detail.aspx?id=1598

Management of Hepatitis C
http://www.sign.ac.uk/sign-133-management-of-hepatitis-c.html

UK

Hepatitis C: guidance, data and analysis
https://www.gov.uk/government/collections/hepatitis-c-guidance-data-and-analysis

Hepatitis C: Summary https://cks.nice.org.uk/hepatitis-c#!topicsummary

Bloodborne viruses (BBVs) in healthcare workers https://www.gov.uk/government/collections/bloodborne-viruses-bbvs-in-healthcare-workers

Hepatitis C patient information (quick read)
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/757881/Hepatitis_C_A4_Flyer_.pdf

Hepatitis C patient information sheet
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/755411/Hepatitis_C_information_for_patients.pdf

Hepatitis C information for GPs
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/759851/Hepatitis_C_information_for_GPs.pdf

 

WHO

Guidelines for the screening, care and treatment of persons with chronic hepatitis C infection
http://www.who.int/hepatitis/publications/hepatitis-c-guidelines-2016/en/

 

Hepatitis E Virus (HEV)

Hepatitis E is an illness of the liver caused by the hepatitis E virus (HEV), which can infect both animals and humans. 

HEV infection usually produces a mild disease however pregnant women are at greater risk of severe illness which can, in rare cases, be fatal.  This is more likely to occur with the strains that are found in Africa and Asia and less common in strains commonly found in the UK. Infection will normally clear by itself within one to four weeks.  Chronic infection of the liver (lasting over 6 months) is very rare and usually only reported in patients with a suppressed immune system. 

Symptoms include yellowing of the skin and eyes (jaundice), darkening of the urine and pale stools.  Patients may also experience tiredness, fever, nausea, vomiting, abdominal pain and loss of appetite.

Incubation Period :

40 days (15-60 days)

Period of Infectivity :

During active infection or if chronically infected

Disease : Hepatitis E (HEV)

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

Scotland

Scottish Health Protection Network - Hepatitis E
https://www.hps.scot.nhs.uk/giz/resourcedetail.aspx?id=1825

UK

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

Protecting patients from getting Hepatitis E through transfusion or transplantation
https://www.gov.uk/government/publications/protecting-patients-from-getting-hepatitis-e-through-transfusion-or-transplantation

SMI V 53 Screening for hepatitis E infection
https://www.gov.uk/government/publications/smi-v-53-screening-for-hepatitis-e-infection

 

Human Immunodeficiency Virus (HIV)

The human immunodeficiency virus (HIV) is a retrovirus that causes chronic infection, which results in progressive failure of the immune system, specifically the CD4 cells (sometimes called T cells).

HIV infection is contracted through exposure to blood or body fluids from an infected person. Newly infected individuals may develop a flu-like illness 2-4 weeks post-exposure, called seroconversion illness. Symptoms include fever, lymphadenopathy, rash and headache. Following this, HIV infection becomes latent and asymptomatic and without treatment will develop into AIDS in 3 - 20 years.

AIDS is defined as either when an HIV infected person’s CD4 count falls below 200 cells per µL or when specific HIV-associated infections or diseases develop such as pneumocystis pneumonia (PcP), oesophageal candidiasis or HIV wasting syndrome (cachexia). Survival once AIDS has been diagnosed is approximately 3 years if untreated.

 

The most common route for HIV infection is via sexual contact with an infected partner, particularly among men who have sex with men (MSM), but the virus can also be spread by sharing drug injecting equipment, vertical transmission during childbirth or from breast milk, occupational exposure to infected blood/body fluids e.g. needlestick injury from an infected patient, or from blood and blood products transfusion (though uncommon in developed countries due to screening processes).

Due to advances in medical treatment with antiretroviral drugs, people with HIV can have a near normal life span and may never develop AIDS.  There is no vaccine for HIV infection however there is post exposure prophylaxis (PEP) available for those who have come into contact with, infected bodily fluids, which significantly reduces the risk of contracting the virus. Pre-exposure prophylaxis for those at risk may also reduce the risk of infection. In Scotland, PrEP is available to people who are considered to be at higher risk of contracting HIV (see https://prep.scot/ for further information, including eligibility criteria). 

Incubation Period :

Seroconversion normally occurs 2-4 weeks post exposure.

Period of Infectivity :

Once infected, in the absence of treatment, individuals can transmit the infection to others for life. Treatment with antiretrovirals can significantly lower the risk of transmission.

Disease : Acquired Immunodeficiency Syndrome (AIDS)

Notifiable

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

Main route of transmission :

Contact

Disease : Human immunodeficiency virus (HIV) infection

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

PHE Integrated guidance on health clearance of healthcare workers and the management of healthcare workers infected with bloodborne viruses (hepatitis B, hepatitis C and HIV) (includes SHPN addendum)
http://www.hps.scot.nhs.uk/pubs/detail.aspx?id=3409

Good Practice Guidance on HIV Prevention in Men who have Sex with Men (MSM) http://www.hps.scot.nhs.uk/bbvsti/resourcedetail.aspx?id=171

UK

HIV: surveillance, data and management https://www.gov.uk/government/collections/hiv-surveillance-data-and-management

HIV infection and AIDS https://cks.nice.org.uk/hiv-infection-and-aids

HIV-infected healthcare workers and exposure prone procedures
https://www.gov.uk/government/publications/hiv-infected-healthcare-workers-and-exposure-prone-procedures

Bloodborne viruses (BBVs) in healthcare workers https://www.gov.uk/government/collections/bloodborne-viruses-bbvs-in-healthcare-workers

Human metapneumovirus

Human metapneumovirus is a virus belonging to the paramyxovirus family along with respiratory syncytial virus (RSV). 

Infection can cause upper and lower respiratory disease in people of all ages but especially the young and elderly.  Symptoms include cough, fever, shortness of breath, and in more serious cases bronchitis and pneumonia which can be fatal especially in people with weakened immune systems. Transmission is highest during the winter months. 

There is currently no vaccine for metapneumovirus.

Incubation Period :

3 to 6 days

Period of Infectivity :

Whilst symptomatic

Disease : Human metapneumovirus

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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I

Influenza - Endemic Influenza (Flu)

Influenza or ‘Flu’ is an acute viral infection affecting the respiratory tract. There are three main types or ‘genera’ of viruses that affect humans: Influenza virus A, Influenza virus B and Influenza virus C. Influenza A, which can infect many animal species, is the most common and virulent and is usually the cause of flu epidemics. In temperate zones, influenza is typically seasonal with most cases occurring during the winter months.

Symptoms include fever, cough, sore throat, runny/stuffy nose, headache, myalgia and extreme fatigue. Diarrhoea and vomiting can occur in some cases. For most healthy individuals, influenza is self-limiting illness with resolution within 7 days. Vulnerable groups at higher risk of complications (such as pneumonia) include children, pregnant women, elderly people, people who are morbidly obese, those with chronic medical conditions (e.g. COPD, diabetes) and people who are immunocompromised. An annual vaccination is available to those within these risk groups.

Pandemic flu is a global outbreak of a novel influenza A virus strain. Flu pandemics are uncommon. However, such pandemics are serious as the virus can spread quickly due to lack of immunity to the novel strain in the population and immediate vaccination might not be available. Large numbers of people worldwide may be affected causing an excessive burden on healthcare services, as well as schools and businesses. The most recent flu pandemic was the 2009/10 ‘Swine flu’ pandemic which was caused by the influenza A virus strain H1N1.

Incubation Period :

1 to 3 days

Period of Infectivity :

1 day before symptoms develop until 5 to 7 days post-symptomatic.

Exclusion period: As a general rule, whilst symptomatic and should be continued for 24 hours after resolution of symptoms.

Disease : Influenza (Flu)

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

PHE Guidance on the use of antiviral agents for the treatment and prophylaxis of influenza (with SHPN addendum)
http://www.hps.scot.nhs.uk/pubs/detail.aspx?id=3382

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
https://www.hps.scot.nhs.uk/web-resources-container/influenza-outbreak-control-measure-trigger-tool-for-hospitals/

Guidance on influenza for care homes
https://www.hps.scot.nhs.uk/haiic/ic/resourcedetail.aspx?id=3612

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

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

Influenza treatment and prophylaxis using anti-viral agents
https://www.gov.uk/government/publications/influenza-treatment-and-prophylaxis-using-anti-viral-agents

Avian influenza A(H5N6):risk assessment
https://www.gov.uk/government/publications/avian-influenza-ah5n6-risk-assessment

Influenza like illness: managing outbreaks in schools
https://www.gov.uk/government/publications/influenza-like-illness-ili-managing-outbreaks-in-schools

 

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J

No Pathogens

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K

No Pathogens

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L

Legionella spp

Legionellosis is a collective term for diseases caused by Legionella bacteria, including the most serious Legionnaires’ disease, as well as the similar but less serious condition of Pontiac fever.

Legionnaires’ disease is the pneumonic form of the disease causing a potentially fatal form of pneumonia.

Pontiac fever causes an acute, self-limiting influenza-like illness with symptoms that include fever, headaches and muscle aches, but unlike Legionnaires’ disease, Pontiac fever does not cause pneumonia.

Legionella bacteria are widely distributed in natural and artificial water supplies, and in soil. Exposure is airborne (either indoor or outdoor) usually through aerosolised water which is contaminated with Legionella

Hospital equipment implicated in outbreaks and identified as producing aerosols include:  showers, cooling towers, water-cooled air conditioning systems and humidifiers.

The bacteria are not transmissible from person to person.

High risks group at risk of this infection include people over 50 years of age, smokers and heavy drinkers, people with kidney disease, diabetes, heart and lung disease and people who are immunocompromised.

Incubation Period :


Legionnaires' Disease: 5-6 days, with a range of 2-10 days
Pontiac Fever: 1-2 days, with a range of 0-3 days

Period of Infectivity :

Not transmissible from person to person

Disease : Legionellosis

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

Guideline on the management of Legionella Incidents, Outbreaks and Clusters in the Community
http://www.hps.scot.nhs.uk/resp/resourcedetail.aspx?id=200

Technical guidance can be found on the HFS website http://www.hfs.scot.nhs.uk/

 

UK

Legionnaires’ disease: risks of pre-heated birthing pools
https://www.gov.uk/government/publications/legionnaires-disease-risks-of-pre-heated-birthing-pools

Legionella: detection in healthcare premises
https://www.gov.uk/government/publications/legionella-detection-in-healthcare-premises

Legionnaires’ disease: The control of legionella bacteria in water systems. Approved Code of Practice and guidance on regulations
http://www.hse.gov.uk/pubns/priced/l8.pdf

 

 

Lice

See Body Lice, Head Lice, Pubic Lice.

 

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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

Meningitis (bacterial)

See Neisseria meningitides

Meticillin resistant Staphylococcus aureus (MRSA)

See Staphylococcus Aureus

Middle East Respiratory Syndrome Coronavirus (MERS-CoV)

See Coronavirus

Monkeypox

Monkeypox is a rare viral infection caused by the monkeypox virus.  African rodents are suspected to be the source of transmission.  The first human case was recorded in 1970 in the Democratic Republic of Congo and since then has only twice been documented outside of Africa; in the United States in 2003 and in the UK in 2018.

Symptoms include fever, headache, muscle aches, exhaustion, swollen lymph nodes and a rash consisting of raised lesions/vesicles that scab over and fall off.

The illness is usually mild and self-limiting with most people recovering within a few weeks however severe illness can occur in some individuals. 

Infection is spread when a person comes into contact with an infected animal or human, or with contaminated clothing or linen.  Monkeypox does not spread easily between people and there is a very low risk of transmission to the general population.

 

Incubation Period :

Between 5 and 21 days

Period of Infectivity :

From onset of symptoms until scabs have crusted over

Exclusion period: Until all scabs have crusted over.

Disease : Monkeypox

Main route of transmission :

Airborne

Guidance and supporting materials

UK

The epidemiology, symptoms, diagnosis and management of monkeypox virus infections

https://www.gov.uk/guidance/monkeypox

 

 

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 chimaera

See nontuberculosis mycobacteria

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.

Person to person transmission of TB predominantly occurs by inhalation of infected airborne particles (airborne route). 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

Mycoplasma pneumoniae

M. pneumoniae is a bacterium that causes acute respiratory illness ranging in severity from mild illness to severe pneumonia.

M. pneumoniae infection may cause a wide range of respiratory presentations such as bronchitis, bronchiolitis, pharyngitis and pneumonia. The most common type of illness, especially in children, is tracheobronchitis (chest cold); symptoms include fatigue, fever, headache and a slowly worsening cough that can last for weeks or months.

M. pneumoniae infections are almost exclusively mild. Most people who are exposed for a short amount of time to someone with M. pneumoniae infection do not become ill, however, it is common for this illness to spread between family members who live together.

M. pneumoniae infection can on rare occasion result in severe complications such as encephalitis, and can be fatal;  high risk groups who are  at risk of developing more serious illness include those recovering from respiratory illness, people with asthma and people who are immunocompromised.

Incubation Period :

1-4 weeks

Period of Infectivity :

While symptomatic

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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Neisseria meningitidis

Meningococcal disease occurs as a result of a systemic bacterial infection with Neisseria meningitidis.

Meningococci are considered to colonise the nasopharynx of approximately 10-35% of individuals and colonisation does not lead to infection in the majority of cases. Meningococcal disease can present as meningitis and/or septicaemia. Early symptoms include malaise, fever and vomiting. Headache, neck stiffness, photophobia, drowsiness or confusion and joint pains may also occur. In meningococcal septicaemia, a rash may develop, along with signs of advancing shock and isolated limb and/or joint pain. The rash may be non-specific early on, however, as the disease progresses it may become petechial or purpuric and may not blanch. In young infants the onset may be insidious and the signs may be non-specific without ‘classical’ features of meningitis. Clinical deterioration may be very rapid with poor peripheral perfusion, pallor, rapid breathing, rapid heart rate and the emergence of a meningococcal rash. In severe cases, patients may present with hypotension or be unresponsive. N. meningitidis infection can also lead to the development of other conditions including pneumonia, myocarditis, endocarditis, pericarditis, arthritis, conjunctivitis, urethritis, pharyngitis and cervicitis.

There is a marked seasonal variation in meningococcal disease, with peak levels occurring in winter months. High risk groups for severe infection include children below 5 years of age and young people aged 15-19. Vaccines that protect against some serogroups of the bacteria are available to people in these groups.

Incubation Period :

3-4 days (range 2-10 days)

Period of Infectivity :

While colonised

Exclusion period:Until recovered (There is no reason to exclude siblings or other close contacts)

Disease : Meningococcal Disease

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

Nipah virus

Nipah virus is a member of the Paramyxoviridae family (genus Henipavirus).  It is a zoonotic virus and fruit bats of the Pteropodidae family are considered to be the natural reservoir.  Infections in humans were reported for the first time in 1998 in Nipah, Malaysia, following an outbreak originating from pig farms.  The virus can be transmitted to humans from animals (particularly bats, pigs, horses), contaminated foods, and also directly from contact with infected humans.

Although asymptomatic infection can occur, clinical illness typically consists of a sudden onset, flu-like or febrile illness, sometimes with gastrointestinal symptoms. Pneumonia and other severe respiratory symptoms can also occur, however the most serious complication is encephalitis, which may progress to coma.  The mortality rate is high at 40 to 75%.  Long term neurological sequelae have been reported and a small number of people relapse or develop delayed onset encephalitis.  There is currently no vaccine available and treatment is limited to supportive care.

Incubation Period :

Incubation period has been reported to be as long as 45 days, although it is usually 4 to 14 days.

Period of Infectivity :

The exact period in humans is unknown however it is likely to be while symptomatic and during the incubation period.

Disease : Nipah virus

Notifiable

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

Main route of transmission :

Airborne

Guidance and supporting materials

UK

Nipah virus: epidemiology, outbreaks and guidance 
https://www.gov.uk/guidance/nipah-virus-epidemiology-outbreaks-and-guidance

International

WHO guidance http://www.who.int/csr/disease/nipah/en/

Nits

Nits are the empty egg cases/sacs attached to hair that Head/Body/Pubic lice hatch from.

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

Scottish

Guidance on Mycobacterium chimaera infections associated with heater cooler units used in cardiopulmonary bypass.
https://www.hps.scot.nhs.uk/web-resources-container/guidance-on-mycobacterium-chimaera-infections-associated-with-heater-cooler-units-used-in-cardiopulmonary-bypass/

UK

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

Slow growing mycobacteria: procedure for testing heater cooler units
https://www.gov.uk/government/publications/isolation-of-slow-growing-mycobacteria-environmental-and-air-sampling

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: As a general rule, 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 - Guidance for Care Homes
https://www.hps.scot.nhs.uk/giz/resourcedetail.aspx?id=3613

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.hps.scot.nhs.uk/haiic/ic/resourcedetail.aspx?id=1597

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

What should you do during norovirus season - advice for medical and healthcare students
https://www.hps.scot.nhs.uk/web-resources-container/what-should-you-do-during-norovirus-season-advice-for-medical-and-healthcare-students/

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
https://www.nhsinform.scot/norovirus

 

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No Pathogens

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Panton Valentine Leukocidin (PVL) -positive Staphylococcus aureus

See Staphylococcus aureus

Parainfluenza

Human parainfluenza viruses (HPIV) are members of the genus Paramyxovirus and belong to the Paramyxoviridae family, which also includes mumps, measles and respiratory syncytial virus (RSV).

The five major serotypes of HPIVs can be grouped into two divisions: (1) HPIV-1 and HPIV-3 and (2) HPIV-2, HPIV-4 and mumps.

Parainfluenza viruses are important causes of upper and lower respiratory disease in infants and young children, elderly people and people who are immunocompromised.

HPIV-1 and HPIV-2 both cause croup, with HPIV-1 most often identified as the cause in children. Both can also cause upper and lower respiratory illness, and cold-like symptoms.

HPIV-3 is more often associated with bronchiolitis, bronchitis, and pneumonia.

HPIV-4 is less commonly recognised but may cause mild to severe respiratory illnesses.

Parainfluenza viruses are responsible for around 15% of childhood colds, croup, bronchitis and pneumonia.

The average duration of illness is 7 - 10 days.

Incubation Period :

1-4 days

Period of Infectivity :

12-24 hours before to 5 days after clinical onset

Disease : Parainfluenza

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

* Only alert organism in high risk units e.g. ICU/PICU/NICU, oncology/haematology 

UK

Human parainfluenza viruses: clinical and public health management
https://www.gov.uk/guidance/human-parainfluenza-viruses-clinical-and-public-health-management

Parvovirus B19 - (Erythema infectiosum - Erythrovirus B19)

Parvovirus B19 (also known as erythrovirus B19) belongs to the Parvoviridae family of viruses. It causes a common childhood illness called erythema infectiosum or fifth disease. The disease is characterised by fever, runny nose, headache and a rash with erythematous cheeks, from which it derives its common name ‘slapped cheek' disease.

Parvovirus B19 infection generally results in a mild febrile illness, but can have more severe manifestations in vunlnerable groups such as patients with underlying haemolytic conditions and those who are immunocompromised. Infection in the first 20 weeks of pregnancy is associated with increased risk of hydrops fetalis and intrauterine death.

Incubation Period :

4 to 14 days

Period of Infectivity :

7–10 days before the rash (if any) develops, until one day after the rash appears.

Exclusion period: While symptomatic until the rash develops.

Disease : Slapped cheek syndrome/erythema infectiosum/fifth disease

Notifiable

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

Main route of transmission :

Droplet

Guidance and supporting materials

Scottish

Infection Prevention and Control in Childcare Settings
http://www.hps.scot.nhs.uk/haiic/ic/resourcedetail.aspx?id=352

UK

Parvovirus B19: guidance, data and analysis - GOV.UK
https://www.gov.uk/guidance/parvovirus-b19

NICE Clinical Knowledge Summary
https://cks.nice.org.uk/parvovirus-b19-infection

Pneumocystis jirovecii

Pneumocystis jirovecii (formerly known as P. Carinii) is a yeast-like fungus of the genus Pneumocystis and is the agent that causes Pneumocystis Pneumonia (PcP).

PcP infections affect the respiratory system and symptoms include fever, cough, shortness of breath and weight loss.

It is an opportunistic infection affecting those with a weakened immune system including individuals with HIV/AIDS, haematological and solid malignancies on chemotherapy and those on high dose steroids or taking other immunosuppressive agents (e.g. after transplant surgery).

Incubation Period :

3-12 weeks

Period of Infectivity :

Considered infectious during incubation and symptomatic period, but only to people who are immunocompromised

Disease : Pneumocystis Pneumonia

Notifiable

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

Main route of transmission :

Airborne

Guidance and supporting materials

* Only alert organism if detected in high risk units e.g. ICU, oncology

 

Scottish

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

Information for staff on Pneumocystis Pneumonia (PcP)
http://www.hps.scot.nhs.uk/pubs/detail.aspx?id=3076

 

Pseudomonas aeruginosa

Pseudomonas is a genus of Gram-negative, aerobic bacteria which contains almost 200 known species. Pseudomonas species are found widely in the environment, and some are part of the normal gut flora.

Pseudomonas aeruginosa is the species that most commonly causes infections in humans. It is an opportunistic pathogen: while it can cause minor infections such as folliculitis in healthy people, severe infections usually only occur in people who are immunocompromised or whose defences have been breached, such as oncology patients, neonates, severe burn patients, those with invasive medical devices, and people with cystic fibrosis. P.aeruginosa infections in vulnerable people can include: bacteraemia, pneumonia (including ventilator-associated pneumonia), infections of wounds, gastrointestinal tract and urinary tract infections. Colonisation usually precedes infection. P.aeruginosa is intrinsically resistant to many commonly-used antibiotics, and can acquire antimicrobial resistance, making infections difficult to treat.

Pseudomonas aeruginosa is commonly found in wet or moist environments, and can thrive in water systems. There have been serious P. aeruginosa outbreaks in adult and neonatal intensive care units, where the cause was thought to have been contamination of the tap water supply.

Period of Infectivity :

While colonised

Disease : Pseudomonas aeruginosa 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

*On alert organisms list if found in high risk units e.g. ICU/oncology/NNU etc

 

Scottish

Guidance for neonatal units (NNUs) (levels 1, 2 & 3), adult and paediatric intensive care units (ICUs) in Scotland to minimise the risk of Pseudomonas aeruginosa infection from water
https://www.hps.scot.nhs.uk/web-resources-container/guidance-for-neonatal-units-nnus-levels-1-2-3-adult-and-paediatric-intensive-care-units-icus-in-scotland-to-minimise-the-risk-of-pseudomonas-aeruginosa-infection-from-water/

Pseudomonas Outbreak Checklist http://www.hps.scot.nhs.uk/pubs/detail.aspx?id=1594

UK

Pseudomonas aeruginosa: guidance, data and analysis https://www.gov.uk/government/collections/pseudomonas-aeruginosa-guidance-data-and-analysis

Pubic lice

Pubic lice, Phthirus pubis (also known as ‘crabs’), are tiny parasitic insects that primarily live in pubic hair. Infestations with the parasites are known as pthiriasis or Pediculosis pubis.

The parasites can infest other areas including eyelashes (causing pediculosis ciliaris),  and areas of coarse hair such as the abdomen, chest, underarms, beard and moustache.

Signs and symptoms of pubic infestation include severe itch (which is worse at night), excoriation with possible secondary infection from scratching, detection of black powdery substance in underwear and blue/grey macular spots in affected areas. For those infestations affecting the eyes blepharitis, conjunctivitis, or corneal epithelial keratitis can occur.

Pubic lice infestations are usually spread through sexual contact.

Incubation Period :

Lice hatch from eggs (‘nits’) 6-10 days after being laid.

Period of Infectivity :

While live lice are present
Exclusion Period: Infected persons should refrain from sexual contact until treatment is completed and re-assessed to ensure no persistent infection

Disease : Pubic lice infestation/ Pediculosis pubis/ pthiriasis

Notifiable

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

Main route of transmission :

Contact

Guidance and supporting materials

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No Pathogens

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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.

In the UK, RSV infection occurs regularly each year during the winter months (November to February).

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. 

There is no treatment available however antivirals may be used for supportive care.  A vaccination is available for high-risk infants.

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

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

Rubella virus is a type of togavirus and causes rubella infection, also known as German measles and 3-day measles. Infections in otherwise healthy individuals are usually mild and self-limiting. Signs and symptoms include rash (which typically lasts 3 days and starts on the face then progresses to trunk and limbs), sore throat, fever, conjunctivitis, lymphadenopathy (which may last for several weeks) and arthralgia. Complications are rare, but include testicular swelling, thrombocytopaenia, arthritis and in severe cases, post-infectious encephalitis, which can be fatal.

Rubella infection in pregnancy is a major concern as it can cause miscarriage or congenital rubella syndrome (CRS). CRS can cause severe birth defects if rubella is contracted before 20 weeks gestation and the earlier in the pregnancy, the greater the risk of complications. CRS can cause cardiac, cerebral, ophthalmic and auditory defects, as well as prematurity, neonatal thrombocytopenia, anaemia and hepatitis.

The most effective strategy for preventing rubella transmission has been the measles-mumps-rubella (MMR) vaccine vaccination programme.

Incubation Period :

14 to 21 days

Period of Infectivity :

Individuals are infectious one week before symptoms appear and up to five days after appearance of the rash. CRS affected infants can be infectious up to one year after birth.

Exclusion period: Individuals infected with rubella should stay off school or work and avoid contact with pregnant women where possible for six days after rash onset.

Disease : Congenital rubella syndrome (CRS)

Notifiable

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

Main route of transmission :

Disease : Rubella infection/German measles/3-day 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

Disease : Salmonella gastroenteritis

Notifiable

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

Main route of transmission :

Contact / Foodborne

Guidance and supporting materials

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

Scottish

Infection Prevention and Control in Childcare Settings (Day Care and Nursery)
http://www.hps.scot.nhs.uk/haiic/ic/resourcedetail.aspx?id=352

UK

Salmonella: guidance, data and analysis https://www.gov.uk/government/collections/salmonella-guidance-data-and-analysis

Scabies

Scabies is a contagious skin condition caused by the mite Sarcoptes scabiei var. hominis.

Infestations normally affect skin folds such as between fingers, on the wrist, elbows, knees, and around the buttock or breast creases. The main symptom of scabies infestation is intense itching of affected areas, particularly at night. There can also be a pimple-like skin rash or tiny raised lines caused by the mite borrowing into the skin to lay eggs.

Transmission normally only occurs with prolonged direct contact with an affected person, though can be spread indirectly via the sharing of clothing, towels or bedding. Outbreaks are most common in the winter and tend to occur in populations in close, prolonged contact, such as children in school/nursery (and their parents) and nursing home residents.

Crusted (Norwegian) Scabies is a severe form of the disease in which the skin develops thick crusts containing large amounts of mites/eggs. Often persons with crusted scabies do not have the usual signs and symptoms making the disease harder to diagnose.

Groups most at risk are those with a weakened immune system, elderly people and people who are disabled (particularly those with neurological disorders). Crusted scabies is highly contagious either from direct or indirect contact and requires quick, aggressive treatment to prevent outbreaks.

Incubation Period :

It can take up to eight weeks for the symptoms of scabies to appear after the initial infection.

Period of Infectivity :

During incubation and infestation.
24 hours after treatment has commenced, individuals are no longer infectious.

Exclusion period: Until first treatment has been completed.

Disease : Scabies infestation

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

Scottish

Infection Prevention and Control in Childcare Settings (Day Care and Nursery)
http://www.hps.scot.nhs.uk/haiic/ic/resourcedetail.aspx?id=352

UK

Scabies management https://cks.nice.org.uk/scabies

Scarlet Fever

See Group A Streptococcus

Serratia marcescens

Serratia marcescens, a member of the Enterobacteriaceae family, is an important cause of invasive infections in neonatal intensive care units (NICUs), with significant associated morbidity and mortality.

Serratia marcescens causes infections such as pneumonia, urinary tract infection, wound infections and bacteraemia.

It is able to survive in moist nosocomial environments and colonize the gastrointestinal tract of neonates.

Outbreaks of Serratia marcescens infections in NICUs have been widely documented. In many of these outbreaks, no point source was identified, and contaminated hands of healthcare workers are thought to have been the principal means of spread.

Risk factors for nosocomial infection of neonates include; low birth weight (<1500g), premature delivery, use of invasive devices, prolonged hospital stay and intensive care, prolonged use of antibiotics and maternal infection prior to delivery.

Death has also been reported in infants with severe conditions and/or congenital malformations, meningitis and septicaemia.

 

Incubation Period :

Unknown

Period of Infectivity :

Until eradicated

Exclusion period:
N/A

Disease : Serratia marcescens infection

Notifiable

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

Main route of transmission :

Contact
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: FOOD STANDARDS AGENCY/SCOTTISH EXECUTIVE HEALTH DEPARTMENT GUIDANCE ON THE INVESTIGATION AND CONTROL OF OUTBREAKS OF FOODBORNE DISEASE IN SCOTLAND

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 / Foodborne

Guidance and supporting materials

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

UK

Shigella: guidance, data and analysis https://www.gov.uk/government/collections/shigella-guidance-data-and-analysis

 

Shingles

See varicella virus

Slapped cheek syndrome (Fifth disease)

See Parvovirus B19

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
  • Notifiable under Public Health (Scotland) Act 2008 : 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=1257

Interim advice for the diagnosis and management of PVL-associated Staphylococcus aureus infections (PVL-S. aureus)
https://www.hps.scot.nhs.uk/pubs/detail.aspx?id=1257

Protocol for CRA MRSA Screening National Rollout in Scotland
http://www.hps.scot.nhs.uk/pubs/detail.aspx?id=1639

Staph aureus bacteraemia quality indicators
https://www.sapg.scot/media/2945/sab_quality_indicators_2017.pdf

Staph aureus bacteraemia algorithm
https://www.sapg.scot/media/2944/sab_algorithm_colour_2017.pdf

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

Stenotrophomonas maltophilia is a gram-negative, aerobic bacterium that is most commonly found in aquatic environments. It is a low virulence organism which, in healthcare settings, may be found on environmental surfaces or prosthetic materials (e.g. central lines, catheters). Whilst it does not normally cause infections in healthy individuals, it has emerged as an important hospital acquired pathogen in vulnerable groups, including people with cystic fibrosis, underlying malignancy, immunosuppression and those with indwelling medical devices e.g. urinary catheters, mechanical ventilation. In these at-risk groups, S. maltophilia can cause bloodstream infections, respiratory infections, urinary infections and surgical site infections. It is resistant to many antibiotic classes resulting in limited treatment options.

Period of Infectivity :

While colonised/infected

Disease : Stenotrophomonas maltophilia 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

*Only on alert organism list if found in high risk units e.g. ICU/oncology/NNU etc.

UK

Stenotrophomonas maltophilia Guidance https://www.gov.uk/guidance/stenotrophomonas-maltophilia

Streptococcus pneumoniae

Streptococcus pneumoniae is a member of the Streptococcus family and is the bacterium responsible for causing pneumococcal infections. It is a normal part of the upper respiratory tract flora, however can become pathogenic with 90 different pneumococcal types (serotypes) that can cause diseases in humans.

Pneumococcal infections are classified as invasive or non-invasive depending on the site affected and include; bronchitis, otitis media, acute sinusitis and conjunctivitis amongst others, and are also one of the leading causes of pneumonia. The elderly, young children (particularly neonates), and people who are immunocompromised are the most susceptible.

Invasive Pneumococcal Diseases (IPD) are pneumococcal infections of sterile sites, such as blood, cerebrospinal fluid (CSF) caused by S. pneumoniae. They are a major cause of morbidity and mortality, especially in the very young, elderly and people who are immunocompromised.

Pneumococcal meningitis is a type of IPD and one of the most frequently reported causes of meningitis. Signs and symptoms include headache, fever, nausea and vomiting, stiffness of the neck and photophobia.

There are two pneumococcal vaccines that can help to protect against pneumococcal disease; one is part of the routine childhood immunisation schedule, whilst the other is for those aged 65 and over or for those under 65 with certain underlying co-morbidities.

Incubation Period :

The incubation period is difficult to define as many individuals are colonised and do not progress to infection. However, infection incubation may be as short as 1-3 days, but can be up to 10 days.

Period of Infectivity :

While the organism is present in respiratory secretions. In active infection, individuals are normally not contagious 24-48 hours after antibiotic treatment has commenced.

Exclusion period: Exclude until 24 hours post-commencement of antibiotic treatment.

Disease : Invasive Pneumococcal Disease (IPD) (in blood, cerebrospinal fluid or other normally sterile site)

Notifiable

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

Main route of transmission :

Contact

Guidance and supporting materials

* Not on alert organism list unless resistant to specified antimicrobials  

Disease : Pneumococcal infection

Notifiable

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

Main route of transmission :

Contact

Guidance and supporting materials

* Not on Alert Organism list unless resistant to specified antimicrobials  

Disease : Pneumococcal 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

*Not on alert organism list unless resistant to specified antimicrobials

Scottish

Pneumococcal Disease https://www.hps.scot.nhs.uk/a-to-z-of-topics/pneumococcal-disease/

UK

Greenbook, Chapter 25 https://www.gov.uk/government/publications/pneumococcal-the-green-book-chapter-25

Pneumococcal disease: guidance, data and analysis https://www.gov.uk/government/collections/pneumococcal-disease-guidance-data-and-analysis

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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.

 

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).

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.

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.

UK

Infection control guidance from the Advisory Committee on Dangerous Pathogens Transmissible Spongiform Encephalopathy Risk Management Sub Group (ACDP TSE RM SG – formerly the TSE Working Group) to reduce the risk of the spread of TSEs in healthcare and community settings. Parts 1 to 4, Annex A – M
https://www.gov.uk/government/publications/guidance-from-the-acdp-tse-risk-management-subgroup-formerly-tse-working-group

Measures currently in place in the UK to reduce the potential risk of transmitting variant Creutzfeldt-Jakob Disease
https://www.gov.uk/government/publications/current-measures-to-reduce-the-risk-of-vcjd-transmission-by-blood

Public Health Action following a report of a new case of CJD or a person at increased risk of CJD
https://www.gov.uk/government/publications/cjd-public-health-action-following-report-of-new-case-or-person-at-increased-risk

CJD: Information leaflets for patients and healthcare professionals
https://www.gov.uk/government/publications/cjd-information-leaflets-for-patients-and-healthcare-professionals

Creutzfeldt-Jakob Disease - A guide for social workers in England
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/719058/creutzfeldt-jakob_disease-guidelines-for-social-workers-in-england.pdf#

Chronic wasting disease: risk assessments
https://www.gov.uk/government/publications/chronic-wasting-disease-risk-assessments

Tuberculosis (TB)

See Mycobacterium tuberculosis

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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 to 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
https://www.hps.scot.nhs.uk/haiic/ic/resourcedetail.aspx?id=1669

Vancomycin-resistant enterococci (VRE): Information for patients
https://www.hps.scot.nhs.uk/haiic/ic/resourcedetail.aspx?id=1670

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/

Varicella virus

Chickenpox

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.

Shingles

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 and it is therefore possible to catch chickenpox from someone with shingles, although it is not possible to catch shingles from someone with chickenpox.

 

Incubation Period :

Varicella: 1-3 weeks
Shingles: Reactivation can occur many years after initial infection.

Period of Infectivity :

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

Shingles: infective while the rash oozes fluid.

Exclusion period: Chickenpox: Until all vesicles have crusted over, usually around 5-6 days.
Shingles: Exclude only if rash is weeping and cannot be covered.

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

Infection Prevention and Control in healthcare settings (Daycare and Nursery)
http://www.hps.scot.nhs.uk/haiic/ic/resourcedetail.aspx?id=352

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

Disease : Shingles

Notifiable

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

Main route of transmission :

Contact / Droplet
Vero cytoxin-producing Escherichia coli (VTEC)

See Escherichia coli

Viral Haemorrhagic Fever (VHF)

Viral haemorrhagic fevers (VHFs) are a diverse group of viral illnesses caused by five distinct RNA virus families. Some VHF agents cause only mild disease, but others can be severe and life-threatening. There are many VHF agents, a notable one being the Ebola virus. Others include Yellow fever virus, Dengue virus, Hantavrius and Crimean-Congo haemorrhagic fever virus.

VHF infections cause fever and bleeding disorders, with other symptoms including headache, muscle weakness and fatigue. Severity of symptoms depends on the type of VHF virus. Yellow fever is the only VHF with an established vaccine.

VHF agents are found in areas of Africa, South America and Asia. Animals are the natural host, but humans are at risk of acquiring infection if they live in endemic areas and healthcare workers caring for those with VHF are at higher risk, especially if not equipped with the appropriate protective equipment. Transmission of VHFs varies depending on virus type. However, there are four main routes of transmission:

  • Bites from infected ticks
  • Bites from infected mosquitoes
  • Direct contact with infected animals (especially rodents), waste products and carcasses
  • Direct contact with infected persons, their body fluids and/or corpse

For those VHF agents that are transmitted via direct contact, many can continue to survive in body fluids outwith the infected host for several days. As such, transmission can occur when handling body fluids (e.g. urine, blood) or contaminated devices from an infected person or animal. Some VHFs, such as Ebola, can remain contagious for several days after death and careful handling and disposal of the deceased is vital to reduce transmission. Of note, survivors of VHF have been found to carry the virus in their body fluids (e.g. urine, breast milk, semen) many months after symptoms abate.

Incubation Period :

Varies, but generally between 2 - 21 days

Period of Infectivity :

Varies depending on causative agent. For example, Ebola virus may be found in body fluids for prolonged periods after symptoms abate.

Exclusion period: Exclusion is essential during symptomatic period, but depending on causative agent, further precautions may be required for varying periods after symptoms abate.

Disease : Viral Haemorrhagic Fever*

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

*All VHFs causing disease are notifiable. Notifiable VHF organisms include; Crimean-Congo haemorrhagic fever virus, Dengue virus, Ebola virus, Guanarito virus, Hantavirus, Junín virus, Kyasanur Forest disease virus, Lassa virus, Machupo virus, Marburg virus, Rift Valley fever virus, Sabia virus and Yellow Fever virus.

Scottish

Ebola: Viral Haemorrhagic Fever (VHF) Infection Prevention and Control Precautions Summary for the Hospital Setting (Version 3.0)
http://www.hps.scot.nhs.uk/travel/resourcedetail.aspx?id=1318

Advice for Purchase of Required PPE for VHF Preparedness
http://www.hps.scot.nhs.uk/travel/resourcedetail.aspx?id=1319

 

UK

Viral haemorrhagic fevers: epidemiology, characteristics, diagnosis and management https://www.gov.uk/government/collections/viral-haemorrhagic-fevers-epidemiology-characteristics-diagnosis-and-management

 Management of Hazard Group 4 viral haemorrhagic fevers and similar human infectious diseases of high consequence https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/534002/Management_of_VHF_A.pdf

 

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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

Zika

Disease : Zika

Main route of transmission :

Guidance and supporting materials

Scottish

Further information can be found on the HPS Website https://www.hps.scot.nhs.uk/a-to-z-of-topics/zika/

 

UK

Further information can be found on the PHE website https://www.gov.uk/government/collections/zika-virus-zikv-clinical-and-travel-guidance

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Footnotes

A-Z of Pathogens