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); ARHAI 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 ARHAI Scotland 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.

Please note that ARHAI Scotland are currently updating the ‘Transmission Based Precautions Definitions’ literature review inclusive of a reassessment of the evidence underpinning contact/droplet/airborne transmission routes.  Appendix 11 and A-Z pathogens will be updated accordingly.

 

 

 

 

A

Acinetobacter baumannii

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.

Currently, there is no incubation period, period of infectivity or exclusion period identified for Acinetobacter baumannii in any high-level source.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : No

Disease : Acinetobacter baumannii infection or colonisation

On the Mandatory NHSScotland Alert organism/Condition list : Yes

*In relation to high risk units e.g. ICU/PICU/NICU and high risk patient cohorts e.g. oncology/haematology patient cohorts regardless of location.

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact

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

Guidance and supporting materials

UK

• Guidance: Acinetobacter species, (PHE)

International

• About Acinetobacter, (CDC)
• Rapid risk assessment: Carbapenem-resistant Acinetobacter baumannii in healthcare settings, (ECDC)
• Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities, (WHO)
• Infectious Diseases Society of America 2023 Guidance on the Treatment of Antimicrobial Resistant Gram-Negative Infections 

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, fever, sore throat, bronchitis, pneumonia, gastroenteritis and conjunctivitis. Less commonly, bladder inflammation/infection and conditions that affect the brain and spinal cord may occur.

Adenovirus infection can occur in any age group, but infants and immunocompromised individuals are more likely than others to develop severe illness from adenoviruses.

Incubation Period :

For respiratory infection this is 2 to 14 days, with symptoms usually lasting 3 to 5 days.

For Adenoviral conjunctivitis this is from 4 to 12 days, with symptoms lasting 4 to 6 weeks.

For gastroenteritis by adenovirus it is between 3 to 10 days.

Exclusion Period :

Exclusion period: 24 hours from last episode of diarrhoea.

Adenoviral conjunctivitis: Since people with adenoviral conjunctivitis remain infectious for 2 weeks after symptom onset, those working in patient-facing roles in health and social care settings should avoid close contact with others during this period.

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.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : No

Disease : Adenoviral conjunctivitis

On the Mandatory NHSScotland Alert organism/Condition list : Yes

*In relation to In-patient neonatal care settings

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact

Guidance and supporting materials

UK

• Clinical Management Guidelines. Conjunctivitis (viral, non-herpetic), (The College of Optometrists)

Disease : Upper +/- lower respiratory tract infection

On the Mandatory NHSScotland Alert organism/Condition list : Yes

*In relation to high risk units e.g. ICU/PICU/NICU and high risk patient cohorts e.g. oncology/haematology patient cohorts regardless of location.

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact / Droplet

Guidance and supporting materials

International

• Guidelines for Preventing Health-Care-Associated Pneumonia, 2003, (Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee)

Disease : Gastrointestinal infection

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact (faecal/oral)

Guidance and supporting materials

International

• About Adenovirus, (CDC)

Anthrax

See Bacillus anthracis

Aspergillus spp

Aspergillus spp. is 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.

Period of Infectivity :

Aspergillosis is not contagious and does not spread from person to person.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : No

Disease : Invasive Pulmonary Aspergillosis

On the Mandatory NHSScotland Alert organism/Condition list : Yes

*In relation to High risk units e.g. ICU/PICU/NICU, oncology/haematology, transplant patients regardless of location.

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Airborne

Guidance and supporting materials

UK

• Construction micro-organisms: Aspergillus during demolition and refurbishment, (HSE).

International

• Aspergillosis guidance, (Health Protection Surveillance Centre, Ireland)
• Clinical overview of Aspergillosis, (CDC)

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B

Bacillus anthracis

Bacillus anthracis is a gram-positive, rod-shaped bacteria causing the infectious disease anthrax, which is usually a disease of herbivorous mammals. 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 (pulmonary) 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.

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.

• Gastrointestinal anthrax can occur through ingestion of spores and leads to severe gastrointestinal disease with nausea, vomiting, anorexia and fever leading to shock, collapse and death.
• Cutaneous anthrax (>90% cases) can occur when workers who handle contaminated animal products get spores in a cut or scrape on their skin.

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 centimetre 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.

• Injection anthrax is a novel form of infection seen in heroin users and most likely contracted from using heroin contaminated with anthrax spores.

Symptoms are 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.

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

 

Incubation Period :

• Inhalation (Pulmonary): 1 to 7 days (rarely up to 2 months)
• Gastrointestinal: 1 to 7 days
• Cutaneous: 1 to 7 days (usually 48 hours)
• Injection: 1 to 4 days after exposure

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

Disease : Anthrax

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : Yes

Main route of transmission :

Contact

Guidance and supporting materials

Scottish

• Guidelines for the public health management of tetanus, botulism or anthrax among people who use drugs, (HPS)

UK

• Anthrax: Guidance, data and analysis, (PHE)
• Anthrax: the green book, chapter 13, (UKHSA)
• Construction micro-organisms: Anthrax from contaminated land and buildings, (HSE)

International

• Guidelines for the Prevention and Treatment of Anthrax, 2023, (CDC) 

 

Bacillus cereus

Bacillus cereus is an aerobic, gram-positive, rod-shaped, spore-forming bacterium that is widely distributed in the natural environment.

It is a frequently recognised cause of toxin-induced acute gastroenteritis, symptoms often include abdominal pain, nausea, vomiting and diarrhoea.  However this genus may also cause sepsis, pneumonia, endocarditis, central nervous system (CNS) and ocular infections.

Bacillus cereus is known to cause bacteraemia in immunocompromised individuals.

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 :

Emetic syndrome - average 2-3 hours (range 1-6) hours

Diarrhoeal syndrome - 8-12 hours (range 6-24 hours)

Exclusion Period :

Whilst symptomatic and 48 hours after cessation of symptoms.

Period of Infectivity :

Not applicable as no risk of person-to-person spread.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

Disease : Gastroenteritis

On the Mandatory NHSScotland Alert organism/Condition list : No

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact / Foodborne

Guidance and supporting materials

UK

• Bacillus: guidance for the management of cases of Bacillus cereus, (PHE)
• Recommendations for the Public Health Management of Gastrointestinal Infections 2019. Principles and practice, (PHE, Chartered Institute of Environmental Health, Food Standards Agency)

 

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 itching 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 individuals 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 and 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 to 2 weeks after being laid

Exclusion Period :

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

Period of Infectivity :

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

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : No

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

On the Mandatory NHSScotland Alert organism/Condition list : No

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact

Guidance and supporting materials

UK

• Pubic and body lice, (Patient website)

International

• About body lice, (CDC)
• Lice (Phthiraptera) - Factsheet for health professionals, (ECDC)

Bordetella pertussis

Pertussis is caused by the bacterium Bordetella pertussis.

The initial symptoms (catarrhal stage) include: runny nose, fever, cough and apnoea (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 to 21 days

Exclusion Period :

2 days from starting antibiotic treatment, or 21 days from onset of symptoms if no antibiotic treatment given

Period of Infectivity :

Pertussis is highly communicable. Individuals with pertussis are most infectious during the catarrhal period and the first 3 weeks after cough onset. Antibiotic therapy will shorten the period of infectivity.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

Disease : Pertussis/Whooping Cough

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : Yes

Main route of transmission :

Droplet

Guidance and supporting materials

Scottish

• Guidelines for the Public Health Management of Pertussis, (SHPN, PHS) 
• Whooping cough, (NHS Inform)

UK

• Pertussis: the green book, Chapter 24, (UKHSA)
• Pertussis guidance, data and analysis, (UKHSA)
• Pertussis: occupational vaccination of healthcare workers, (UKHSA) 
• Whooping cough, (NICE) 

Borrelia burgdorferi

Lyme borreliosis or Lyme disease is a zoonotic infection caused by the bacterium Borrelia burgdorferi and is transmitted to humans through the bite of an infected tick.

Ticks are small spider-like creatures that are found on bushes and undergrowth in countryside, parks and gardens.  They feed on the blood of birds and mammals, including humans.  If a tick bites an animal carrying Borrelia burgdorferi, the tick can also become infected and then transfer the bacteria to a human by biting them. 

Most tick bites do not transmit Lyme disease and prompt, correct removal of the tick reduces the risk of transmission.  There is no evidence of transmission between humans.

Many people with early-stage Lyme disease develop a distinctive circular rash (known as erythema migrans) at the site of the tick bite, usually around 3 to 30 days after being bitten.  Some people also experience flu-like symptoms such as fatigue, muscle pain, joint pain, headaches, fever, chills and swollen lymph nodes may occur in the absence of rash.

Late-stage disease can develop months or even years later if Lyme disease is left untreated or if treatment is delayed.  Presentations may include inflammatory arthritis, nerve problems (numbness, limb pain, facial palsy and memory problems), cardiac problems, encephalitis and meningitis.  A small number of people develop long-term health problems similar to fibromyalgia or chronic fatigue syndrome.

Lyme disease is treated with antibiotics however there is no clear consensus on the best treatment for the long-term health problems that some people develop.  There is currently no vaccine available for prevention.

Incubation Period :

3 to 30 days

Exclusion Period :

Not transmissible from person to person.

Period of Infectivity :

Not transmissible from person to person.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

Disease : Lyme borreliosis or Lyme disease

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

• Zoonotic, not transmitted by humans

Guidance and supporting materials

Scottish

• Identification and Management of Lyme Disease – Educational Resources, (Scottish Government)
• Lyme disease, (NHS Inform) 
• Tick bites, (NHS Inform)
• Lyme disease, (PHS)

UK

• Lyme disease (NG95), (NICE)
• Lyme disease: Resources and guidance, (UKHSA)

International

• Lyme disease, (CDC)

Burkholderia spp.

Burkholderia is a genus of Pseudomonadota whose pathogenic members include:

• Burkholderia cepacia complex, an opportunistic pathogen in hospital settings
• Burkholderia pseudomallei, causative agent of melioidosis
• Burkholderia cepacia, an important pathogen of pulmonary infections in people with cystic fibrosis (CF)

Burkholderia cepacia complex is a group of Gram-negative bacteria commonly found in soil and water. 

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

Contaminated products such as ultrasound gel have been associated with outbreaks of infection in various settings worldwide and risk of contamination of non-sterile ultrasound gel has been highlighted. A decision tree is available within the UKHSA guidance that can assist in indicating which gel to use in various clinical situations.

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 person-to-person contact, direct/indirect contact with contaminated surfaces and exposure to B. cepacia in the environment.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : No

Disease : Burkholderia cepacia complex

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact

Guidance and supporting materials

UK

• The Burkholderia cepacia complex. Suggestions for Prevention and Infection Control,  (The UK Cystic Fibrosis Trust Infection Control Group)
• Guidance: Good infection prevention practice: using ultrasound gel, (UKHSA)

International

• About Burkholderia cepacia complex, (CDC) 

 

 

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C

Campylobacter

Campylobacter are a 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 which is a very rare and serious condition affecting the nerves causing problems such as numbness, weakness and pain in the feet, hands and limbs. Most people will make a full recovery eventually, although occasionally it can be life-threatening and leave some people with long-term problems.

Incubation Period :

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

Exclusion Period :

Whilst symptomatic and 48 hours after cessation of symptoms.

Period of Infectivity :

Cases are considered infectious whilst symptomatic.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

Disease : Campylobacter Gastroenteritis

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact / Foodborne

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

Guidance and supporting materials

Scottish

• Care Home IPC resource for gastro-intestinal illness, (ARHAI)
• Campylobacter, (Food Standards Scotland)

UK

• Campylobacter guidance, data and analysis, (PHE)
• Recommendations for the Public Health Management of Gastrointestinal Infections 2019. Principles and practice, (PHE, Chartered Institute of Environmental Health, Food Standards Agency)

 

 

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 high dependency or intensive care settings. Those with severe underlying co-morbidities and immunosuppression, including those with diabetes, chronic kidney disease, malignancies and Human Immunodeficiency Virus (HIV) are most at-risk.

Exclusion Period :

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

Period of Infectivity :

While colonised or infected.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : No

Disease : Candida auris infection or colonisation

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact

Guidance and supporting materials

Scottish

• Guidance for the laboratory investigation, management and infection prevention and control for cases of Candida auris, (SHPN, PHS)

UK

• Candida auris infection control in community care settings, (PHE)

International

• Rapid Risk Assessment. Candida auris in healthcare settings - Europe, (ECDC)
• Infection Control Guidance: Candida auris, (CDC)

Carbapenemase producing Enterobacterales (CPE)

Enterobacterales 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 Enterobacterales 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 Enterobacterales (CPE) are a type of Enterobacterales 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.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

Disease : Carbapenemase-producing Enterobacterales infection or colonisation

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact

Guidance and supporting materials

Scottish

• CPE information leaflets for healthcare workers, patients and family, (HPS)
• Patient Screening for Carbapenemase Producing Enterobacteriaceae (CPE) - Leaflets for Healthcare Workers and Patients, (HPS)
• Toolkit for the early detection, management and control of carbapenemase-producing Enterobacteriaceae in Scottish Acute Settings, (ARHAI)
• Toolkit for managing carbapenemase-producing Enterobacteriaceae (CPE) in Scottish non-acute care settings, (HPS)

UK

• Actions to contain carbapenemase-producing Enterobacterales, (UKHSA)

International

• Carbapenem-resistant Enterobacterales (CRE) Infection Control, (CDC) 
• Risk assessment on the spread of carbapenemase-producing Enterobacteriaceae (CPE) through patient transfer between healthcare facilities, with special emphasis on cross-border transfer, (ECDC)
• Rapid risk assessment: Carbapenem-resistant Enterobacteriaceae - second update, (ECDC)

Chickenpox

See Varicella virus

Chlamydia pneumoniae

Chlamydia pneumoniae (also known as Chlamydophila pneumoniae) is a gram negative bacterium that is a 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 to 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.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : No

Disease : Chlamydia pneumoniae pneumonia

On the Mandatory NHSScotland Alert organism/Condition list : No

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Droplet

Guidance and supporting materials

International

• Chlamydia pneumoniae Infection, (CDC)
• Chlamydia pneumoniae Infection, (Department of Health, Victoria, Australia)
• Guidelines for diagnosis and treatment of Adults with Community-acquired Pneumonia, (American Thoracic Society and Infectious Diseases Society of America)

Clostridioides difficile

Clostridioides difficile infection (CDI) , also known as Clostridium difficile,  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.

Exclusion Period :

Isolation precautions may be discontinued when the patient has been symptom-free for 48 hrs and bowel movements have returned to normal.

Period of Infectivity :

Whilst symptomatic and as a general principle until 48 hours after cessation of symptoms. Note – some people will continue to shed spores once they are no longer symptomatic.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

Disease : Clostridioides difficile infection

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact

• 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.

Guidance and supporting materials

Scottish

• Guidance on prevention and control of Clostridioides difficile Infection (CDI) in community-based settings in Scotland. Scottish Health Protection Network Guidance, (PHS)
• Updated advice on antimicrobial management of Clostridioides difficile Infection (CDI), (SAPG)
• Care Home IPC resource for gastro-intestinal illness, (ARHAI)
• Protocol for the Scottish Surveillance Programme for Clostridium difficile Associated Disease User Manual, (ARHAI)
• Protocol for the Clostridium difficile snapshot programme, (ARHAI)
• Clostridiodes difficile infection: Information leaflet for people getting care, their visitors an anyone else in a healthcare setting, (HPS)
• Bundle for preventing cross transmission, (HPS)
• Clostridium difficile infection trigger tool, (HPS)

UK

• Clostridium difficile infection - how to deal with the problem, (PHE, DHSC)
• Recommendations for the Public Health Management of Gastrointestinal Infections 2019. Principles and practice, (PHE, Chartered Institute of Environmental Health, Food Standards Agency)

International 

• About C.diff, (CDC)

 

Clostridium tetani

Tetanus is a rare disease resulting from a neurotoxin that is produced during infection with Clostridium tetani.  C.tetani is a common environmental bacterium that forms spores that are highly resistant to extreme hot and cold temperatures.  The bacterium is present in soil and manure and usually enters the body through a wound, burn, puncture or scratch.  Tetanus is not spread from person to person.

People who inject drugs (PWID) are at increased risk of infection.

The disease is particularly serious in newborn babies and pregnant women who have not been sufficiently vaccinated with tetanus-toxoid-containing vaccines. Maternal tetanus is when tetanus occurs during pregnancy or within 6 weeks of the end of pregnancy, and tetanus within the first 28 days of life is called neonatal tetanus.

There are three forms of tetanus (generalised, localised, and cephalic) however generalised tetanus is the most common presentation.

• Generalised tetanus is characterised by lockjaw, tonic muscle contractions and spasms.  Tonic contractions and spasms may lead to dysphagia (trouble swallowing), opisthotonus (spasm of the muscles causing backwards arching of the head, neck and spine), and a rigid abdomen; in severe cases they may cause respiratory distress. 
• Localised tetanus is rigidity and spasms confined to the area around the site of the infection and may be more common in partially immunised individuals.  Localised symptoms can continue for weeks or may develop into generalised tetanus.
• Cephalic tetanus is localised tetanus after a head or neck injury, involving the muscles supplied by the cranial nerves.

Treatment includes supportive care, wound debridement, and may involve administration of antimicrobials and anti-tetanus antibodies.

Immunisation against tetanus is the most effective method of prevention and is included as part of the UK childhood immunisation schedule, with routine primary vaccination recommended at two, three, and four months of age, followed by a booster dose from age three years and four months, with a further booster at 13 to 18 years of age.

Prophylactic immunisation is recommended following injuries involving tetanus-prone wounds if routine immunisation was not received or was received more than 10 years ago.

Incubation Period :

Between 3 and 21 days (but can range from 1 day to several months).

Period of Infectivity :

Tetanus cannot be transmitted from person to person.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

Disease : Tetanus

On the Mandatory NHSScotland Alert organism/Condition list : No

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : Yes

Main route of transmission :

Contact

Guidance and supporting materials

Scottish

• Guidelines for the public health management of tetanus, botulism or anthrax among people who use drugs, (HPS)

UK

• Green book, chapter 30, (UKHSA)
• Tetanus: guidance on the management of suspected tetanus cases and on the assessment and management of tetanus-prone wounds (UKHSA)
• Tetanus: advice for people who inject drugs. A resource for clinicians to give to their patients (PHE)

International

• Chapter 21: Tetanus, Pink Book, (CDC)

 

Coronavirus

Coronaviruses are a 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.

• Information on COVID-19 can be found under SARS-CoV-2
• Information on Middle East Respiratory Syndrome (MERS-Cov)

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : No

Disease : Coronavirus infection (non-MERS, non-SARS, non-COVID-19)

On the Mandatory NHSScotland Alert organism/Condition list : No

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Droplet / Airborne

Corynebacterium diphtheriae

See Diphtheria

Corynebacterium ulcerans

See Diphtheria

COVID-19

See SARS-CoV-2

Creutzfeldt-Jakob Disease (CJD)

See Transmissible Spongiform Encephalopathies

Cryptococcus spp.

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

The most common Cryptococcus species that can cause disease in humans are C. neoformans and C. gattii (formerly C. neoformans var. gattii). Both species are found worldwide. C. gattii  was previously confined mainly to tropical and subtropical regions, but has recently emerged in temperate regions including Europe, and can cause disease in healthy individuals, albeit not commonly. C. neoformans 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. (Symptoms of C. gattii infection can appear between two and 13 months after breathing in the fungus, with an average of approximately six to seven months.)

Period of Infectivity :

The infection cannot spread between people or between people and animals.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : No

Disease : Cryptococcosis

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : 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 to 10 days, but can be as long as 28 days

Exclusion Period :

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

Period of Infectivity :

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

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

Disease : Cryptosporidiosis

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact (faecal/oral)

Guidance and supporting materials

UK

• Cryptosporidiosis: guidance, data and analysis, (UKHSA)
• Recommendations for the Public Health Management of Gastrointestinal Infections 2019. Principles and practice (PHE, Chartered Institute of Environmental Health, Food Standards Agency 2019)
• Managing cryptosporidium in swimming pools-SHPN guide to using the external guidance, (PHS)

 

 

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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, hands 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 to 5 days, with a range of 1 to 10 days

Exclusion Period :

Exclusion is essential. Family contacts must be excluded until cleared to return to daily interaction with the public, work colleagues and/or fellow pupils by your local HPT.

Period of Infectivity :

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

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

• * for toxigenic strains

Disease : Diphtheria - Pharyngeal

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : Yes

Main route of transmission :

Droplet

Disease : Diphtheria - Cutaneous

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : Yes

Main route of transmission :

Contact

Guidance and supporting materials

UK

• Diphtheria - the Green book, (UKHSA)
• Diphtheria: public health control and management in England, (UKHSA)
• Infectious diseases in asylum seekers: actions for health professionals, (UKHSA)

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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 Picornaviridae family of viruses.

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

Exclusion Period :

Transmission based precautions should continue whilst they remain symptomatic and/or are considered infectious and the door must remain closed.

Period of Infectivity :

While symptomatic (has been reported up to 21 days)

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : No

Disease : Acute flaccid myelitis (AFM)

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Droplet

Disease : Severe respiratory illness

On the Mandatory NHSScotland Alert organism/Condition list : No

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Droplet

Guidance and supporting materials

UK

• Guidance on the diagnosis, management and epidemiology of enterovirus infections, (UKHSA)
• Enterovirus – D68 Risk Assessment, (PHE)

International

• About enterovirus D68, (CDC)

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, serious conditions, including haemolytic uraemic syndrome (HUS) and thrombotic thrombocytopaenic purpura (TTP), can develop.

 

Incubation Period :

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

Exclusion Period :

A minimum of 48 hours symptom free/no loose stools and until microbiologically clear.

Period of Infectivity :

Whilst symptomatic and 48 hours after cessation of symptoms. Symptoms can last up 14 days.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : No

Disease : Escherichia coli Gastroenteritis

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : Yes

Main route of transmission :

Droplet / Foodborne / Contact (faecal/oral)

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

Guidance and supporting materials

Scottish

• Guidance for the Public Health Management of Escherichia coli 0157 and other Shiga toxin-producing (STEC) infections, (HPS)

UK

• Shiga toxin-producing Escherichia coli: Guidance, data and analysis, (UKHSA)

• Recommendations for the Public Health Management of Gastrointestinal Infections 2019. Principles and practice (PHE, Chartered Institute of Environmental Health, Food Standards Agency 2019)

 

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.

Currently, there is no incubation period, period of infectivity or exclusion period identified for this group of organisms in any high-level source.

Period of Infectivity :

While colonised or infected

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : No

Disease : Extended-spectrum beta-lactamase (ESBL) bacterium infection or colonisation

On the Mandatory NHSScotland Alert organism/Condition list : Yes

*In relation to High risk units e.g. ICU/PICU/NICU, oncology/haematology

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact (faecal/oral)

Guidance and supporting materials

UK

• Extended-spectrum beta-lactamases (ESBLs): guidance, data, analysis, (PHE)
• Extended-spectrum beta-lactamases (ESBLs): treatment, prevention, surveillance, (PHE)
• Extended-spectrum beta-lactamases (ESBLs): FAQs, (PHE)

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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 to 3 weeks

Exclusion Period :

Whilst symptomatic and 48 hours after cessation of symptoms and until microbiologically clear. Avoid swimming until 14 days after last diarrhoeal episode.

Period of Infectivity :

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

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

Disease : Giardiasis/Giardia

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Foodborne / Contact (faecal/oral)

• Other transmission routes are: waterborne and sexual transmission (particularly amongst MSM)

Guidance and supporting materials

UK

• Giardia: guidance and data, (PHE)
• Giardiasis, (NHS England)
• Recommendations for the Public Health Management of Gastrointestinal Infections 2019. Principles and practice (PHE, Chartered Institute of Environmental Health, Food Standards Agency 2019)

 

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 (strep throat), scarlet fever, pneumonia. In rare cases, patients may go on to develop post-streptococcal complications, such as rheumatic fever, glomerulonephritis, necrotising fasciitis, shock and impetigo.

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. A rare complication of iGAS is empyema, usually in the lungs.
• Vulnerable groups at risk from contracting iGAS infections include:
  • perinatal women (≥37 weeks of pregnancy up to 28 days of giving birth)
  • neonates (up to 28 days after birth)
  • elderly people (>75 years) 
  • persons with diabetes
  • those who are immunocompromised

Incubation Period :

Scarlet fever, Streptococcal throat: 2-5 days

Impetigo: from colonization of the skin to development of the characteristic lesions, is about 10 days.

Streptococcal Toxic Shock Syndrome: varies depending on site of entry. Once initial symptoms occur, hypotension generally develops within 24 to 48 hours.

Exclusion Period :

Scarlet fever, Streptococcal throat: 24 hours after commencing appropriate antibiotics.

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

Period of Infectivity :

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

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

Disease : Respiratory

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Droplet

Disease : Bacteraemia, Meningitis

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact

Guidance and supporting materials

Scottish

• Management of contacts of invasive group A Streptococcus (iGAS) infection in community settings. SHPN guide to using the external guidance, (PHS)
• Group A Streptococcal infection - information for patients, (HPS)
• Group A Streptococcus - information for healthcare workers, (HPS)

UK

• Guidelines for prevention and control of Group A streptococcal infection in acute healthcare and maternity settings in the UK, (Journal of infection)
• Streptococcal infections, (PHE)
• UK Guidelines for the management of contacts of invasive group A streptococcus (iGAS) infection in community settings, (UKHSA)
• Group A streptococcal Disease - information for people in prison, (PHE)

Disease : Scarlet Fever

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Droplet

Guidance and supporting materials

UK

• Scarlet fever symptoms diagnosis and treatment, (UKHSA)
• Guidelines for the public health management of scarlet fever outbreaks in schools, nurseries and other childcare settings, (UKHSA)

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H

Haemophilus influenzae type b (Hib)

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, pericarditis, endocarditis, and peritonitis. Hib may also cause sinusitis and otitis media.

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 a serious condition that can be fatal 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 contracting the infection, and as such may require antibiotic chemoprophylaxis.

Incubation Period :

2-10 days

Exclusion Period :

Until 24 hours after initiation of effective therapy.

Period of Infectivity :

Carriers are infectious as long as organisms are present in the nasopharynx, this may be for a prolonged period even without nasal discharge.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

• *(from blood, cerebrospinal fluid or other normally sterile site)

Disease : Epiglottitis

On the Mandatory NHSScotland Alert organism/Condition list : Yes

*Only if resistant to any 3rd/4th/5th generation cephalosporins or carbapenems.

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : Yes

Main route of transmission :

Droplet

Disease : Meningitis

On the Mandatory NHSScotland Alert organism/Condition list : Yes

*Only if resistant to any 3rd/4th/5th generation cephalosporins or carbapenems

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : Yes

Main route of transmission :

Droplet

Guidance and supporting materials

Scottish

• Overview - Haemophilus influenzae, (PHS)

UK

• Haemophilus influenzae: guidance, data and analysis, (UKHSA)
• Haemophilus influenzae type b (Hib): revised recommendations for the prevention of secondary cases, (UKHSA, DHSC, NHS England)
• Haemophilus influenzae type b (Hib): the green book, chapter 16, (UKHSA)

International

• Factsheet about Invasive Haemophilus influenzae disease, (ECDC)
• Appendix A: Type and Duration of Precautions Recommended for Selected Infections and Conditions, (CDC)
• Haemophilus influenza type b (Hib), (WHO)

 

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.  

Incubation Period :

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

Exclusion Period :

Person to person spread is rare

Period of Infectivity :

Unknown

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

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

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : Yes

Main route of transmission :

Airborne

• (inhaling aerosolized excreta or fluids)

Guidance and supporting materials

Scottish

• Hantavirus, (PHS)

UK

• Hantavirus: The characteristics, diagnosis, epidemiology of hantaviruses, (PHE)
• HAIRS risk assessment: hantavirus, (PHE) 
• Hantavirus Disease, (HSE)

International

• Clinical Overview of Hantavirus, (CDC)
• Disease information about hantavirus, (ECDC)

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 7 to 10 days after being laid

Exclusion Period :

None

Period of Infectivity :

While live lice are present

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : No

Disease : Head lice infestation - Pediculosis capitis

On the Mandatory NHSScotland Alert organism/Condition list : No

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact

Guidance and supporting materials

Scottish

• National Guidance on Managing Head Lice Infection in Children, (SG)

UK

• Head Lice clinical knowledge summary, (NICE)

Hepatitis A Virus (HAV)

Hepatitis A virus (HAV) can cause a short term and highly contagious infection of the liver. Those infected (especially children) may be asymptomatic, however symptoms 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 usually last less than 2 months, although some people can be ill for as long as 6 months. Relapse can occur with another acute episode which is normally followed by recovery.

Hepatitis A is transmitted from person to person, or through 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.

Vaccination and post-exposure prophylaxis are available for prevention and treatment of HAV infection.

 

Incubation Period :

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

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).

Period of Infectivity :

Typically 2 weeks before onset of symptoms to 1 week after the onset of jaundice.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

Disease : Hepatitis A Virus Infection

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Foodborne / Contact (faecal/oral)

Guidance and supporting materials

Scottish

• Hepatitis A, (PHS)

UK

• Hepatitis A infection: prevention and control guidance, (UKHSA)
• Hepatitis A: The green book Chapter 17, (UKHSA)
• Recommendations for the Public Health Management of Gastrointestinal Infections 2019 Principles and practice, (PHE, Chartered Institute of Environmental Health, Food Standards Agency)
• Hepatitis A Virus: Clinical Knowledge Summary, (NICE)

 

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. Chronic HBV infection may also be asymptomatic, but can be associated with the development of cirrhosis and hepatocellular carcinoma (HCC).

In countries where HBV is endemic, the most common route of spread of HBV is through vertical transmission from mother to child at birth. However transmission of the virus may also occur through parenteral exposure to infected blood or body fluids, such as from sharing injecting drug equipment or occupational exposure to blood products for example needlestick injuries. Moreover, 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 be used as post-exposure prophylaxis.

Incubation Period :

40 to 160 days

Exclusion Period :

No exclusion required for chronic cases. Acute cases of hepatitis B should take doctor’s advice on when to return to work

Period of Infectivity :

During active infection (average of 4 weeks, with range of 1 and 9 weeks) or if chronically infected

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

Disease : Hepatitis B Virus Infection

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact / Vertical

• with high risk bodily fluids and/or blood.

Guidance and supporting materials

Scotland

• Integrated guidance on health clearance of healthcare workers and the management of healthcare workers infected with bloodborne viruses, hepatitis B, hepatitis C and HIV. SHPN Guide, (PHS)
• Hepatitis B, (PHS)

UK

• Hepatitis B: guidance, data and analysis, (UKHSA)
• Hepatitis B: the green book, chapter 18, (UKHSA)
• Hepatitis B (chronic): diagnosis and management, (NICE)
• UKHSA Guidance: Managing specific infectious diseases, (UKHSA)
• Guidance for health clearance of healthcare workers (HCWs) and management of those infected with bloodborne viruses (BBVs) hepatitis B, hepatitis C and HIV, (UKHSA)

International

• Hepatitis B Factsheet (WHO)

 

 

Hepatitis C Virus (HCV)

Hepatitis C Virus (HCV) is a virus that often 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 symptoms including decreased appetite, fatigue, nausea, vomiting, myalgia and fever. 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 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 to 26 weeks

Exclusion Period :

Exclusion is not required.

Period of Infectivity :

Communicability is from 1 or more weeks before the onset of symptoms, and during the acute clinical stage of HCV infection. People with chronic infection – should be considered potentially infectious, although the risk is minimal in the non-viraemic (PCR-negative) individual.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

Disease : Hepatitis C Virus Infection

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact

• with high risk bodily fluids and/or blood.

Guidance and supporting materials

Scottish

• Integrated guidance on health clearance of healthcare workers and the management of healthcare workers infected with bloodborne viruses (hepatitis B, hepatitis C and HIV). SHPN guide on using the external guidance, (SHPN, PHS)
• Management of Hepatitis C, (SIGN)

UK

• Hepatitis C: guidance, data and analysis, (UKHSA)
• Hepatitis C: Summary, (NICE)
• Hepatitis C: patient re-engagement exercise, (PHE)
• Guidance: Managing specific infectious diseases, (UKHSA)
• Guidance for health clearance of healthcare workers (HCWs) and management of those infected with bloodborne viruses (BBVs) hepatitis B, hepatitis C and HIV, (UKHSA)

International

• Hepatitis C, (WHO)

 

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, joint pain, fever, nausea, vomiting, abdominal pain and loss of appetite.

Incubation Period :

40 days (15 to 60 days)

Exclusion Period :

There is no specific exclusion period but during the first 2 weeks of illness the preparation of food for others and/or having close contact with those who are pregnant or have chronic liver disease should be avoided.

Period of Infectivity :

The specific period of infectivity is unknown, but virus excretion in stool has been demonstrated from 1 week prior to onset to 30 days after the onset of jaundice. Chronically infected persons shed virus as long as they remain infected.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

Disease : Hepatitis E Virus (HEV)

On the Mandatory NHSScotland Alert organism/Condition list : No

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact (faecal/oral)

Guidance and supporting materials

Scottish

• Hepatitis E, (PHS)

UK

• Hepatitis E, symptoms, transmission, prevention and treatment, (PHE)
• Protecting patients from getting Hepatitis E through transfusion or transplantation, (DHSC)
• Hepatitis E, health protection response to reports of infection, (PHE)
• Recommendations for the Public Health Management of Gastrointestinal Infections 2019. Principles and practice (PHE, Chartered Institute of Environmental Health, Food Standards Agency 2019)

International

• Hepatitis E: Basics, (CDC)

 

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 to 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 can develop into AIDS in 1 to 2 years while other may remain immunocompetent more than 10 years later. 
• 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 (PrEP) 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 to 4 weeks post exposure.

Exclusion Period :

Exclusion is not required.

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.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : No

Disease : Acquired Immunodeficiency Syndrome (AIDS)

On the Mandatory NHSScotland Alert organism/Condition list : No

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact / Vertical

• with high risk body fluids and/or blood.

Disease : Human immunodeficiency virus (HIV) infection

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact / Vertical

• with high risk bodily fluids and/or blood.

Guidance and supporting materials

Scottish

• Integrated guidance on health clearance of healthcare workers and the management of healthcare workers infected with bloodborne viruses (hepatitis B, hepatitis C and HIV). SHPN guide on using the external guidance, (PHS, SUTIN)
• Good Practice Guidance on HIV Prevention in Men who have Sex with Men (MSM), (HPS)
• HIV, (PHS)

UK

• HIV: surveillance, data and management, (UKHSA)
• HIV infection and AIDS, (NICE)
• Guidance: Managing specific infectious diseases, (UKHSA)
• Guidance for health clearance of healthcare workers (HCWs) and management of those infected with bloodborne viruses (BBVs) hepatitis B, hepatitis C and HIV, (UKHSA)

 

 

 

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

Exclusion Period :

Whilst symptomatic

Period of Infectivity :

HMPV RNA is found in excretions 5 days to 2 weeks after initiation of symptoms. However, the extent of contagiousness is unknown.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : No

Disease : Human metapneumovirus

On the Mandatory NHSScotland Alert organism/Condition list : No

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact / Droplet

Guidance and supporting materials

Scottish

• Human metapneumovirus (HMPV), (PHS)

UK

• Diagnosis and management of respiratory viral infections in patients with haematological malignancy, (British Society for Haematology)

International

• Appendix A: Type and Duration of Precautions Recommended for Selected Infections and Conditions, (CDC)
• About Human Metapneumovirus, (CDC)

 

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Influenza - Pandemic influenza (flu)

Pandemic influenza 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 :

Typically sudden onset averaging between 2 to 3 days with a range between 1 to 4 days.

Exclusion Period :

There is no precise exclusion period. Adults and children with symptoms of influenza are advised to remain at home until symptom-free.

Period of Infectivity :

Cases are infectious 1 day before to 3 to 5 days after symptoms appear.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

Disease : Pandemic Influenza (flu)

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Droplet

Guidance and supporting materials

UK

• UK Influenza Pandemic Preparedness Strategy
• Pandemic flu - workplace guidance, (HSE)
• Guidance pandemic flu
• Framework for managing the response to pandemic diseases, (NHS England)
• Pandemic Influenza: Guidance for infection control in ambulance services, (DH)
• Swine Influenza: How to spot the disease, (UKHSA)

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 a 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 (for example COPD, diabetes) and people who are immunocompromised. An annual vaccination is available to those within these risk groups as well as healthcare workers. 

Incubation Period :

Typically 2 days (range 1 to 4 days)

Exclusion Period :

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

Period of Infectivity :

1 day before symptoms develop to 5 to 7 days after symptoms appear.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

Disease : Influenza (Flu)

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

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. SHPN guide to using the UK guidelines, (PHS)
• Care Home IPC resource for respiratory illness, (ARHAI)

UK

• Seasonal influenza, guidance, data and analysis, (UKHSA)
• Influenza: the green book, chapter 19, (UKHSA)
• Suspected acute viral respiratory infections: managing outbreaks in schools, (UKHSA)
• Point of care tests for influenza and other respiratory viruses - Winter 2019-20, (PHE)
• Avian influenza A(H5N6):risk assessment, (UKHSA)
• Avian influenza: guidance, data and analysis, (UKHSA)
• Investigation and initial clinical management of possible human cases of avian influenza with potential to cause severe human disease, (UKHSA)

International

• Diagnosis and Treatment of Adults with Community-acquired Pneumonia-An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America (2019)

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No Pathogens

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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.

Those 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 to 6 days, with a range of 2 to 14 days if not longer

Pontiac Fever: Typically 0 to 3 days

Period of Infectivity :

Not transmissible from person to person

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

Disease : Legionellosis

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Airborne

• Environmental source

Guidance and supporting materials

Scottish

• Guideline on the management of Legionella Incidents, Outbreaks and Clusters in the Community, (HPS)
• Guidance: Water safety for emerging technologies (SHTM 04-02), (HFS)
• Legionella, (PHS)

UK

• Legionnaires' disease: guidance, data and analysis, (PHE)
• Legionnaires’ disease: risks of pre-heated birthing pools, (PHE)
• Legionella: detection in healthcare premises, (PHE)
• Legionnaires’ disease: The control of legionella bacteria in water systems. Approved Code of Practice and guidance on regulations, (HSE)
• Legionella control in evaporative cooling systems: underlying causes of breaches in health and safety compliance, (HSE)

Lice

See Body Lice, Head Lice, Pubic Lice.

 

Lyme disease

See Borrelia burgdorferi

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Measles

See morbillivirus

Meningitis (bacterial)

See Neisseria meningitides

Meticillin resistant Staphylococcus aureus (MRSA)

See Staphylococcus Aureus

Middle Eastern Respiratory Syndrome Coronavirus (MERS-CoV)

This is a novel coronavirus that recently emerged in the Middle East and is classed as a high consequence infectious disease (HCID).  It 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 diarrhoeal 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 :

Typically around 5 or 6 days with a range between 2 to 14.

Period of Infectivity :

Limited data are available on the duration of respiratory and extrapulmonary shedding of MERS-CoV. Culturable virus has been detected up to 25 days after onset of symptoms.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : No

Disease : Middle East Respiratory Syndrome Coronavirus (MERS-CoV)

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Droplet / Airborne

Guidance and supporting materials

Scottish

• Infection control advice for severe respiratory illness from novel or emerging pathogens: MERS-CoV and avian influenza
• Literature Review Personal Protective Equipment (PPE) for Infectious Diseases of High Consequence

UK

• MERS-CoV: public health investigation and management of possible cases
• PHE: High consequence infectious diseases (HCID)

International 

• Middle East Respiratory Syndrome (MERS): MERS Clinical features
• Middle East Respiratory Syndrome/MERS | CDC Yellow Book 2024 

 

Morbillivirus

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

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 to 2 days before rash onset which may last for 2 to 4 days.

Measles rash appears red and blotchy, developing 2 to 4 days after the onset of fever, and spreading from the head to the body over the next 3 to 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 or encephalitis, immune thrombocytopenic purpura (ITP) and late onset subacute sclerosing panencephalitis (SSPE).

Incubation Period :

About ten days (range 7 to 18 days)

Exclusion Period :

From symptom onset to 4 days after rash onset.

Period of Infectivity :

Individuals are usually infectious 4 days from symptom onset to 4 days after rash onset.

Measles is transmitted via respiratory droplets, or direct contact with nasal/throat secretions of infected individuals.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

Disease : Measles (Rubeola)

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : Yes

Main route of transmission :

Droplet / Airborne

Guidance and supporting materials

Scottish

• Guidance for the control of measles incidents and outbreaks in Scotland, (PHS)
• MMR vaccination information, (NHS Inform)
• Measles, (PHS)

UK

• National measles guidelines, (UKHSA)
• Guidance for risk assessment and infection prevention and control measures for measles in healthcare settings, (NHS England)
• Measles: guidance, data and analysis, (UKHSA)
• Measles: guidance on public health response to cases who have travelled by air whilst infectious, (UKHSA)
• Measles Clinical Knowledge Summary, (NICE)
• Measles: the green book, chapter 21, (UKHSA)

Mpox

Mpox is a rare viral infection caused by the mpox virus.  The first human case was recorded in 1970 in the Democratic Republic of Congo and since May 2022, cases of human mpox have been reported in multiple countries that have had no prior cases in animal or human populations, including the UK. Most of these cases are from Clade IIb, lineage B.1. In 2024, Clade I mpox cases were reported from countries in Africa beyond the 5 Central African Region countries where it historically circulated. As of August 2024, no cases of Clade I mpox have been detected in the UK.

Importations of mpox caused by Congo basin clade (Clade I) are classified as a High Consequence Infectious Disease (HCID).  

In June 2022, the Advisory Committee on Dangerous Pathogens (ACDP) considered the HCID criteria in the context of the outbreak in 2022. Consensus was reached between Public Health Agencies of the Four Nations that the specific outbreak clade of mpox in the UK should no longer be designated, and therefore managed, as a HCID. 

In August 2024, operational guidance was published by UKHSA confirming that all laboratory confirmed mpox Clade I cases should be managed as a high consequence infectious disease (HCID).

See HCID status of mpox - GOV.UK (www.gov.uk) for more information. 

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

Within 1 to 5 days of fever appearing, a rash develops, often starting on the face and spreading to other parts of the body including palms of the hands, soles of the feet, mouth, anus, and genitals. Some individuals may not have widespread rash, with rash/lesions may be localised to the genitals in some cases.

The illness is usually mild and self-limiting with most people recovering within a few weeks however severe illness can occur in some individuals including children, pregnant women, and those who are immunosuppressed.

Infection is spread when a person comes into close contact with an infected animal or human (via lesions, body fluids or respiratory droplets), or with contaminated clothing or linen. Mpox does not spread easily between people and there is a very low risk of transmission to the general population.

Incubation Period :

Usually from 6 to 13 days but can range from 5 to 21 days.

Exclusion Period :

UKHSA has published guidance on de-isolation and discharge of mpox patients that outlines clinical, laboratory, and lesion criteria that should be met before removing patients from isolation or discharge from various settings.

The clinical team should judge if patient is clinically well enough for safe de-isolation.

• The patient returns negative PCR results for EDTA blood, urine, throat swab samples.
• There have been no new lesions for 48 hours, there are no mucous membrane lesions, all lesions have crusted over, all scabs covering the lesions have dropped off, and intact skin remains underneath.

Period of Infectivity :

From onset of symptoms until scabs have fallen off and there is intact skin underneath

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

Disease : Mpox

On the Mandatory NHSScotland Alert organism/Condition list : No

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : Yes

Main route of transmission :

Contact / Droplet / Airborne

Guidance and supporting materials

Scottish

• Mpox IPC guidance for healthcare settings (ARHAI, v2.0, 29 November 2024)
• Literature Review Personal Protective Equipment (PPE) for Infectious Diseases of High Consequence, (HPS)
• Mpox, (PHS)

UK

• Mpox: Background information, (UKHSA)
• Mpox: guidance on when to suspect a case of mpox, (UKHSA)
• Clade I mpox: affected countries, (UKHSA)
• De-isolation and discharge of mpox-infected patients, (UKHSA)
• High consequence infectious diseases (HCID), (UKHSA)

• Smallpox and mpox: the green book, chapter 29, (UKHSA)

International

• Mpox: how it spreads, (CDC) 

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, myalgia 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 :

Symptoms typically appear 16 to 18 days after infection but this can range between 12 to 25 days.

Exclusion Period :

Healthcare professionals with no evidence of immunity to mumps who have been exposed to patients with mumps but are asymptomatic should be excluded from duty from the 12th day after first exposure to the 26th day after last exposure.

Period of Infectivity :

Two days before symptom onset and up to nine days afterwards.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

Disease : Mumps (infectious parotitis)

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : Yes

Main route of transmission :

Droplet

Guidance and supporting materials

Scottish

• MMR Vaccine, (NHS Inform)
• Mumps, (PHS)

UK

• Mumps: risk in pregnancy, infection in healthcare settings and MMR vaccine, (UKHSA)
• Mumps: the green book, chapter 23, (UKHSA)
• Mumps: Clinical Knowledge Summary, (NICE)

 

Mycobacterium abscessus

See nontuberculosis mycobacteria.

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.

Miliary TB is classified as both pulmonary and extrapulmonary tuberculosis. It is a form of tuberculosis where tubercle bacilli are spread by the blood to the lungs and other organs resulting in tuberculous foci formation that are similar in size and appearance to millet seeds. Additional symptoms of miliary TB may include, but are not limited to: weakness, cough and organ-specific dysfunction. There are two types of miliary TB: acute miliary TB and cryptic miliary TB. Acute miliary TB usually affects those patients under the age of 40 whilst cryptic miliary TB usually affects those patients older than 60. Miliary TB is most common in infants and children under 5 years of age, and in immunocompromised people.

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.

Exclusion Period :

For pulmonary TB: Whilst symptomatic and for 2 weeks after appropriate antibiotic treatment commences. For non-pulmonary TB: No exclusion.

Period of Infectivity :

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

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

Disease : Extrapulmonary Tuberculosis

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : Yes

Main route of transmission :

Contact

Disease : Miliary Tuberculosis

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : Yes

Main route of transmission :

Airborne

Disease : Pulmonary or laryngeal Tuberculosis

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : Yes

Main route of transmission :

Airborne

Guidance and supporting materials

Scottish

• Tuberculosis guideline. SHPN guide to using the UK guidelines, (PHS, SHPN)       
• A TB Action plan for Scotland, (SG)
• Tuberculosis, (PHS)

UK

• Tuberculosis: the green book chapter 32, (UKHSA)
• Tuberculosis: Quality Standard, (NICE)
• TB information for prison staff, (PHE)
• Tuberculosis: NICE Guideline (NG33), (NICE)

International

• Guidelines on tuberculosis infection prevention and control (WHO)

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 or people who live together.

On rare occasions M. pneumoniae infection can 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 to 4 weeks

Period of Infectivity :

While symptomatic

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : No

Disease : Pneumonia

On the Mandatory NHSScotland Alert organism/Condition list : No

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Droplet

Guidance and supporting materials

International

• Clinical features of mycoplasma pneumoniae infection, (CDC)
• Diagnosis and Treatment of Adults with Community-acquired Pneumonia - (An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America)

 

 

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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 young infants the onset may be insidious, and the signs may be non-specific without ‘classical’ features of meningitis. Babies may be slow or inactive, irritable, vomiting, feeding poorly, or have a bulging anterior fontanelle.

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. 

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 :

2 to 7 days

Exclusion Period :

While symptomatic and until 24 hours after initiation of effective therapy (there is no reason to exclude siblings or other close contacts)

Period of Infectivity :

Patients infected with N. meningitidis may be contagious in the 7 days before the onset of symptoms and are rendered non-infectious 24 hours after beginning effective antimicrobial therapy.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

Disease : Meningococcal Disease

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : Yes

Main route of transmission :

Droplet

Guidance and supporting materials

UK

• Meningococcal: the green book, chapter 22, (UKHSA)
• Meningococcal disease: guidance on public health management, (UKHSA)
• Health protection in children and young people settings, including education, (UKHSA)

International 

• Meningococcal disease, (CDC)
• Factsheet about meningococcal disease, (ECDC)

Nipah virus

Nipah virus is a member of the Paramyxoviridae family (genus Henipavirus) and is classed as a high consequence infectious disease (HCID).  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.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : No

Disease : Nipah virus

On the Mandatory NHSScotland Alert organism/Condition list : No

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact / Airborne

• Airborne and direct contact transmission

Guidance and supporting materials

UK

• Nipah virus: epidemiology, outbreaks and guidance, (PHE)
• High consequence infectious diseases (HCID), (PHE)

International

• Nipah Virus Infection, (WHO)
• Factsheet on Nipah virus disease, (ECDC)

Nits

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

• See head/body/pubic lice

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, joints 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 requiring antibiotic and steroid therapy.

NTM comprise a multispecies group of organisms common throughout the environment and are 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 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 :

M. abscessus is typically not transmitted from person-to-person. However, in cystic fibrosis patients, person-to-person transmission has been reported, although duration of infectiousness is unclear.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : No

Disease : Mycobacteriosis

On the Mandatory NHSScotland Alert organism/Condition list : No

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact / Droplet

Disease : Mycobacterium abscessus infection

On the Mandatory NHSScotland Alert organism/Condition list : No

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact

Guidance and supporting materials

Scottish

• Guidance on decontamination and testing of cardiac heater cooler units (HCUs), (ARHAI)
• Infections associated with heater cooler units used in cardiopulmonary bypass and ECMO: Scottish Appendix, (HPS)

UK

• Mycobacterium chimaera infections: guidance for secondary care, (PHE)
• Slow growing mycobacteria: procedure for testing heater cooler units, (PHE)
• British Thoracic Society guidelines for the management of non-tuberculous mycobacterial pulmonary disease, (BTS)
• Mycobacterium abscessus. Recommendations for infection prevention and control.(Cystic Fibrosis Trust)

International

• About Nontuberculous Mycobacteria (NTM) Infections, (CDC)

Norovirus

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 to 48 hours

Exclusion Period :

As a general rule, whilst symptomatic and 48 hours after cessation of symptoms.

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.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

Disease : Norovirus gastroenteritis

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact

Guidance and supporting materials

Scottish

• General information to prepare for and manage norovirus in care settings, (HPS)
• Norovirus, (NHS Inform)
• Care Home IPC resource for gastro-intestinal illness, (ARHAI)

UK

• Recommendations for the Public Health Management of Gastrointestinal Infections 2019. Principles and practice (PHE, Chartered Institute of Environmental Health, Food Standards Agency 2019)

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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 to 10 days.

Incubation Period :

1 to 7 days

Period of Infectivity :

12 to 24 hours before to 5 days after clinical onset

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : No

Disease : Parainfluenza

On the Mandatory NHSScotland Alert organism/Condition list : Yes

*Only if in high risk units, for example ICU/PICU/NICU, or high risk patient cohorts for example oncology/haematology, regardless of location.

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact / Droplet

Guidance and supporting materials

UK

• Human parainfluenza viruses: clinical and public health management, (PHE)
• Influenza-like illness (ILI). Managing outbreaks in care homes, (UKHSA)

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 vulnerable 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 :

Usually 4 to 14 days but can be up to 21 days.

Exclusion Period :

While symptomatic until the rash develops.

Period of Infectivity :

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

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : No

Disease : Slapped cheek syndrome/erythema infectiosum/fifth disease

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Droplet

Guidance and supporting materials

Scottish

• Slapped Cheek Syndrome, (NHS Inform)

UK

• Parvovirus B19: guidance, data and analysis, (UKHSA)
• Parvovirus B19 Infection. Clinical Knowledge Summary, (NICE)

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 to 12 weeks

Exclusion Period :

For patients in high risk units/settings - until resolution of symptoms or discharge from hospital

Period of Infectivity :

Considered infectious while symptomatic/colonised

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : No

Disease : Pneumocystis Pneumonia

On the Mandatory NHSScotland Alert organism/Condition list : Yes

*Only if in high risk units e.g. ICU/PICU/NICU and in high risk patient cohorts e.g. Oncology/haematology patient cohorts & transplant patients regardless of location

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Droplet / Airborne

Guidance and supporting materials

Scottish

• PcP: Patient information leaflet, (HPS)
• Information for staff on Pneumocystis Pneumonia (PcP), (HPS)

International

• Pneumocystis pneumonia basics, (CDC)

Pontiac fever

See Legionella spp.

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.

Incubation Period :

No defined incubation period

Period of Infectivity :

While colonised

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : No

Disease : Pseudomonas aeruginosa infection or colonisation

On the Mandatory NHSScotland Alert organism/Condition list : Yes

*Only if in high risk units e.g. ICU/PICU/NICU, or high risk patient cohorts for example oncology/haematology, regardless of location.

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact / Droplet

Guidance and supporting materials

Scottish

• Water section of Chapter 4 of the NIPCM  

UK

• Pseudomonas aeruginosa: guidance, data and analysis, (UKHSA)

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 to 10 days after being laid. However, it can take up to 3 weeks after coming into contact with pubic lice before noticing any symptoms.

Exclusion Period :

Infected persons should avoid sexual or close bodily contact, and sharing clothing, bedding and personal hygiene products until treatment is completed. They should be re-assessed to ensure no persistent infection.

Period of Infectivity :

While live lice are present and until treated.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : No

Disease : Pubic lice infestation/ Pediculosis pubis/ pthiriasis

On the Mandatory NHSScotland Alert organism/Condition list : No

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact

Guidance and supporting materials

Scotland

• Pubic Lice, (NHS Inform)

UK

• Pubic Lice. Clinical Knowledge Summary, (NICE)

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No Pathogens

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Rabies

The rabies virus is a member of the family of Rhabdoviridae. The most common mode for rabies transmission is through virus-laden saliva from bites or scratches from an infected animal (in particular dogs but 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 with 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 is typically within one year from exposure (ranges from a few days to a few years).

Period of Infectivity :

Person to person transmission is rare.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

Disease : Rabies

On the Mandatory NHSScotland Alert organism/Condition list : No

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : Yes

Main route of transmission :

Contact

Guidance and supporting materials

Scottish

• Rabies: guidance on pre-exposure and post-exposures measures for humans in Scotland, (PHS)
  • Easy read guide

UK

• Rabies pre-exposure prophylaxis: guidelines, (UKHSA)
• Rabies post-exposure treatment: management, (UKHSA)
• Rabies vaccination: the green book, chapter 27, (UKHSA)

International

• Rabies, (CDC)

Respiratory syncytial 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.  Vaccination is available for high-risk infants.

Incubation Period :

2 to 8 days

Period of Infectivity :

From 1 to 2 days before onset of symptoms. Usually lasts 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.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : No

Disease : RSV Infection

On the Mandatory NHSScotland Alert organism/Condition list : Yes

*Only in relation to high risk units for example ICU/PICU/NICU or high risk patient cohorts for example oncology/haematology, regardless of location.

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact / Droplet

Guidance and supporting materials

Scotland

• Respiratory syncytial virus (RSV), (NHS Inform)

UK

• RSV: the green book, chapter 27a, (UKHSA)
• Respiratory, syncytial virus (RSV): guidance, data and analysis. (PHE)

Rhinovirus

Human rhinoviruses (HRVs) are characterised into three genetically distinct HRV groups, designated as A, B, and C, within the genus Enterovirus and the family Picornaviridae. HRVs are primarily associated with upper respiratory tract infection, otitis media, and sinusitis. It is the most common cause of the common cold worldwide.

The symptoms of a rhinovirus cold are largely subjective and may include nasal congestion or discharge, sore or scratchy throat, and cough. In addition, children can also have fever during the first 2 to 3 days and moderate enlargement of the anterior cervical nodes. Illness generally lasts from 5 to 7 days in adults, but it can persist for longer (10 to 14) days in children. HRVs are the most common cause of respiratory viral illness during the spring, summer, and autumn months.

HRV is also a significant lower respiratory tract pathogen in patients with chronic pulmonary disease, children, and immunocompromised hosts.

HRVs are transmitted from person to person via contact (either directly or through fomites) or aerosol (small or large particle).

There are no approved antiviral therapies for HRVs currently, and treatment remains primarily supportive.

Incubation Period :

Average of 2 days.

Period of Infectivity :

From a few days before onset of symptoms until all symptoms have gone, usually around 2 weeks.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : No

Disease : Upper respiratory tract infections

On the Mandatory NHSScotland Alert organism/Condition list : No

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact / Droplet

Guidance and supporting materials

UK

• Common cold. Clinical Knowledge Summary, (NICE)

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 can last 1 to 4 days and include severe vomiting and diarrhoea, accompanied by stomach cramps - on rare occasions it can cause severe dehydration and death in young children.

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

Incubation Period :

24 to 72 hours

Exclusion Period :

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

Period of Infectivity :

Infectious from 2 days before symptom onset to 10 days after symptoms resolve. Prolonged shedding of the virus can occur in immunocompromised individuals.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : No

Disease : Rotavirus gastroenteritis

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact / Droplet

Guidance and supporting materials

UK

• Rotavirus: the green book, chapter 27b, (UKHSA)
• Recommendations for the Public Health Management of Gastrointestinal Infections 2019. Principles and practice (PHE, Chartered Institute of Environmental Health, Food Standards Agency 2019)

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, thrombocytopenia, 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) vaccination programme.

Incubation Period :

14 to 21 days

Exclusion Period :

Individuals infected with rubella should stay off school or work and avoid contact with pregnant women for five days after rash onset.

Period of Infectivity :

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

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

Disease : Congenital rubella syndrome (CRS)

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : Yes

Main route of transmission :

• Vertical (Maternal to foetal)

Disease : Rubella infection/German measles/3-day measles

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : Yes

Main route of transmission :

Droplet

Guidance and supporting materials

Scottish

• MMR Vaccination(NHS Inform)

UK

• Rubella: the green book, chapter 28, (UKHSA)
• Rubella (German measles): guidance, data and analysis, (UKHSA)
• Rubella. Clinical Knowledge Summary, (NICE)

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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 to 72 hours. Ingested dose will influence incubation period, symptoms and disease severity.

Exclusion Period :

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

Period of Infectivity :

While symptomatic, usually 4 to 7 days. However, asymptomatic/chronic carriers and children may shed organism for much longer.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

Disease : Salmonella gastroenteritis

On the Mandatory NHSScotland Alert organism/Condition list : No

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact / Foodborne

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

Guidance and supporting materials

Scottish

• Care Home IPC resource for gastro-intestinal illness, (ARHAI)

UK

• Salmonella: guidance, data and analysis, (UKHSA)

• Recommendations for the Public Health Management of Gastrointestinal Infections 2019. Principles and practice (PHE, Chartered Institute of Environmental Health, Food Standards Agency 2019)

Salmonella (Typhoidal)

Typhoid fever is a systemic infection caused by the gram-negative bacterium Salmonella typhi.

Transmission occurs through the ingestion of food or water that is contaminated with faeces.  Direct faecal-oral transmission can also occur.

Symptoms range from mild fever, diarrhoea, muscle aches and headache, to severe disseminated disease with multi-organ involvement in 10-15% of cases.  The fatality rate is less than 1% with prompt antibiotic treatment but may be as high as 20% if left untreated.

Typhoid fever is very rare in the UK and most cases are imported due to foreign travel to countries where typhoid fever is endemic, or contact with someone who has travelled.  Vaccination is available for those who live or travel to endemic areas where the risk of typhoid fever is high.

Incubation Period :

10 to 20 days (range 3 to 56 days) depending on host factors and size of the infecting dose.

Exclusion Period :

Whilst symptomatic and for 48 hours after symptoms have resolved or longer if advised by the HPT or Environmental Health Officer (EHO).

Period of Infectivity :

Extremely variable. People are infectious for the duration of excretion of bacteria. Cases are not considered infectious prior to onset of symptoms.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

Disease : Typhoid Fever

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : Yes

Main route of transmission :

Contact (faecal/oral)

Guidance and supporting materials

Scottish

• Public health operational guidelines for typhoid and paratyphoid (enteric fever). SHPN guide to using the external guidance, (PHS, SHPN)
• Care Home IPC resource for gastro-intestinal illness, (ARHAI)

UK

• Typhoid: the green book, chapter 33, (UKHSA)
• Recommendations for the Public Health Management of Gastrointestinal Infections 2019. Principles and practice (PHE, Chartered Institute of Environmental Health, Food Standards Agency 2019)

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 burrowing 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 :

Symptoms can appear 3 to 6 weeks after the initial infection. However, these can occur earlier (1 to 3 days) in a reinfested person.

Exclusion Period :

Until first treatment has been completed.

Period of Infectivity :

During incubation and infestation.

24 hours after treatment has commenced, individuals are no longer infectious.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : No

Disease : Scabies infestation

On the Mandatory NHSScotland Alert organism/Condition list : Yes

*In relation to in-patient/care and day care settings

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact

Guidance and supporting materials

UK

• Scabies. Clinical Knowledge Summary, (NICE)
• UKHSA Guidance on the management of scabies cases and outbreaks in long-term care facilities and other closed settings, (UKHSA)

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

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : No

Disease : Serratia marcescens infection

On the Mandatory NHSScotland Alert organism/Condition list : Yes

*Only if high risk units (for example ICU/PICU/NICU), or high risk patient cohorts (for example oncology/haematology), regardless of location.

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact

Guidance and supporting materials

Scottish

• Healthcare infections in neonatal units. Information for parents and guardians, (HPS)

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‑CoV‑2)

SARS-CoV-2 is an RNA virus and a member of the Coronaviridae family and genus Betacoronavirus.

This is a novel coronavirus that emerged in Wuhan, China, in 2019.

Symptoms of COVID-19 include, but are not limited to, new onset of cough and fever, loss of smell, and flu-like symptoms. Children appear to exhibit mild disease with cough and fever as main symptoms.

The disease is primarily transmitted from person to person via respiratory particles. However indirect transmission may occur through contact with surfaces contaminated with the virus (fomite transmission).

Incubation Period :

3 to 6 days (range 1 to 14 days).

Exclusion Period :

Hospitalised patients - 5 days from symptom onset (or first positive test if symptom onset undetermined) including resolution of fever for 48 hours without the use of medication.
If the patient is severely immunosuppressed or symptoms persist beyond 5 days, testing may be used to support decision-making (2 negative LFD tests taken 24 hours apart).

In care home settings residents can end self-isolation if they meet all of the following criteria:

• five full days of isolation completed
• have been without a fever for 48 hours without the use of medication (such as paracetamol)
• no longer feel unwell

Routine testing has been replaced with testing to support clinical diagnosis, eligibility for COVID-19 treatments, and surveillance and outbreak management (as per the NIPCM, local IPC and HP teams). Patients in healthcare settings may undergo testing for appropriate placement and management.

Period of Infectivity :

Individuals are infectious around 2 days before symptom onset to 10 days after.

People are most infectious during their symptomatic period, usually in the first 5 days (after the day they took the positive test or from the day symptoms started). However, children and young persons under 18 years old are most infectious in the first 3 days

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

• This is for COVID-19 disease

Disease : Coronavirus disease 2019 (COVID-19) (SARS CoV-2)

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : Yes

Main route of transmission :

Droplet / Airborne

Guidance and supporting materials

Scottish

• COVID-19 - health protection guidance, (PHS)
• Coronavirus (COVID-19), (NHS Inform) 

UK

• COVID-19 Green Book chapter 14a, (UKHSA)

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 to 3 days ( can range from 12 to 96 hours and up to 1 week for Sh. dysenteriae).

Exclusion Period :

Individuals should stay away from nursery, school or work until symptom free for at least 48 hours.

Some groups may need to be excluded until clear of the infecting organism.

Period of Infectivity :

While symptomatic and for a further 48 hours after cessation of symptoms. People are most infectious when diarrhoea is present and as long as organisms are excreted in stool (average of 2- 4 weeks but prolonged carriage of several months has been reported).

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

Disease : Bacillary dysentery (Shigellosis)

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Foodborne / Contact (faecal/oral)

• Foodborne transmission is rarely reported in the care environment where the main route is through contact (faecal/oral).

Guidance and supporting materials

UK

• Shigella: public health management, (PHE)
• Recommendations for the Public Health Management of Gastrointestinal Infections 2019, (PHE, Chartered Institute of Environmental Health)

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 which may occur when the 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.

Refer to Appendix 13 - Alert organism/conditions list for Staph. aureus reporting requirements.

Incubation Period :

N/A

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.

Period of Infectivity :

While colonised/infected.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

• *For Enterotoxigenic Staphylococcus aureus, Staphylococcus aureus (all blood isolates) and Methicillin-resistant Staphylococcus aureus (MRSA)

Disease : MRSA infection

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact

Disease : PVL-S.aureus infection

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : Yes
• *For bacteraemia, necrotising pneumonia and enterotoxigenic infections

Main route of transmission :

Contact

Guidance and supporting materials

Scottish

• Protocol for Enhanced Staphylococcus aureus bacteraemia surveillance, (HPS)
• Interim advice for the diagnosis and management of PVL-associated Staphylococcus aureus infections (PVL-S. aureus), (HPS)
• Protocol for CRA MRSA Screening National Rollout in Scotland, (HPS)
• Quality of care indicators for the management of SAB in adults, (SAPG)

UK

• Staphylococcus aureus: guidance, data and analysis, (UKHSA)
• Guidelines for the control and prevention of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities, (Journal of Hospital Infection)

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

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : No

Disease : Stenotrophomonas maltophilia infection or colonisation

On the Mandatory NHSScotland Alert organism/Condition list : Yes

*Only if in high risk units for example ICU/PICU/NICU or high risk patient cohorts, for example oncology/haematology, regardless of location.

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact

Guidance and supporting materials

UK

• Stenotrophomonas maltophilia guidance, (PHE)

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 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 to 3 days, but can be up to 10 days.

Exclusion Period :

Exclude until 24 hours post-commencement of antibiotic treatment.

Period of Infectivity :

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

On alert organism list only when exceptional resistance phenotypes of gram-negative bacteria.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

• *from blood, cerebrospinal fluid or other normally sterile site

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

On the Mandatory NHSScotland Alert organism/Condition list : Yes

*Only if resistant to specified antimicrobials

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact

Disease : Pneumococcal meningitis

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Droplet

Disease : Non-invasive Pneumococcal infection

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact

Guidance and supporting materials

Scottish

• Pneumococcal Infections, (NHS Inform)

UK

• Pneumococcal: the green book, chapter 25, (UKHSA)
• Pneumococcal disease: guidance, data and analysis, (UKHSA)

International

• Diagnosis and Treatment of Adults with Community-acquired Pneumonia-An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America

Streptococcus pyogenes

See Group A Streptococcus

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T

Tetanus

See Clostridium tetani

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
• 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.

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.

Main route of transmission

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)
• 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 to 2 years for transmission by contaminated neurosurgical instruments to over 30 years for transmission via human-derived pituitary hormones.

Exclusion Period :

Isolation of patients with CJD is not necessary as there is no evidence that normal social or routine clinical contact with a CJD patient presents a risk to others.

Period of Infectivity :

Blood and body fluid samples from patients with, or “at increased risk” of, CJD should be treated as potentially infectious for blood-borne viruses.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : No

Disease : TSEs, Creutzfeldt-Jakob Disease (CJD)

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No
• 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.

Main route of transmission :

• Iatrogenic transmission

Guidance and supporting materials

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, (DHSC)
  • Transmissible Spongiform Encephalopathy Agents: Safe Working and the Prevention of Infection: Part 4
• Risk reduction measures for variant Creutzfeldt-Jakob disease: PCWG report, (DHSC)
• Public Health Action following a report of a new case of CJD or a person at increased risk of CJD, (PHE)
• CJD: Information leaflets for patients and healthcare professionals, (PHE)
• Creutzfeldt-Jakob disease - a guide for social workers in England, (DHSC)
• Chronic wasting disease: risk assessments, (PHE, DEFRA, FSA) 

Tuberculosis (TB)

See Mycobacterium tuberculosis

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No Pathogens

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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.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : No

Disease : Vancomycin-resistant enterococcal infection or colonisation

On the Mandatory NHSScotland Alert organism/Condition list : Yes

*Only in High risk units for example ICU/PICU/NICU, or high risk patient cohorts (for example oncology/haematology) regardless of location.

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact

Guidance and supporting materials

Scottish

• Vancomycin-resistant enterococci (VRE): Information for healthcare workers, (HPS)
• Vancomycin-resistant enterococci (VRE): Information for patients, (HPS)

UK

• Guidelines for the control of glycopeptide-resistant enterococci in hospitals, (Journal of Hospital Infection)

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. Vesicles appear in the dermatome with affected areas painful with burning or tingling.

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. However, it is not possible to catch shingles from someone with chickenpox.

A shingles vaccine is available to some high-risk groups over 65 years old and immunocompromised individuals.

Incubation Period :

Varicella: 1 to 3 weeks

Shingles: reactivation can occur many years after initial infection.

Exclusion Period :

Chickenpox: until all vesicles have crusted over, usually 5 to 6 days.

Shingles: exclude only if rash is weeping and cannot be covered, until lesions are dry and scabbed.

Period of Infectivity :

Varicella: 1 to 2 days before the rash appears up until all vesicles become dry and have crusted over .

Shingles: infective while the rash oozes fluid, until last blister has dried and scabbed over. The rash typically lasts between two and four weeks.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

Disease : Chickenpox

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Droplet / Airborne

Guidance and supporting materials

UK

• Varicella: the green book, chapter 34, (UKHSA)
• Chickenpox: Public Health Management and Guidance, (UKHSA) 
  
• Chickenpox: Clinical Knowledge Summary, (NICE)

Disease : Shingles

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact / Droplet

Guidance and supporting materials

Scottish

• Shingles, (NHS Inform)

UK

• Shingles (Herpes zoster): the green book, chapter 28a, (UKHSA)
• Shingles vaccination: guidance for healthcare professionals, (UKHSA)

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, Hantavirus 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 to 21 days

Exclusion Period :

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

Period of Infectivity :

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

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

• 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.

Disease : Viral Haemorrhagic Fever

On the Mandatory NHSScotland Alert organism/Condition list : Yes

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : Yes
• 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.

Main route of transmission :

Contact

Guidance and supporting materials

Scottish

• Ebola: Viral Haemorrhagic Fever (VHF) Infection Prevention and Control Precautions Summary for the Hospital Setting, (HPS)
• Advice for Purchase of Required PPE for VHF Preparedness, (HPS)

HCID PPE ensemble update and current position On 23 October 2024, the Advisory Committee on Dangerous Pathogens (ACDP) issued an update to 'Viral Haemorrhagic fever (VHF): ACDP algorithm and guidance on management of patients'.  The IPC content contained within this update is not aligned to the Scottish NIPCM and ARHAI Scotland will be working to review existing materials to align where possible. NHSScotland has not yet moved to the UK unified HCID PPE ensemble.  Work is currently underway to plan operationalisation of this in NHSScotland via a dedicated task and finish group led by ARHAI Scotland.   In the meantime, NHS boards should continue with the PPE ensemble outlined in the VHF entry contained within the A-Z of pathogens for any suspected or confirmed case. A training video outlining PPE donning and doffing sequence for VHF is also available from NES: The correct order for Donning and the safe order for Removal and disposal of Personal Protective Equipment (PPE).ARHAI Scotland will review all other VHF content contained within the  Scottish NIPCM to align it with the ACDP guidance where relevant and  will disseminate updates via the established communication channels and the 'NIPCM latest news' once complete.

UK

• Viral haemorrhagic fevers: epidemiology, characteristics, diagnosis and management, (UKHSA)
• Management of Hazard Group 4 viral haemorrhagic fevers and similar human infectious diseases of high consequence, (DHSC)
• PHE: High consequence infectious diseases (HCID), (UKHSA)
• Public health recommendations for asymptomatic contacts of an Ebola case in the UK, (PHE)

   

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W

Whooping cough

See Bordetella pertussis

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X

No Pathogens

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Y

Yersinia enterocolitica

Y. enterocolitica is a common foodborne pathogen. Infection mainly occurs by ingestion of contaminated food or water, raw or undercooked pork meat being a common contamination source.

Infection with Y. enterocolitica typically manifests as fever, diarrhoea, and abdominal pain in children younger than 5 years. Relapsing disease and, rarely, necrotizing enterocolitis also have been described. In adults and older children, a pseudo appendicitis syndrome attributable to mesenteric lymphadenitis (fever, abdominal pain, tenderness in the right lower quadrant of the abdomen, and leukocytosis) predominates. A major complication of Y. enterocolitica-associated enteric infection is bacteraemia occurring mostly in children younger than 1 year and in older children with predisposing conditions, such as excessive iron storage and immunosuppressive states.

Extraintestinal manifestations of Y. enterocolitica are uncommon and include pharyngitis, meningitis, osteomyelitis, pyomyositis, conjunctivitis, pneumonia, empyema, endocarditis, acute peritonitis, abscesses of the liver and spleen, urinary tract infection, and primary cutaneous infection. Postinfectious sequelae with Y enterocolitica infection include erythema nodosum, reactive arthritis, and proliferative glomerulonephritis.

Incubation Period :

Usually 3-7 days with extremes of 1-12 days reported.

Exclusion Period :

Minimum of 48 hours symptom free/no loose stools.

Period of Infectivity :

Excretion of the organism in stool may persist for several months after infection but infectivity decreases substantially after the first 4 days or so.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

Disease : Yersiniosis

On the Mandatory NHSScotland Alert organism/Condition list : No

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

Contact (faecal/oral)

Guidance and supporting materials

UK

• Recommendations for the Public Health Management of Gastrointestinal Infections 2019. Principles and practice (PHE, Chartered Institute of Environmental Health, Food Standards Agency 2019)

International

• About Yersinia infection, (CDC)

Yersinia pestis

Plague is a rare disease caused by Yersinia pestis, a gram-negative bacterium that is primarily found in wild rodents. The disease occurs in three main forms: pneumonic, septicemic, and bubonic.

Symptoms vary depending on the disease form but most people initially experience fever, chills, headache, and weakness. 

• Bubonic plague affects the lymph nodes, which become inflamed and swollen (termed ‘buboes’). 
• Septicemic plague involves the bloodstream and can occur as a primary infection or due to progression of untreated bubonic plague. 
• Pneumonic plague is the most severe form involving a rapidly developing pneumonia with shortness of breath, chest pain, cough and sometimes bloody or watery mucous.  If untreated, plague can be fatal.

Plague is no longer a risk in the UK.

Humans contract bubonic and septicemic plague after being bitten by an infected rodent flea that is carrying the bacterium, or by handling an animal infected with plague.  Human to human transmission occurs only with pneumonic plague when respiratory droplets are coughed or sneezed from an infected person onto a close contact.  Pneumonic plague is highly infectious.

Treatment with antibiotics is effective if diagnosed promptly. There is currently no effective vaccine.

Incubation Period :

1 to 8 days (usually 1 to 3 days for pneumonic plague)

Exclusion Period :

Until 48 hours after initiation of effective antibiotic therapy (for pneumonic plague)

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : Yes

Disease : Yersinia pestis (Pneumonic plague)

On the Mandatory NHSScotland Alert organism/Condition list : No

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : Yes

Main route of transmission :

Droplet

Guidance and supporting materials

UK

• PHE: High consequence infectious diseases (HCID), (UKHSA)
• Plague: epidemiology, outbreaks and guidance, (PHE) 

International

• Appendix A: Type and duration of precautions recommended for selected infections and conditions, (CDC)

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Z

Zika

Zika virus is a mosquito-borne flavivirus, transmitted by the Aedes mosquitoes.

Zika virus can be transmitted between people during pregnancy (from mother to foetus). Less commonly, Zika virus can be spread from unprotected sex with an infected person, and through blood transfusions or organ transplants from infected donors

Symptoms of infection typically last for 2 to 7 days and are generally mild, including fever, rash, conjunctivitis, muscle and joint pain, fatigue and headache.  Some people can develop neurological complications including Guillain-Barre syndrome, neuropathy and myelitis.  Most people with Zika virus infection do not develop symptoms.

Infection during pregnancy can cause infants to be born with microcephaly and other congenital malformations, known as congenital Zika syndrome.  There is also a risk of preterm birth and miscarriage.

There is no treatment for Zika virus infection and currently no available vaccine.

 

Incubation Period :

3 to 14 days

Period of Infectivity :

The exact timeframe is unknown; aggregated data about detection of Zika virus RNA from case reports indicate a median duration of detection of Zika virus of 40 days (95% CI: 30-49 days) and maximum duration of 370 days in semen, however, infectious virus has only been reported up to 69 days.

Notifiable Organism :

Notifiable organism under Public Health (Scotland) Act 2008 (Schedule 1, part 2 Notifiable Organisms) : No

Disease : Zika virus disease

On the Mandatory NHSScotland Alert organism/Condition list : No

Notifiable Disease

• Notifiable disease under Public Health (Scotland) Act 2008 (Schedule 1, part 1 Notifiable Diseases) : No

Main route of transmission :

• Mainly mosquito bites. However sexual, donor-derived, and vertically (mother to foetus) transmission may also occur.

Guidance and supporting materials

Scottish

• Zika Virus, (NHS Inform)

UK

• Health advice for women returning from a country or area with risk for Zika virus transmission, (PHE)
• Zika virus infection and pregnancy, (Royal College of Obstetricians and Gynaecologists)
• Zika virus (ZIKV): clinical and travel guidance, (UKHSA)

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Footnotes