Notifiable diseases
We have attempted to summarise the new situation, as it has applied in England since 6 April, on this page. This should not be considered definitive, and may include errors. The the list at the PHE web site should be consulted, or the following definitive documents are available:
- Health Protection (Part 2A orders) Regulations
- Health Protection (Notification) Regulations
- Health Protection Legislation (England) Guidance from Department of Health, Health Protection Agency, and Chartered Institute of Environmental Health[1]
Note that the usual rules on confidentiality are over-ridden by these Regulations: where a practitioner is obliged to notify a disease, they are not subject to the normal restrictions on maintaining patient confidentiality for the purposes of the notification.
Notifiable diseases, with explanatory notes and guidance on the need for urgent notification
Time frame and process for notifications
The registered medical practitioner (RMP) should send a written notification to the proper officer of the local authority so that it is received within three days, beginning with the day on which the RMP forms the clinical suspicion or makes the clinical diagnosis.
However, if the RMP considers the case requires urgent notification, they need to notify it orally – usually by telephone – as soon as reasonably practicable and follow this up with written notification within three days. It is recommended that urgent notifications are made as soon as possible after the RMP forms the clinical suspicion or makes the clinical diagnosis, and always within 24 hours.
Guidance on the procedures for notification, and a notification form, are available on the PHE web site. (Notifiers may modify the form to suit their requirements. Some HPUs have altered the form for local use; other RMPs can alter the form if they choose (e.g. to create a template containing their details), but the amended form must continue to include all the fields on the official form.
There is an aspiration that GPs should be able to notify electronically, so that their computer systems automatically recognise a diagnosis of a notifiable disease, and automatically notify it to the proper officer. This will require considerable development work.
According to the guidance:
"Written notifications to the proper officer of the local authority are either paper-based or, if the receiving local authority consents and facilities are available, may be made electronically by secure online reporting, by secure e-mail or by secure fax.
"The details of notification arrangements will usually be available on the local authority’s website. The local authority may indicate its consent to receiving electronic notification on their website."[2]
Data to be included
According to the guidance, the following data must have been included (to the best of the RMP's knowledge) for each case notified:[3]
- name, date of birth and sex;
- home address including postcode;
- contact telephone number;
- current residence (if it is not the home address);
- NHS number;
- occupation (if the RMP considers it relevant);
- name, address and postcode of place of work or educational establishment (if the RMP considers it relevant);
- ethnicity;
- relevant overseas travel history;
- contact details of a parent (if the patient is a child);
- disease or infection which the patient has or is suspected of having or the nature of the patient’s contamination or suspected contamination;
- date of onset of symptoms; and
- date of diagnosis; and
- the name, address and telephone number of the RMP making the notification.
Table 1: Notifiable diseases, with explanatory notes and guidance on the need for urgent notification
Disease | Definition / comment | Likely to be urgent? |
---|---|---|
Acute encephalitis | Viral and bacterial | Yes, if suspected bacterial infection |
Acute poliomyelitis | Yes | |
Acute infectious hepatitis | Close contacts of acute hepatitis A and hepatitis B cases need rapid prophylaxis. Urgent notification will facilitate prompt laboratory testing. Hepatitis C cases known to be acute need to be followed up rapidly as this may signify recent transmission from a source that could be controlled. | Yes |
Anthrax | Yes | |
Botulism | Yes | |
Brucellosis | No – unless thought to be UK-acquired | |
Cholera | Yes | |
Diphtheria | Yes | |
Enteric fever (typhoid fever or paratyphoid fever) | Clinical diagnosis of a case before microbiological confirmation (e.g. case with fever, constipation, rose spots and travel history) would be an appropriate trigger for initial public health measures, such as exclusion of cases and contacts in high risk groups (e.g. food handlers). | Yes |
Food poisoning | Any disease of infectious or toxic nature caused by, or thought to be caused by consumption of food or water (definition of the Advisory Committee on the Microbiological Safety of Food). | Clusters and outbreaks, yes. For specific organisms see Table 2 |
Haemolytic uraemic syndrome (HUS) | Yes | |
Infectious bloody diarrhoea | See also HUS in Table 1 (Schedule 1) and VTEC in Table 2 (Schedule 2). | Yes |
Invasive group A streptococcal disease and scarlet fever | Yes, if IGAS. No, if scarlet fever | |
Legionnaires’ Disease | Yes | |
Leprosy | No | |
Malaria | No, unless thought to be UK-acquired | |
Measles | Yes | |
Meningococcal septicaemia | Yes | |
Mumps | Post-exposure immunization (MMR or HNIG) does not provide protection for contacts. | No |
Plague | Yes | |
Rabies | A person bitten by a suspected rabid animal should be reported and managed urgently, but if a patient is diagnosed with symptoms of rabies, they will not pose a risk to human health. | Yes |
Rubella | Post-exposure immunisation (MMR or HNIG) does not provide protection for contacts. | No |
SARS | Yes | |
Smallpox | yes | |
Tetanus | No, unless associated with injecting drug use | |
Tuberculosis | No, unless healthcare worker or suspected cluster or multi drug resistance | |
Typhus | No | |
Viral haemorrhagic fever (VHF) | Yes | |
Whooping cough (Pertussis) | Yes, if diagnosed during acute phase | |
Yellow fever | No, unless thought to be UK-acquired |
NB: RMPs are also required to notify suspected cases of other infections (“other relevant infection”) or contamination (“relevant contamination”) that present, or could present, significant harm to human health - see Health Protection Legislation (England) Guidance sections 3.2 and 3.3
Causative agents, with explanatory notes and guidance on the need for urgent notification
As regards urgency, the key consideration will be the likelihood that an intervention is needed to protect human health and the urgency of such an intervention. The likelihood of the diagnosis of an infection being considered urgent may also increase if it is part of a known or suspected cluster, or in someone with increased risk of transmission such as enteric infection in a food handler.
NB: The table below is only for guidance and each case should be considered individually.
Table 2: Causative agents, with explanatory notes and guidance on the need for urgent notification
Notifiable organism | Definition / comment | Likely to be urgent? |
---|---|---|
Bacillus anthracis | Yes | |
Bacillus cereus | Only if associated with food poisoning | No, unless part of a known cluster |
Bordetella pertussis | Yes if diagnosed during acute phase | |
Borrelia spp | No | |
Brucella spp | No, unless thought to be UK-acquired | |
Burkholderia mallei | Yes | |
Burkholderia pseudomallei | Yes | |
Campylobacter spp | No, unless part of a known cluster | |
Chikungunya virus | No, unless thought to be UK-acquired | |
Chlamydophila psittaci | Yes if diagnosed during acute phase or part of a known cluster | |
Clostridium botulinum | Yes | |
Clostridium perfringens | Only if associated with food poisoning | No, unless known to be part of a cluster |
Clostridium tetani | No, unless associated with injecting drug use | |
Corynebacterium diphtheriae | Notify without delay, before results of toxigenicity tests are known | Yes |
Corynebacterium ulcerans | Notify without delay, before results of toxigenicity tests are known | Yes |
Coxiella burnetii | Yes if diagnosed during acute phase or part of a known cluster | |
Crimean-Congo haemorrhagic fever virus | Yes | |
Cryptosporidium spp | No, unless part of known cluster, known food handler or evidence of increase above expected numbers | |
Dengue virus | No, unless thought to be UK-acquired | |
Ebola virus | Yes | |
Entamoeba histolytica | No, unless known to be part of a cluster or known food handler | |
Francisella tularensis | Yes | |
Giardia lamblia | No, unless part of known cluster, known food handler or evidence of increase above expected numbers | |
Guanarito virus | Yes | |
Haemophilus influenzae | Invasive i.e. from blood, cerebrospinal fluid or other normally sterile site | Yes |
Hanta virus | No, unless thought to be UK-acquired | |
Hepatitis A, B, C, delta, and E viruses | All acute and chronic cases | All acute cases and any chronic cases who might represent a high risk to others, such as healthcare workers who perform exposure-prone procedures |
Influenza virus | No, unless known to be a new sub-type of the virus or associated with known cluster or closed communities such as care homes | |
Junin virus | Yes | |
Kyasanur Forest disease virus | Yes | |
Lassa virus | Yes | |
Legionella spp | Yes | |
Leptospira interrogans | No | |
Listeria monocytogenes | Yes | |
Machupo virus | Yes | |
Marburg virus | Yes | |
Measles virus | Yes | |
Mumps virus | No | |
Mycobacterium tuberculosis complex | No, unless healthcare worker or suspected cluster or multi-drug resistance | |
Neisseria meningitidis | Excluding asymptomatic cases (e.g. throat carriage) | Yes |
Omsk haemorrhagic fever virus | Yes | |
Plasmodium falciparum, vivax, ovale, malariae, knowlesi | No, unless thought to be UK-acquired | |
Polio virus | Wild or vaccine types | Yes |
Rabies virus | Classical rabies and rabies-related lyssaviruses | Yes |
Rickettsia spp | No, unless thought to be UK-acquired | |
Rift Valley fever virus | Yes | |
Rubella virus | No | |
Sabia virus | Yes | |
Salmonella spp | Including S. Typhi and S. Paratyphi | Yes, if S. Typhi or S. Paratyphi or suspected outbreak or food handler or closed communities such as care homes No, if sporadic case of other Salmonella species |
SARS coronavirus | Yes | |
Shigella spp | Yes, except Sh. sonnei unless suspected outbreak or food handler or closed communities such as care homes | |
Streptococcus pneumoniae | Invasive i.e. from blood, cerebrospinal fluid or other normally sterile site | No, unless part of a known cluster |
Streptococcus pyogenes | Invasive i.e. from blood, cerebrospinal fluid or other normally sterile site, or associated with necrotising soft tissue infection | Yes |
Varicella zoster virus | No | |
Variola virus | Yes | |
Verocytotoxigenic Escherichia coli | Including E. coli O157 | Yes |
Vibrio cholerae | Yes | |
West Nile virus | No, unless thought to be UK-acquired | |
Yellow fever virus | No, unless thought to be UK-acquired | |
Yersinia pestis | Yes | |
Zika virus | No, unless thought to be UK-acquired |
Notification for under 8s day care and childminding
Ofsted should be notified of any food poisoning affecting two or more children looked after on the premises, any child having meningitis or the outbreak on the premises of any notifiable disease identified as such in the Public Health (Control of Disease) Act 1984 or because the notification requirement has been applied to them by regulations (the relevant regulations are the Public Health (Infectious Diseases) Regulations 1988). - SureStart National Standards paragraph 7.12 (Sick Children)
According to the HPA website, national standards for childminders and day care organisations for children aged under 8 now require childminders to inform OFSTED of any child with a notifiable disease.[4]
History of disease notification
History of disease notification in England
Notification was first made mandatory (London 1891, rest of England 1899) the responsibility for notification fell both on the head of household - (or nearest relative - or person in charge of the building), as well as the attending phyisician. This situation existed right up until 1968, when it became sole responsibility of the attending physician
Please see Notifiable diseases in 1984 Public Health Act for the situation as it applied in the UK until 6 April, and as it may still apply in Scotland, Wales, and Northern Ireland since that date.
History of disease notification elsewhere
Template:Sweden According to this ProMED report,<refsec>ProMED-mail. MEASLES UPDATE (09). 20130303.1568573: ProMED-mail, Updated 3 March; Accessed: (3 March)</refsec> "Swedes are required by law to report falling ill to their doctor." It is not clear from the report which illnesses need to be reported, or how "illness" is defined.
External links
- Health Protection (LA powers) Regulations
- Health Protection (Part 2A orders) Regulations
- Health Protection (Notification) Regulations
- Health Protection Legislation (England) Guidance from Department of Health, Health Protection Agency, and Chartered Institute of Environmental Health[5]
- "Notifications of Infectious Diseases (NOIDs)" page from Public Health England
References
- ↑ Department of Health, Health Protection Agency, Chartered Institute of Environmental Health. Health Protection Legislation (England) Guidance. London: Department of Health, Health Protection Agency, and Chartered Institute of Environmental Health, (25 March); 1-113
- ↑ Department of Health, Health Protection Agency, Chartered Institute of Environmental Health. Health Protection Legislation (England) Guidance. London: Department of Health, Health Protection Agency, and Chartered Institute of Environmental Health, (25 March); S3.7.2, p21
- ↑ Department of Health, Health Protection Agency, Chartered Institute of Environmental Health. Health Protection Legislation (England) Guidance. London: Department of Health, Health Protection Agency, and Chartered Institute of Environmental Health, (25 March); S3.7.3, p22-4
- ↑ SureStart. National standards for under 8s day care and childminding: Addendum. Nottingham: Department for Education and Skills, Department for Work and Pensions
- ↑ Department of Health, Health Protection Agency, Chartered Institute of Environmental Health. Health Protection Legislation (England) Guidance. London: Department of Health, Health Protection Agency, and Chartered Institute of Environmental Health, (25 March); 1-113