GRAMPIAN HEALTH BOARD



CASE MANAGEMENT

GENERAL INFECTIONS

Basic principles

Any individual who is unwell and has symptoms of an acute illness should NOT attend nursery, school, work etc

Thorough personal and environmental hygiene must be practised at all times. NHS Grampian’s Safe Working Practice document is available from the Health Protection Team.

ENTERIC INFECTIONS

Cases and contacts with enteric symptoms should follow standard management except where specific exclusions are stated for high-risk groups A, B, C, D. Remember - if there is any doubt about hygiene, exclude under Group A

Standard management

Cases and contacts can return to work or school 48 hours after symptoms have settled. However, contacts of the case who have or who have had symptoms suggestive of the same infection may be screened to establish the nature of the illness and managed accordingly.

• Exclude from work, school, nursery etc until 48 hours after a full recovery

• Ensure thorough hand hygiene – use liquid soap and separate towels

| | |

|Group A |Any person of doubtful hygiene or with unsatisfactory toilet, handwashing or hand drying facilities at home, work or school |

| | |

|Group B |Children who attend pre-school groups or nursery |

| | |

|Group C |People whose work involves preparing or serving unwrapped foods not subjected to further heating/cooking |

| | |

|Group D |Health or Social Care staff who have direct contact with highly susceptible patients or persons in whom a gastrointestinal infection would have particularly |

| |serious consequences |

REPORTING AND INVESTIGATION OF ILLNESS

NHS Grampian’s Health Protection Team (HPT) is responsible for the surveillance, investigation and control of communicable disease and non-infectious environmental hazards in Grampian. An outbreak is defined either as two or more linked cases of the same illness or when the observed number of cases exceeds the number expected. All suspected outbreaks should be reported to the HPT.

Infectious diseases are reported to the Health Protection Team from a variety of sources including;

• NHS laboratories

• Educational establishments including nursery, primary and secondary schools

• Care homes, day care centres, prisons, community and recreational facilities

• Health and social care colleagues and other professionals

There are specific diseases that require the diagnosing doctor to notify to the Health Protection Team under Public Health Legislation. These diseases are identified throughout the document.

Please find all references at the end of the document.

DEFINITIONS

|Foodborne disease |Any disease of an infectious or toxic nature caused by or thought to be caused by the consumption of food or water. Food comprises all foodstuffs and drinks. |

|Incubation period |The interval between exposure to an infection and the appearance of the first symptoms |

|Vomiting |Sudden onset of vomiting where there is no non-infective cause |

|Symptomatic |Symptoms of illness displayed, with or without confirmation of infecting organism |

|Asymptomatic |No symptoms of illness displayed, with or without confirmation of infecting organism |

|Case |Individual with symptoms and /or a laboratory confirmed specimen |

|Contact |An individual linked to a case that has been exposed to the infectious organism e.g. household member. Symptomatic contacts are often managed as cases until proven |

| |negative |

| | | | | | |

| |CLINICAL FEATURES |INCUBATION PERIOD |COMMON SOURCES & MEANS OF SPREAD |MANAGEMENT |EXCLUSION |

|DISEASE | | | | | |

| | | | | | |

|AEROMONAS |Watery diarrhoea, mild fever |1 – 7 days |Water, fish |Cases - Standard Management |Cases – None |

| | | | | | |

|Notifiable as food poisoning | | | |Contacts - None |Contacts - None |

| | | | | | |

|Leaflet available | | | | | |

| | | | |Discuss with HPT |Discuss with HPT |

|AMOEBIC DYSENTERY |Bloody diarrhoea, fever – wide |2 days to 1 year, |Water, raw vegetables | | |

| |range of severity |usually 2 – 4 weeks | |Cases – Standard management except groups |Cases – Exclude groups C&D until one negative|

|Notifiable as food poisoning | | | |C&D |one week after treatment. |

| | | | | | |

| | | | |Contacts - Screen contacts |Contacts – Discuss with HPT |

| | | | | | |

|BACILLUS CEREUS |Two clinical syndromes may |1 – 5 hours |Rice, cereals, milk powder, |Cases – Standard Management |Cases - None |

| |occur |8 –16 hours |pasta | | |

|Notifiable as food poisoning |1. Mainly vomiting, 2. | | |Contacts - None |Contacts - None |

| |abdominal pain, diarrhoea, | | | | |

| |vomiting | | | | |

| | | | | | |

|CAMPYLOBACTER |Abdominal pain, profuse |1 – 10 days, |Close contact with infected animals; |Cases – Standard Management |Cases – None |

|Notifiable |diarrhoea which might be |usually 2 – 5 days |poultry, water, unpasteurised milk, | | |

| |bloody, malaise, headache, | | |Contacts - None |Contacts - None |

|Leaflet available |fever | | | | |

| | | | |Discuss with HPT |Discuss with HPT |

|CHOLERA |Profuse watery stools, rapid |6 hours – 5 days, |Shellfish, water | | |

| |dehydration, collapse |usually 2 – 3 days | |Cases – Standard management except ABCD |Cases – ABCD - 2 consecutive negative stool |

|Vibrio cholerae serogroups 01 and| | | | |specimens at least 24 hours apart. |

|0139 | | | |Contacts – Clinical surveillance and screen | |

| | | | |contacts if common exposure |Contacts – Discuss with HPT |

|Notifiable | | | | | |

| | | | | | |

|DISEASE |CLINICAL FEATURES |INCUBATION PERIOD |COMMON SOURCES AND MEANS OF SPREAD |MANAGEMENT |EXCLUSION |

| | | | | | |

|OTHER CHOLERA ORGANISMS |Watery diarrhoea, abdominal |4 – 96 hours, |Fish, shellfish, marine environments, |Discuss with HPT |Discuss with HPT |

|(non O1 or O139) |cramps, fever, headache |usually 12 – 24 hours |sea water | | |

| | | | |Cases - Standard Management |Cases - None |

|Notifiable as food poisoning | | | |(If sero group unknown manage as O1 and O139)| |

| | | | | | |

| | | | |Contacts - None | |

| | | | | |Contacts - None |

| | | | |Urgently discuss with HPT | |

|CLOSTRIDIUM BOTULINUM |Double vision, dry mouth, |2 hours – 8 days, |Fish, vegetables, preserved foods, both| | |

|Notifiable as food poisoning |difficulty swallowing, |usually 12 – 36 hours |canned and vacuum packed |Cases - Standard Management |Cases - None |

|URGENTLY TO HPT |respiratory failure, paralysis | | | | |

| | | |Injecting drug use |Contacts - None |Contacts - None |

| | | | | | |

| |Symptoms usually seen in |Within a few days of |Found in human intestines but usually |Cases - Standard Management |Cases None |

|CLOSTRIDIUM DIFFICILE |hospital patients include |starting antibiotics |suppressed by normal flora. | | |

| |diarrhoea, abdominal pain, | |Person to person spread via hands |Contacts - None |Contacts - None |

| |fever | |and/or the environment | | |

| | | | | | |

|CLOSTRIDIUM PERFRINGENS |Abdominal pain, diarrhoea |6 – 24 hours, |Stews, rolled meat, pies and stovies |Cases - Standard Management |Cases None |

|Notifiable as food poisoning | |usually 10 – 12 hours | | | |

| | | | |Contacts - None |Contacts - None |

| | | | | | |

|CRYPTOSPORIDIUM |Abdominal cramp, watery |1 – 12 days, |Water, raw milk, animal contact |Cases -Standard Management |Cases - None |

|Notifiable as food poisoning |diarrhoea, fever , nausea |usually 7 days |especially young animals such as calves| | |

| | | |and lambs, person to person |Contacts - None |Contacts - None |

|Leaflet available | | | | | |

| | | | | | |

|DISEASE |CLINICAL FEATURES |INCUBATION PERIOD |COMMON SOURCES AND MEANS OF SPREAD |MANAGEMENT |EXCLUSION |

| | | | |Discuss with HPT |Discuss with HPT |

|DYSENTERY |Diarrhoea, may be bloody, |1 – 7 days, |Mostly person to person in the UK | | |

|(Shigella sonnei) |abdominal cramps, toxaemia |usually 3 days | |Cases - Standard management except groups |Cases – Groups A&B - 2 consecutive negative|

|Notifiable | | | |A&B |stools, at least 24 hours apart. |

| | | | | | |

|Leaflet available | | | | |Symptomatic contacts – As cases |

| | | | |Symptomatic contacts - As cases. | |

| | | | | |Asymptomatic Contacts – None |

| | | | |Asymptomatic contacts- None | |

| | | | |Discuss with HPT |Discuss with HPT |

|DYSENTERY (Sh.boydii |Diarrhoea, may be bloody, |1 – 7 days, |Faecally contaminated food or water |Cases -Standard Management except groups |Cases - ABCD and under 8’s - 2 consecutive |

|Sh.dysenteriae |abdominal cramps, toxaemia |usually 3 days |Mostly person to person in the UK |ABCD and under 8’s |negative stools at least 24 hours apart. |

|Sh.flexneri) | | | | | |

| | | | |Symptomatic Contacts – Standard management |Symptomatic contacts - As cases. |

|Notifiable | | | |except groups ABCD and under 8’s | |

| | | | | | |

|Leaflet available | | | |Asymptomatic contacts - if not in groups |Asymptomatic contacts – screen and exclude |

| | | | |ABCD and under 8’s - None |ABCD and under 8s - until 2 consecutive |

| | | | | |negative stools (PHLS 2004) |

| | | | | | |

|ESCHERICHIA COLI ENTERITIS |Abdominal pain, fever, |10 – 72 hours |Contaminated food and water |Cases - Standard Management |Cases - None |

|(Including Enterotoxigenic and |diarrhoea, vomiting | |Person to person spread | | |

|Enteropathogenic) | | | |Contacts – None |Contacts – None |

| | | | | | |

|Notifiable as food poisoning | | | | | |

| | | | | | |

|DISEASE |CLINICAL FEATURES |INCUBATION PERIOD |COMMON SOURCES AND MEANS OF SPREAD |MANAGEMENT |EXCLUSION |

|E COLI O157 VTEC |Abdominal pain, |12 hours to 14 days, usually 2 – 5 days |1. Swallowing the bacteria |Discuss all cases and contacts with HPT |Discuss all cases and contacts with HPT |

| |diarrhoea, bloody | |During and/or after direct contact with | | |

|Notifiable as food |diarrhoea, | |infected animal faeces e.g. caring for |Test all household contacts | |

|poisoning |Haemolytic Uremic | |infected animals or spraying slurry | | |

| |Syndrome (HUS) | |During and/or after indirect contact with|Cases- Standard management if not in groups| |

|Leaflet available | | |infected animals faeces e.g. from |ABCD or under 8 |Cases – ABCD and under 8’s -exclude until |

| | | |clothing contaminated with cattle faeces,| |2 consecutive negative stools specimens 24 |

| | | |during picnics or BBQ’s in the | |hours apart |

| | | |countryside |Symptomatic Contacts – As case i.e. | |

| | | |When eating raw or undercooked meat |Standard Management unless in groups ABCD | |

| | | |contaminated with the bacteria. |or under 8. |Symptomatic Contacts – Exclude as case |

| | | |By drinking or eating unpasteurised (raw)| | |

| | | |or poorly pasteurised milk or milk |Asymptomatic Contacts – None unless in | |

| | | |products which are contaminated with the |groups ABCD or under 8 | |

| | | |bacteria e.g. cheese. | |Asymptomatic Contacts – ABCD and under 8’s |

| | | |On unwashed vegetables or fruit |SISS Guidance for the diagnosis and |exclude until 2 consecutive negative stools|

| | | |fertilised with infected manure |management of suspected or proven |24 hours apart. |

| | | |2. Drinking rural or private |Escherichia Coli O157 infection. | |

| | | |water supplies |( |

| | | |contaminated with |s/journal_34_1/E_coli_O157.pdf) J R Coll | |

| | | |Infected faeces |Physicians Edinb 2004; 34: 37-40 ) | |

| | | |Person to person spread can occur within | | |

| | | |families or community groups e.g. school | | |

| | | |where there is a breakdown in hygiene | | |

| | | |practices | | |

| | | | | | |

|DISEASE |CLINICAL FEATURES |INCUBATION PERIOD |COMMON SOURCES AND MEANS OF SPREAD |MANAGEMENT |EXCLUSION |

| | | | | | |

|GIARDIASIS |Mucoid diarrhoea, |1 – 4 weeks, |Water |Cases - Standard Management |Cases – None |

|Notifiable as food |abdominal cramps, |usually 7 – 10 days | | | |

|poisoning |weight loss | | |Contacts - None |Contacts – None |

| | | | | | |

|Leaflet available | | | | | |

| | | | | | |

| | | |Person-to-person contact within families |Cases – See exclusion |Cases – exclude until 7 days after |

|HEPATITIS A |Fever, malaise, |15 – 50 days, |Eating infected food - either previously handled by | |onset of jaundice |

|Notifiable |anorexia, jaundice, |usually 28 – 30 days |someone with Hepatitis A or salads, fruits, etc washed in | | |

| |nausea | |contaminated water |Contacts - HPT will advise on immunisation|Contacts - None |

|Leaflet available | | |Through anal sex, usually men who have sex with men. |and/or the use of immunoglobulin | |

| | | |Contamination of drinking water by infected faecal | | |

| | | |material | | |

| | | |Sharing drug injecting equipment, including needles, | | |

| | | |syringes, filters, spoons etc. | | |

| | | | | | |

|NOROVIRUS |Vomiting and/ or |15 – 50 hours after |Person to person via faecal-oral route |Cases – Standard management |Cases – None |

| |diarrhoea |exposure to the virus. |Ingesting suspended viral particles dispersed after | | |

|(VIRAL GASTRO-INTESTINAL |Abdominal cramps, | |vomiting |Contacts - None |Contacts – None |

|INFECTION) |headaches, fever, | |Contaminated food or environment | | |

| |nausea, |Symptoms usually resolve|Consumption of shellfish harvested from contaminated water| | |

|leaflet available | |in 12-60 hours | | | |

| | | | | | |

|DISEASE |CLINICAL FEATURES |INCUBATION PERIOD |COMMON SOURCES AND MEANS OF SPREAD |MANAGEMENT |EXCLUSION |

| | | | | | |

|SALMONELLA INFECTION |Diarrhoea, abdominal|6 – 72 hours, |Poultry, eggs, meat, person to person uncommon |Cases- Standard Management if not in AB |Cases – AB Discuss exclusion with HPT |

|Notifiable as food |pain, nausea, fever,|usually 12 – 36 hours | | | |

|poisoning |vomiting | | |Contacts- None |Symptomatic contacts – AB Discuss exclusion |

| | | | | |with HPT |

|Leaflet available | | | | | |

| | | | | |Asymptomatic contacts – None |

| | | | |Discuss with HPT |Discuss with HPT |

|SALMONELLA TYPHI & |Rigors, fever, |1 – 56 days, |Faecal – oral, occasionally foodborne |Cases – See exclusions |Cases – Group C - 6 negative stool specimens at |

| |cough, rash, |usually 1 – 3 weeks | | |2 week intervals, starting 2 weeks after |

|PARATYPHI |variable | | | |completion of antibiotic treatment. |

|Notifiable as food |gastro-intestinal | | | | |

|poisoning |symptoms (can | | | |Cases - Groups ABD - 3 negative stool specimens |

| |include | | | |at 1 week intervals. |

|Leaflet available |constipation) | | | | |

| | | | | |Contacts –Exclude ABCD until 3 negative stools |

| | | | | |at 48 hour intervals starting 3 weeks after last|

| | | | |Contacts- Test all household and those with |contact with untreated case |

| | | | |common exposure | |

| | | | | | |

|STAPHYLOCOC-CUS.AUREUS |Vomiting, abdominal |1 – 6 hours |Pre-cooked foods, custards etc |Cases - Standard Management |Cases - None |

|Notifiable as food |pain | | | | |

|poisoning | | | |Contacts - None |Contacts - None |

| | | | | | |

|VIBRIO PARAHAEM-OLYTICUS |Watery diarrhoea, |4 – 96 hours, |Fish, shellfish, marine environments, sea water |Cases - Standard Management |Cases - None |

| |abdominal cramps, |usually 12 – 24 hours | | | |

|Notifiable as food |fever, headache | | |Contacts - None |Contacts - None |

|poisoning | | | | | |

| | | | | | |

|DISEASE |CLINICAL FEATURES |INCUBATION PERIOD |COMMON SOURCES AND MEANS OF SPREAD |MANAGEMENT |EXCLUSION |

| | | | | | |

|YERSINIA |Watery diarrhoea, |3 – 7 days |Pork, domestic birds, imported chocolate |Cases - Standard Management |Cases - None |

|Notifiable as food |mesenteric | | | | |

|poisoning |lymph-adenitis, | | |Contacts - None |Contacts - None |

| |fever | | | | |

|Leaflet available | | | | | |

| | | | | | | |

|DISEASE |CLINICAL FEATURES |INCUBATION PERIOD |COMMON SOURCES AND MEANS|RISK OF FURTHER SPREAD |MANAGEMENT |EXCLUSION |

| | | |OF SPREAD | | | |

| | | | | |Discuss with HPT |Community Settings |

|CHICKENPOX |Sudden onset – fever, |2 – 3 weeks, usually |Person to person by |High risk of spread, mainly due | | |

| |malaise, generalised |13-17 days |direct contact, droplet |to airborne spread of respiratory|Cases |Cases |

|(Varicella Zoster) |rash. Initially | |or airborne spread of |secretions, from 1 – 2 days |Pregnant, neonate and immunocompromised –|5 days from the onset of rash. |

| |macular, lesions | |respiratory or vesicular|before onset of rash and the |see GP urgently. |If immunocompromised – until lesions have |

|Notifiable |become papules then | |fluids |first 5 days |In addition to the above risk groups, |crusted. |

| |vesicles. Rash | | |Note: Infectivity may be |Aciclovir should be considered for all | |

| |develops in successive| | |prolonged in the |adults over 16 years if treatment can | |

| |“crops” usually | | |immunocompromised |commence within 24 hours of onset of | |

| |starting on the face | | | |rash. | |

| |and scalp so lesions | | | | |Contacts |

| |at all stages are | | | |Contacts |None. |

| |present during the | | | |Pregnant, neonate and immunocompromised -|Note: Susceptible contacts are potentially |

| |first few days. | | | |see GP urgently. VZIG may be indicated |infectious 8-21 days after contact (8-28 |

| | | | | | |days if VZIG has been given) and should be |

| | | | | |NHS Healthcare settings |advised to avoid contact with those at |

| | | | | |HCW’s with no previous history of |increased risk during this period where |

| | | | | |chickenpox or shingles who have contact |possible. |

| | | | | |with a case should be tested for | |

| | | | | |antibody; if negative exclude from |NHS Healthcare Settings |

| | | | | |contact with those at increased risk of |Cases should be isolated from those at |

| | | | | |serious disease for 8-21 days after |increased risk of severe disease: antibody |

| | | | | |contact |negative pregnant women, neonates and the |

| | | | | |All non-immune HCW’s should be offered |immunocompromised until lesions have |

| | | | | |immunisation. |crusted over |

| | | | | | | |

| | | | | |Ref: Immunisation against Infectious |Note: Susceptible contacts (including |

| | | | | |Disease |staff) are potentially infectious 8 -21 |

| | | | | |(Jan 2004) |days after contact (8 –28 days if VZIG has |

| | | | | |SEHD (Jan 2004) |been given) and should also be excluded |

| | | | | |PHLS Guidance (2002) |from contact with those at increased risk |

| | | | | | |during this period. |

| | | | | | | |

|DISEASE |CLINICAL FEATURES |INCUBATION PERIOD |COMMON SOURCES AND MEANS|RISK OF FURTHER SPREAD |MANAGEMENT |EXCLUSION |

| | | |OF SPREAD | | | |

| | | | | | | |

| |Pain, occasionally flu|Reactivation of VZV. |Contact with vesicle |Much lower risk of spread than in|Cases |Cases |

|SHINGLES |like symptoms |14-16 days depends on |fluid or indirectly via |chickenpox. Spread may be |Pregnant, neonate and immunocompromised –|For exposed lesions (e.g. face) – exclude |

| |accompanied by |immunity |articles freshly soiled |possible until all lesions have |see GP urgently. In these groups consider|for 5 days from onset of rash. If |

|(Herpes Zoster) |clusters of clear | |with vesicle fluid |crusted usually about 1 week |Aciclovir at any stage of illness. |immunocompromised – until lesions have |

| |vesicles | | |following the onset of the rash. |Consider for other cases if given within |crusted. If lesions can be covered no |

| | | | |Immunocompromised individuals may|72 hours |exclusion is usually necessary. |

| | | | |be infectious 1 – 2 days prior to|Basic principles. (see page 2) | |

| | | | |rash and it may be several weeks | | |

| | | | |until all lesions crust. |Contacts |Contacts |

| | | | | |Pregnant, neonate and immunocompromised –|None. |

| | | | | |see GP. VZIG may be indicated |Note: Susceptible contacts are potentially |

| | | | | |Ref: Immunisation against Infectious |infectious 8-21 days after contact (8-28 |

| | | | | |Disease |days if VZIG has been given) and should be |

| | | | | |(Jan 2004) |advised to avoid contact with those at |

| | | | | | |increased risk during this period where |

| | | | | | |possible. |

| | | | | | | |

| | | | | | |NHS Healthcare Settings |

| | | | | | |Cases should be isolated from those at |

| | | | | | |increased risk of severe disease: antibody |

| | | | | | |negative pregnant women, neonates and the |

| | | | | | |immunocompromised until lesions have |

| | | | | | |crusted over. |

| | | | | | |Note: Susceptible contacts (including |

| | | | | | |staff) are potentially infectious 8 -21 |

| | | | | | |days after contact (8 –28 days if VZIG has |

| | | | | | |been given) and should also be excluded |

| | | | | | |from contact with those at increased risk |

| | | | | | |during this period. |

| | | | | | | |

|DISEASE |CLINICAL FEATURES |INCUBATION PERIOD |COMMON SOURCES AND MEANS|RISK OF FURTHER SPREAD |MANAGEMENT |EXCLUSION |

| | | |OF SPREAD | | | |

| | | | | | | |

|COLD SORES |Fever, malaise, |2 – 12 days |Direct contact with |Virus can be found in saliva |Cases |Cases |

| |blister-like lesions | |saliva and fluid from |after recovery and during |Treat any secondary bacterial infection. |Children with open sores who “mouth” toys, |

|(Herpes Simplex) |on lips and in the | |blisters. |reactivations (which may be |Basic principles. |bite or drool. |

| |mouth, including the | | |subclinical) for the rest of | | |

| |tongue. | | |life. |Contacts |Contacts |

| | | | | |None. |None. |

| | | | | | | |

|CONJUNCTIVITIS |Watering eyes, |24 – 72 hours |Contact with discharge |High during acute stage of |Cases |Cases |

| |swelling of the | |from the conjunctiva and|infection |Topical antibiotic if appropriate |Until symptoms settle or until treated with|

|(Children) |conjunctiva, swelling | |respiratory secretions. | |Basic principles |an antibiotic for 24 hours. |

| |of the eyelids and | |Contact with | | | |

| |yellow/green | |contaminated fingers, | |Contacts |Contacts |

|Leaflet available |discharge. | |clothing and other | |Basic principles. |None |

| | | |items. | | | |

| | | | | | | |

|DIPHTHERIA |Nasal discharge, sore |2 –5 days, although |Prolonged direct person |High in non-immunised individuals|Discuss cases and contacts with HPT |Discuss cases and contacts with HPT |

|(Corynebacterium diphtheriae)|throat, patches of |sometimes longer |– person transmission by| | | |

| |adherent greyish | |intimate respiratory and| |HPT will assess all cases and contacts to|Cases |

|Toxigenic |membrane to uvula and | |physical contact. More | |establish the need for chemoprophylaxis |Until 2 negative nose and throat swabs (+ |

| |soft palate. | |rarely contact with | |and immunisation |skin lesions if cutaneous) taken 24 hours |

|Notifiable |Swelling of soft | |articles soiled with | | |apart, 24 hours after completing treatment.|

| |tissues in the neck | |discharge from lesions | | | |

|URGENTLY NOTIFY TO HPT |(“bull-neck” | |of infected people. | | | |

| |appearance) | | | | |Contacts |

| | | |Raw milk can be a | | |HPT to assess |

| | | |vehicle. | | | |

| | | | | | | |

|DISEASE |CLINICAL FEATURES |INCUBATION PERIOD |COMMON SOURCES AND MEANS|RISK OF FURTHER SPREAD |MANAGEMENT |EXCLUSION |

| | | |OF SPREAD | | | |

| | | | | | | |

|FIFTH DISEASE |Striking erythema of |4 - 20 days |Person to person by |Spread most likely 1 – 2 weeks |Discuss with HPT | |

| |the cheeks |more commonly |direct contact, droplet |before the rash appears. By the |Cases |Cases |

|(Parvovirus B19, Slapped |(slapped-face |13 - 18 days |or airborne spread |time the rash appears the person |Pregnant |None. |

|Cheek Syndrome, erythema |appearance) | |particularly in closed |is not infectious. |Blood disorder | |

|infectiosum) |Mild usually | |environments e.g. | |Immune suppression | |

| |non-febrile illness | |classrooms | |All see GP urgently | |

| |Adults may have some | | | | | |

|Leaflet Available |joint pain/swelling | |Contact with infected | |Contacts |Contacts |

| | | |respiratory secretions. | |Pregnant |None. |

| | | | | |Blood disorder | |

| | | | | |Immune suppression | |

| | | |Mother to foetus | |All see GP urgently | |

| | | | | |(PHLS 2002) | |

| | | | | |Management of Healthcare Workers | |

| | | | | |(PHLS 1999) | |

| | | | | | | |

|GLANDULAR FEVER |Fever, sore throat, |4 – 6 weeks |Person to person via |Virus found in salivary |Cases |Cases |

| |malaise, rarely | |saliva. Saliva on toys|secretions after recovery during |Basic principles. |None. |

|(Infectious Mononucleosis) |jaundice can occur | |etc can cause infection |reactivation episodes, which are | | |

| | | |in children. |sub-clinical. |Contacts |Contacts |

| | | | | |None. |None. |

| | | | | | | |

|DISEASE |CLINICAL FEATURES |INCUBATION PERIOD |COMMON SOURCES AND MEANS|RISK OF FURTHER SPREAD |MANAGEMENT |EXCLUSION |

| | | |OF SPREAD | | | |

| | | | | | | |

|HAND, FOOT AND MOUTH DISEASE |Sudden onset - fever, |3 – 5 days |Faecal-oral |During the acute stage of the |Cases |Cases |

| |sore throat, greyish | |Person to person via |illness and as long as virus |Basic principles. |None. |

|(Coxsackie Virus) |lesions in the mouth | |saliva and respiratory |persists in stools which may be | | |

| |and on the fingers, | |secretions by direct |for several weeks. |Contacts |Contacts |

|Leaflet available |palms and the soles of| |contact, droplet or | |None. |None. |

| |the feet. | |airborne spread. | | | |

| | | | | | | |

| | | |Not to be confused with | | | |

| | | |Foot & Mouth Disease | | | |

| | |

|HEAD LICE |PLEASE REFER TO NHS GRAMPIAN’S HEAD LICE POLICY |

|Leaflet available | |

| | | | | | | |

|IMPETIGO |Blister-like lesions |4 –10 days |Direct contact with |As long as lesions are |Cases |Cases |

| |then yellow/green | |discharge from lesions |discharging or a carrier state |Basic principles. |Until skin is healed or has been treated |

|(Staphylococcal or |discharge. Skin | |and on contaminated |persists. | |for 48 hours with an appropriate |

|Streptococcal infection) |surrounding the | |items including hands. | | |antibiotic. |

| |lesions is red and | | | | | |

| |inflamed. | | | |Contacts |Contacts |

| | | | | |Basic principles. |None. |

| | | | | | | |

|DISEASE |CLINICAL FEATURES |INCUBATION PERIOD |COMMON SOURCES AND MEANS|RISK OF FURTHER SPREAD |MANAGEMENT |EXCLUSION |

| | | |OF SPREAD | | | |

| | | | | | | |

|INFLUENZA |Fever, headache, |1 – 4 days |Airborne, droplet spread|Fairly high in the first 5 days |Cases |Cases |

| |muscle pain, | |particularly in closed |of symptoms. |Basic principles. |None. |

| |exhaustion, runny | |environments. Close | | | |

| |nose, sore throat, and| |contact with respiratory| |Contacts |Contacts |

|Leaflet Available |cough. | |secretions. | |Basic principles. |None. |

| | | | | | | |

| | | | | | |Subject to change during an influenza |

| | | | | | |pandemic. |

| | | | | | | |

|MEASLES |Fever, conjunctivitis,|10 – 15 days, commonly |Airborne, droplet spread|High from the prodromal stage to |Discuss with HPT |Discuss with HPT |

| |runny nose, and cough.|12 days to onset of |and direct contact with |5 days after the onset of |Cases |Cases |

|Notifiable |White “Koplik” spots |illness and 16 days to |respiratory secretions |illness |Salivary testing kit to HPA Colindale to |Until 5 days after onset of rash |

| |on the buccal mucosa, |the appearance of rash |of an individual with | |confirm diagnosis. | |

|URGENTLY NOTIFY TO HPT |which fade as the rash| |measles infection. | |Basic principles. | |

| |appears around day 3 | | | | | |

| |of illness. Rash | | | |Contacts |Contacts |

| |appears in the | | | |In some circumstances MMR or HNIG may be |None. |

| |hairline rapidly | | | |indicated following discussion with HPT. | |

| |spreading to face, | | | |Basic principles. | |

| |trunk and limbs fading| | | | | |

| |over 7-10 days | | | |PHLS (2002) | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

|DISEASE |CLINICAL FEATURES |INCUBATION PERIOD |COMMON SOURCES AND MEANS OF |RISK OF FURTHER SPREAD |MANAGEMENT |EXCLUSION |

| | | |SPREAD | | | |

| | | | | |Discuss cases and contacts with HPT | Discuss with HPT |

|MENINGOCOCCAL |Fever, severe headache, |2 – 10 days commonly |Direct contact with |Low. Requires frequent close, | | |

|INFECTION |nausea, vomiting, stiff |3 – 5 days. |respiratory secretions, |prolonged personal contact e.g. |HPT will assess all cases and | |

| |neck, and petechial | |including droplets. |household |contacts to establish the need for |Cases |

| |rash. Delirium, shock |Disease more common in | | |chemoprophylaxis and immunisation |None. |

| |and coma. |winter months. | | | | |

|Notifiable | | | | |Please refer to |Contacts |

| | | | | |NHS Grampian Public Health Management|None. |

|URGENTLY NOTIFY TO HPT | | | | |of Meningitis (2005) Policy | |

| | | | | | | |

|Leaflets available | | | | | | |

| | | | | | | |

|MOLLUSCUM CONTAGIOSUM |Smooth, firm, spherical,|About 2 – 7 weeks. |Direct contact – including |Probably as long as the lesions |Cases |Cases |

| |painless lesions | |sexual and by autoinoculation|persist but exact length of time |None. |Avoid skin to skin contact e.g. |

| |(flesh-coloured, white, | |(accidental transfer of |is unknown. |Basic principles. |contact sports |

| |yellow or translucent) | |infected material from | | | |

| |with a dip in the | |lesions from one body site to| |Contacts |Contacts |

| |middle. Lesions may | |another). This may cause the| |None. |None. |

| |appear in crops and | |appearance of a new crop of | | | |

| |persist for months. | |lesions on another part of | | | |

| |Lesions may spread to | |the body | | | |

| |other parts of the body.| | | | | |

| | | |Contact with items handled by| | | |

| | | |an infected person | | | |

| |Adults – lesions on the | | | | | |

| |lower trunk, pubic area,| | | | | |

| |and inner thighs. | | | | | |

| |Children - lesions | | | | | |

| |initially mainly on the | | | | | |

| |trunk. | | | | | |

| | | | | | | |

|DISEASE |CLINICAL FEATURES |INCUBATION PERIOD |COMMON SOURCES AND MEANS OF |RISK OF FURTHER SPREAD |MANAGEMENT |EXCLUSION |

| | | |SPREAD | | | |

| | | | | | | |

|MUMPS |Fever, swelling and |12 – 25 days commonly 18|Droplet spread and direct |Infectious from 7 days before |Cases |Cases |

| |tenderness of one or |days |contact with saliva. |swelling appears to 9 days after.|Salivary testing kit to HPA Colindale|7 days after onset of swelling – 10 |

|Notifiable |both salivary glands, | | | |to confirm diagnosis. HPT will send |days if contact with unvaccinated |

| |orchitis (20-30% adult | | | |kit to GP on notification, |population e.g. babies. |

|Leaflet available |males), oophoritis (5% | | | |Basic principles. | |

| |adult females) | | | | | |

| | | | | |Contacts |Contacts |

| | | | | |None. |None. |

| | | | | | | |

|POLIOMYELITIS |Fever, malaise, |3 – 35 days, commonly |Faecal-oral spread, close |High in the few days before and |Discuss cases and contacts with HPT |Discuss cases and contacts with HPT |

| |headache, nausea, |7 – 14 days |contact with pharyngeal |after onset of symptoms. Can be| | |

|Notifiable |vomiting, muscle pain | |secretions |transmitted as long as virus | | |

| |and stiffness and sudden| | |present in stools and nasopharynx| | |

| |onset flaccid paralysis | | | | | |

| | | | | | | |

|URGENTLY NOTIFY TO HPT | | | | | | |

| | | | | | | |

|RINGWORM |Fungal infection. Flat, |4 - 10 days. |Direct and indirect contact |Fairly high as fungus survives |Cases |Cases |

|(Body) |spreading ring shaped | |with lesions of infected |for long periods of time. |Complete treatment. |Avoid skin to skin contact e.g. close|

| |lesions | |people and animals | |Basic principles. |contact sports, swimming pools, etc |

| | | | | | |until treatment complete. |

| | | | | | | |

| | | | | | |Contacts |

| | | | | |Contacts |None. |

| | | | | |None. | |

| | | | | | | |

|DISEASE |CLINICAL FEATURES |INCUBATION PERIOD |COMMON SOURCES AND MEANS OF |RISK OF FURTHER SPREAD |MANAGEMENT |EXCLUSION |

| | | |SPREAD | | | |

| | | | | | |Discuss with HPT |

|RUBELLA |A mild prodrome of |14 – 23 days, |Droplets spread or direct |High in closed environments and |Cases |Cases |

| |malaise and fever 1-2 |commonly |contact with respiratory |from infants with CRS. From 1 |If pregnant see GP urgently. |4 days from onset of rash. |

|Notifiable |days prior to |16 – 18 days |secretions. Virus also |week before to 4 days after onset|Salivary testing kit to HPA | |

| |appearance of rash | |found in urine of infants |of rash. |Colindale to confirm diagnosis. | |

| |(especially adults) | |with Congenital Rubella | | | |

| |Diffuse maculopapular | |Syndrome (CRS) but is not | |Contacts | |

| |rash (resembling | |generally a source of | |If pregnant see GP urgently. | |

| |measles or scarlet | |infection | |PHLS (2002) |Contacts |

| |fever), | | | | |None. |

| |lymph-adenopathy (may | | | | | |

| |be generalised), | | | | | |

| |arthropathy | | | | | |

| |(especially adult | | | | | |

| |women) | | | | | |

| | | | | | | |

| |Intense itching, |2 – 6 weeks before onset of |Prolonged direct skin to skin|The risk of further spread is |Cases |Cases |

|SCABIES |particularly at night.|itching if not previously |contact. Sexual contact |more likely among families and |Treatment should be reapplied |Until treatment is complete. |

| |Rash will be present |exposed. |. |intimate contacts. |within 4 - 7 days. | |

| |on the fingers, | | |Individuals with poor immunity | | |

|Leaflet available |elbows, knees, ankles |1 – 4 days after re-exposure | |are susceptible |Contacts |Contacts |

| |waist, under the | | | |Only household and close personal |None. |

| |breast and the genital| | |Bedding and clothing are not |contacts need to be treated. | |

| |area. | | |considered a major risk of | | |

| | | | |transmission |Please refer to | |

| | | | | |NHS Grampian Scabies Policy (2003)|If outbreak suspected discuss with HPT |

| | | | | | | |

| | | | | | | |

|DISEASE |CLINICAL FEATURES |INCUBATION PERIOD |COMMON SOURCES AND MEANS OF |RISK OF FURTHER SPREAD |MANAGEMENT |EXCLUSION |

| | | |SPREAD | | | |

| | | | | | | |

|STREPTOCOCCAL INFECTION |Group A Strep | |Airborne, droplet spread or |If untreated, for |Cases |Cases |

| |Causes wide range of | |direct contact with |10 – 21 days. |Treatment with appropriate antibiotic|Until 48 hours after start of |

|Erysipelas Notifiable |infections including: | |respiratory secretions. |If treated with an appropriate | |antibiotics. |

| |Sore throat | | |antibiotic –for 48 hours. |Contacts | |

|Scarlet Fever Notifiable |Impetigo | | | |None. |Contacts |

| |Erysipelas |1 – 4 | | | |None. |

|Leaflet available for Scarlet |Scarlet Fever |days, | | | | |

|Fever | |rarely | | | | |

| | |longer | | | | |

|REPORT CASES OF INVASIVE GROUP A |iGAS | | | | | |

|STREPTOCOCCUS (iGAS) to HPT |Toxic Shock Syndrome | | |Increased risk of sporadic iGAS |Cases | |

| |Necrotising faciitis | | |aged 65+ |Treatment with appropriate antibiotic|Cases |

|(HPA, 2004) |Bacteraemia | | |recent Varicella infection | |Until 48 hours after start of |

| |Focal infections e.g. | | |HIV +ve |Contacts |antibiotics. |

| |meningitis, pneumonia, | | |diabetes |Discuss contacts with HPT. | |

| |peritonitis, puerperal | | |heart disease |Close contacts may require antibiotic|Contacts |

| |sepsis, septic arthritis | | |cancer |chemoprophylaxis. |None. |

| |etc. | | |high dose steroids | | |

| | | | |IV drugs |(HPA, 2004) | |

| |GBS can cause | | | | | |

| |neonatal meningitis and/or| | |(HPA, 2004) | | |

| |septicaemia | | | | | |

| | | | | | | |

|Group B Streptococcus | | | | |Cases | |

|(GBS) | | |Asymptomatic GBS carriage is |Intra partum antibiotic treatment|Treatment with an appropriate | |

| | | |common in pregnant women. |of women colonised with GBS |antibiotic | |

| | | |Neonates acquire the disease |appears to reduce neonatal | | |

| | |Early onset: 0 – 6 days.|as they pass through the |infection. | |Cases |

| | |90% of cases < 24hours |birth canal. | |Contacts |Until 48 hours after start of |

| | | |Horizontal transmission from | |None |antibiotics. |

| | |Late onset: |mother | | | |

| | |1 – 12 weeks, more |Healthcare acquired | | | |

| | |commonly 3 – 4 weeks | | | |Contacts |

| | | | | | |None. |

| | | | | | | |

|DISEASE |CLINICAL FEATURES |INCUBATION PERIOD |COMMON SOURCES AND MEANS OF |RISK OF FURTHER SPREAD |MANAGEMENT |EXCLUSION |

| | | |SPREAD | | | |

| | | | | | | |

|THREADWORMS |Perianal itching, sleep |Worms lay eggs in e |Eggs are transferred to |More likely in households on |Cases |Cases |

| |disturbance |intestines, which |fingers during anal itching |hands, bedding and clothing. |Initial course of treatment to be |None. |

| | |develop into infective |then transferred into the | |repeated 2 weeks later. | |

| | |embryos within 6 hrs |mouth on the hands. | | | |

| | | | | |Contacts | |

| | | | | |Household members should be treated |Contacts |

| | | | | |at the same time. |None. |

| | | | | | | |

|TUBERCULOSIS |Persistent cough usually |4 – 12 weeks |Airborne, droplet spread |Low risk of spread but more |Discuss with HPT | |

|(Pulmonary) |with sputum. Sometimes |but can reactivate years|following inhalation of |likely in household and close |Cases |Cases |

|i.e. Mycobacterium tuberculosis |haemoptysis, malaise, |after exposure |bacilli |contacts |Ongoing by Chest consultant and TB |Usually until 2 weeks after start|

|infection of the lung |unexplained weight loss, | | | |Specialist Nurse (HPT) for a minimum |of treatment regime. |

| |fever/night sweats | | | |of 6 months. |MDRTB – Discuss with CPHM |

|Notifiable | | | | | | |

| | | | | |Contacts | |

|Leaflet available | | | | |TB Specialist nurse will identify at | |

| | | | | |risk contacts and screen as |Contacts |

| | | | | |appropriate. |None. |

| | | | | |Discuss with HPT | |

|TUBERCULOSIS (Non-Pulmonary) |Dependant on site of TB. |4 – 12 weeks but can |Airborne, droplet spread |Not infectious |Cases |Cases |

|i.e. Mycobacterium tuberculosis |Usually includes |reactivate years after |following inhalation of | |Ongoing by Chest consultant and TB |None. |

|not infecting the lung |unexplained weight loss, |exposure |bacilli | |Specialist Nurse (HPT) for a minimum | |

| |malaise and fever/night | | | |of 6 months | |

|Notifiable |sweats. | | | | | |

| | | | | |Contacts | |

|Leaflet available | | | | |None unless case is a child – |Contacts |

| | | | | |screening may be undertaken to |None. |

| | | | | |identify source. | |

| | | | | | | |

|DISEASE |CLINICAL FEATURES |INCUBATION PERIOD |COMMON SOURCES AND MEANS OF |RISK OF FURTHER SPREAD |MANAGEMENT |EXCLUSION |

| | | |SPREAD | | | |

| | | | | | | |

|Environmental |Dependant on site of TB. |4 – 12 weeks but can |Usually through water or |Not infectious |Cases |Cases |

|(atypical) |May include unexplained |reactivate years after |soil. | |Ongoing by Chest consultant and TB |None. |

|TUBERCULOSIS |weight loss, malaise and |exposure | | |Specialist Nurse (HPT) for a minimum | |

| |fever/night sweats. | | | |of 6 months | |

|i.e. infection with Mycobacterium| | | | | | |

|other than TB | | | | |Contacts | |

| | | | | |None. |Contacts |

| | | | | | |None. |

| | | | | | | |

|WARTS |Many different types of |1 – 20 months, usually 2|Direct contact. Contact |Increased risk of spread in |Cases |Cases |

| |wart. Generally a |– 3 months. |with contaminated items such |immunosuppressed individuals. |Plantar warts should be covered when |None. |

| |raised, rough textured | |as razors, floors etc have | |swimming etc. Basic principles. | |

| |papule, sometimes in | |been implicated. | | | |

| |clusters. May persist for | |Some types can be transmitted| |Contacts |Contacts |

| |months or years. | |sexually. | |None |None. |

| | | | | | | |

|WHOOPING COUGH |Insidious onset cough |6 – 20 days, |Airborne/droplet spread and |High in period before onset of |Discuss with HPT |Discuss with HPT |

|(Pertussis) |becoming paroxysmal. |commonly |direct contact with |paroxysmal cough. After this, |Cases |Cases |

| |Cough following by high |7 – 10 days |respiratory secretions |communicability decreases to |7 day course of antibiotics |5 days after starting treatment. |

|Notifiable |pitched inspiratory | | |negligible risk by 3 weeks. | | |

| |“whoop” and/or vomiting. | | | | |Contacts |

| | | | | |Contacts |Depends on vaccination status. |

| | | | | |None. |May require 7-day course of |

| | | | | | |antibiotics. |

| | | | | | | |

| | | | | | |Dodhia et al (2002) |

References

Natasha S. Crowcroft, C.E. Roth, Bernard J. Cohen & Elizabeth Miller. Guidance for control of Parvovirus B19 infection in healthcare settings and the community. J Pub Health Med 1999; 21 (4): 439-446

H.Dodhia, N.S.Crowcroft, J.C.Bramley & E.Millar. UK guidelines for use of erythromycin chemoprophylaxis in persons exposed to pertussis.

J Pub Health Med 2002; 24 (3): 200-206

HPA Interim guidelines for the management of close community contacts of invasive group A streptococcal disease. (.uk)

Commun Dis Public Health 2004; 7 (4); 354-61

Immunisation Against Infectious Diseases 1996 “The Green Book” Updated chapters found at .uk

PHLS Preventing person-to-person spread following gastrointestinal infections: guidelines for public health physicians and environmental health officers. (.uk) Commun Dis Public Health 2004; 7 (4): 362-384

PHLS Guidelines on the management of, and exposure to, rash illness in pregnancy (including consideration of relevant antibody screening programmes in pregnancy). (.uk) Commun Dis Public Health 2002; 5 (1): 59–71

SEHD Varicella Immunisation for Healthcare Workers. SEHD/CMO (2004) 2

-----------------------

HEALTH PROTECTION TEAM

PUBLIC HEALTH UNIT

EXCLUSION POLICIES

FOR INFECTIOUS DISEASES

NOVEMBER 2005

Issued by the Health Protection Team

NHS Grampian

Summerfield House

2 Eday Road

Aberdeen AB15 6RE

01224 558520 Fax 01225 558566

Email: grampian.healthprotection@

Website:

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