Communicable Disease Control Handbook About the authors Dr JeremyHawker isDeputyDirectoroftheLocalandRegionalServicesDivision oftheHealthProtectionAgency,England.HehaspreviouslyworkedasRegionalEpidemiologist intheWestMidlandsregionofEnglandandasConsultantinCommunicableDiseaseControl inBirmingham,UK.HeholdsanhonoraryacademicappointmentattheUniversityof Birmingham.Hisparticularinterestsaretraininginhealthprotectionandeffectivepublic healthpractice. Dr NormanBegg istheformerheadoftheImmunisationDivisionofthePublic HealthLaboratoryService(nowtheHealthProtectionAgency)andhasservedasDeputyDirector oftheCommunicableDiseaseSurveillanceCentre.Hehaspublishedextensivelyinthefieldof immunisation,includingco-editing‘ImmunisationAgainstInfectiousDisease’,thebookthat describesimmunisationpolicyintheUK.HeisalsoaformerchairoftheWHOEuropean AdvisoryGrouponImmunisation.HeisnowDirectorofMedicalAffairsatGlaxoSmithKline. Dr IainBlair isaConsultantforCommunicableDiseaseControl(CCDC)andDirector oftheHampshireandIsleofWightHealthProtectionUnit(UK).HehasservedasCCDCinthree otherareasandasaRegionalInfectiousDiseaseEpidemiologist.Heisanhonoraryseniorlecturer atBirminghamUniversityand,havingoriginallytrainedasageneralpractitioner,hasworkedin CanadaandtheMiddleEast. Professor Ralf Reintjes hasworkedinmanyEuropeancountriesasaconsultant forWHOandtheEU.HewasaFellowofthe‘EuropeanProgrammeforIntervention EpidemiologyTraining(EPIET)’attheNationalInstituteofPublicHealthandtheEnvironment (RIVM)intheNetherlandsandistheformerheadoftheDepartmentofHygiene,Infectious DiseaseEpidemiology,andVaccinationsinNorthRhine-Westphalia,Germany.Heisnow ProfessorforEpidemiologyandPublicHealthSurveillanceinHamburg,Germany,andvisiting lecturerinTampere,Finland.HehaspublishedextensivelyinthefieldofCommunicableDisease EpidemiologyandSurveillance. Professor Julius Weinberg trainedasanInfectiousDiseasePhysician,and theninPublicHealth.HehasworkedinZimbabweandEasternEuropeaswellastheUK.Hewasa ConsultantEpidemiologistandHeadofEpidemiologicalProgrammesatthePHLS/CDSCand wasinvolvedinthedevelopmentofInternationalInfectiousDiseaseSurveillancecollaborations. HeiscurrentlyinvolvedinthedevelopmentoftheUKNationalElectronicLibraryforInfection andactedasexpertadvisortoaHouseofLordsSelectCommitteeinquiryintoinfectiousdisease services.HeisPro-ViceChancellorforResearchandDirectoroftheInstituteforHealthSciences atCityUniversityinLondon. Communicable Disease Control Handbook Dr Jeremy Hawker DeputyDirector,LocalandRegionalServices,Health ProtectionAgency,UK Dr Norman Begg Directorof MedicalAffairs,GlaxoSmithKline, Uxbridge,UK Dr Iain Blair ConsultantinCommunicableDisease,HealthProtection Agency,Hampshire,UK Professor Ralf Reintjes ProfessorforEpidemiologyandPublicHealth Surveillance,HamburgUniversityofAppliedScience,Germany Professor Julius Weinberg Pro-ViceChancellor,CityUniversity, London,UK Second edition ©2005JeremyHawker,NormanBegg,IainBlair,RalfReintjesandJuliusWeinberg PublishedbyBlackwellPublishingLtd BlackwellPublishing,Inc.,350MainStreet,Malden,Massachusetts02148-5020,USA BlackwellPublishingLtd,9600GarsingtonRoad,OxfordOX42DQ,UK BlackwellPublishingAsiaPtyLtd,550SwanstonStreet,Carlton,Victoria3053,Australia TherightoftheAuthorstobeidentifiedastheAuthorsofthisWorkhasbeenassertedinaccordancewiththe Copyright,DesignsandPatentsAct1988. 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Contents Foreword,ix 3.15 Coxsackievirusinfections,86 Abbreviations,xi 3.16 Cryptosporidiosis,88 3.17 Cyclosporiasis,93 3.18 Cytomegalovirus,93 Section1:Introduction 3.19 Denguefever,94 1.1 Howtousethisbook,3 3.20 Diphtheria,95 1.2 Basicconceptsintheepidemiologyand 3.21 Encephalitis,acute,98 controlofinfectiousdisease,5 3.22 Enterococci,including 1.3 Healthprotectionon-call,10 glycopeptide-resistantenterococci,98 3.23 Epstein–Barrvirus,100 3.24 EscherichiacoliO157(andotherE.coli Section2:Commontopics gastroenteritis),101 2.1 Meningitisandmeningism,17 3.25 Giardiasis,106 2.2 Gastrointestinalinfection,20 3.26 Gonorrhoea,syphilisandotheracute 2.3 Community-acquiredpneumonia, STIs,108 28 3.27 Hantavirus,111 2.4 Rashinpregnancy,29 3.28 Headlice,112 2.5 Rashandfeverinchildren,34 3.29 Helicobacterpylori,114 2.6 Illnessinreturningtravellers,37 3.30 HepatitisA,115 2.7 Sexuallytransmittedinfections,38 3.31 HepatitisB,118 2.8 Jaundice,42 3.32 HepatitisC,122 2.9 Infectionintheimmunocompromised, 3.33 Deltahepatitis,125 43 3.34 HepatitisE,125 2.10 Blood-borneviralinfections,45 3.35 Herpessimplex,126 2.11 Vaccinequeries,49 3.36 Haemophilusinfluenzaetypeb,127 3.37 HIV,129 3.38 Influenza,135 Section3:Diseases 3.39 JapaneseBencephalitis,141 3.1 Amoebicdysentery,55 3.40 Kawasakisyndrome,141 3.2 Anthrax,56 3.41 Legionellosis,142 3.3 Bacilluscereus,59 3.42 Leprosy,145 3.4 Botulism,60 3.43 Leptospirosis,146 3.5 Brucellosis,65 3.44 Listeria,148 3.6 Campylobacter,67 3.45 Lymedisease,150 3.7 Chickenpoxandshingles 3.46 Malaria,151 (varicella-zosterinfections),71 3.47 Measles,154 3.8 Chlamydiapneumoniae,73 3.48 Meningococcalinfection,156 3.9 Chlamydiapsittaci,75 3.49 Molluscumcontagiosum,161 3.10 Chlamydiatrachomatis(genital),77 3.50 MRSA(methicillin-resistant 3.11 Cholera,78 Staphylococcusaureus),162 3.12 CJD(Creutzfeldt–Jakobdisease)and 3.51 Mumps,165 otherhumantransmissiblespongiform 3.52 Mycoplasma,166 encephalopathies,80 3.53 Norovirus,168 3.13 Clostridiumdifficile,82 3.54 Ophthalmianeonatorum,170 3.14 Clostridiumperfringens,84 3.55 Paratyphoidfever,171 v vi Contents 3.56 ParvovirusB19(fifthdisease),173 4.3 Managinginfectiousdiseaseincidents 3.57 Plague,174 andoutbreaks,275 3.58 Pneumococcalinfection,176 4.4 Communityinfectioncontrol,282 3.59 Poliomyelitis,179 4.5 Healthcare-associatedinfection, 3.60 Qfever,180 285 3.61 Rabies,182 4.6 Riskstoandfromhealthcareworkers, 3.62 Relapsingfever,184 290 3.63 Respiratorysyncytialvirus,185 4.7 Co-ordinationofimmunisation 3.64 Ringworm,187 services,295 3.65 Rotavirus,190 4.8 Co-ordinationofservicesforHIV 3.66 Rubella,192 infectionintheUK,298 3.67 Salmonellosis,193 4.9 Servicesfortuberculosiscontrol, 3.68 SARS(Severeacuterespiratory 299 syndrome),197 4.10 Travelhealthandillnessinreturning 3.69 Scabies,200 travellers,302 3.70 Shigella,203 4.11 Non-infectiousenvironmentalhazards, 3.71 Smallpox,206 305 3.72 Staphylococcalfoodpoisoning,208 4.12 Managingacutechemicalincidents, 3.73 Streptococcalinfections,209 310 3.74 Tetanus,212 4.13 Managingacuteradiationincidents, 3.75 Threadworms,213 313 3.76 Tick-borneencephalitis,214 4.14 Deliberatereleaseofbiological, 3.77 Toxocara,214 chemicalorradiologicalagents,315 3.78 Toxoplasmosis,215 4.15 Porthealth,324 3.79 Tuberculosis,216 4.16 Mediarelations,325 3.80 Tularaemia,225 4.17 Clinicalgovernanceandaudit,327 3.81 Typhoidfever,226 3.82 Typhus,otherrickettsialinfectionsand Section5:Communicabledisease ehrlichiosis,228 controlinEurope 3.83 Vibrioparahaemolyticus,230 3.84 Viralhaemorrhagicfevers,232 5.1 Introduction,333 3.85 Wartsandverrucae,235 5.2 Austria,335 3.86 WestNilevirus,236 5.3 Belgium,336 3.87 Whoopingcough,237 5.4 Cyprus,339 3.88 Yellowfever,240 5.5 CzechRepublic,340 3.89 Yersiniosis,241 5.6 Denmark,342 3.90 Otherhazards,243 5.7 Estonia,344 1 Helminths,243 5.8 Finland,345 2 Protozoa,251 5.9 France,347 3 Fungi,251 5.10 Germany,349 4 Rareviruses,251 5.11 Greece,351 5 Bites,stingsandvenoms,251 5.12 Hungary,352 6 Chemicalfood-borneillness,263 5.13 Ireland,353 5.14 Italy,354 5.15 Latvia,356 Section4:Servicesand 5.16 Lithuania,358 organisations 5.17 Luxembourg,358 4.1 Administrativearrangementsfor 5.18 Malta,360 communicablediseasecontrol,267 5.19 TheNetherlands,361 4.2 Surveillanceofcommunicabledisease, 5.20 Norway,363 271 5.21 Poland,364 Contents vii 5.22 Portugal,366 Appendices 5.23 Slovakia,368 1 Usefuladdressesandtelephone 5.24 Slovenia,369 numbers,379 5.25 Spain,371 2 Guidancedocumentsandbooks,380 5.26 Sweden,372 5.27 Switzerland,374 5.28 UnitedKingdom,376 Index,385 Foreword Inthemid1960s,abeliefbegantogrowthat surveillancemechanisms,toensureearlyde- communicable diseases might soon be con- tectionofsuchanevent. finedtothehistorybooks,asamajorhealth Added to these conventional threats, the problem of past centuries. Events over the spectreofbioterrorismnowloomslarge.This lasttwodecadeshaveshownhowmisguided bringsconsequencesforidentifyingandman- suchideaswere.Infectioncontinuestopresent agingpreviouslyrarediseasessuchasanthrax freshchallenges,bothhereinthiscountryand orplague,oraneliminateddiseaselikesmall- worldwide. pox.Itunderlinestheneedforinternational Eventssuchasthesevereacuterespiratory co-operation.SARS,althoughanaturallyoc- syndrome (SARS) outbreak in 2003 demon- curring disease, demonstrated how interna- strateveryclearlythatnaturalthreatsareever tional medical and scientific networks can present.Worldwide,HIVandAIDScontinue respond really effectively to meet the chal- tocausedevastatinglossoflife,economicruin lenges posed by significant global threats. andpoverty.Collectively,politicalleadersas Learning,constantlyupdatingourknowledge wellastheinternationalscientificandmed- and experience are key components of ef- icalcommunityhaveyettofindaneffective fective disease control. Consequently, I am means of prevention and control. Closer to very pleased to see the emphasis given in home, tuberculosis and antimicrobial resis- thiseditionofthehandbooktointernational tance,includingthespreadofinfectionssuch health. as methicillin-resistant Staphylococcus aureus In2002,inrecognitionofthesevariouswide (MRSA),challengethepopulation’shealthand ranging and ongoing needs I published my thesafetyofhealthcare.Theemergenceofdis- strategyforInfectiousDiseasesGettingAhead easeslikeWestNilevirusinhithertounaffected of the Curve. To make sure the UK was well partsoftheworld(theUSAandCanada)are placed to maintain and extend existing ar- a warning of the ever present threat of new rangementsforprotectingthepublic,thisrec- andemerginginfectiousdiseases.In2003,the ommendedtheestablishmentofanewHealth identificationoftwoincidentsassociatedwith ProtectionAgency.Theagencycameintoforce European bat lyssa virus (a rabies virus), in in2003andbringsexpertiseininfection(and EnglandandinScotlandwasjustanotherex- toxicologyandradiology)togetherwithemer- ample of how we need to expect the unex- gency preparedness. It builds on previously pected. strongarrangementsprovidedbytheformer The spread in the last one to two years of PublicHealthLaboratoryService.Theagency’s avianinfluenzainEasternAsiapresentsareal aimsaretodevelopandintegratethesurveil- and present danger to public health world- lanceofdisease,andalsoco-ordinatethere- wide. Those countries that have the respon- sponse,linkingintohospitals,communities sibilityfordealingwithpotentialinfectionin and other organisations. Veterinary surveil- humans,whohavecontactwithinfectedpoul- lancenetworksarebeingalignedwithhealth try,needtobeabletorespondappropriately. systems. Consultants in communicable dis- Theglobalcommunitygenerallymustprepare easecontrolremainattheforefrontofdeliv- forthepossibilityoftheemergenceofapan- eryoflocalinfectionservices,togetherwith demicinfluenzastrain.Influenzapandemics manyothers–infectiousdiseasedoctorsand occurinregularcyclesovertheyearsandwe nurses,microbiologists,communityandhos- needtobeconstantlyvigilant,withthehelpof pital infection control nurses immunisation theWorldHealthOrganization(WHO)andits co-ordinators. ix x Foreword Today, infection is everyone’s business – sourceofdetailedinformationforeveryonein citizens, political leaders, doctors, scientists thefieldofcommunicablediseasecontrol. andotherhealthprofessionalsalike.Itisno longer a quiet backwater of interest only to SirLiamDonaldson thespecialist.Thiscomprehensiveandprac- ChiefMedicalOfficer ticalhandbookwillprovideaveryaccessible England Abbreviations ACDP Advisory Committee on Dangerous HUS Haemolyticuraemicsyndrome Pathogens ICD Infectioncontroldoctor(hospital) AIDS Acquired immunodeficiency syn- ICN Infectioncontrolnurse drome ICT Infectioncontrolteam(hospital) BCG Bacille Calmette–Gu´erin (vaccine IDU Intravenousdruguser againstTB) IFA Indirect immunofluorescent anti- CCDC Consultant in Communicable Dis- bodytest easeControl(localpublichealthdoc- IgG ImmunoglobulinclassG torwithexecutiveresponsibilitiesfor IgM ImmunoglobulinclassM CDC) IPV Inactivatedpoliovirusvaccine CDC Communicablediseasecontrol LA LocalAuthority CDR Communicablediseasereport MMR Measles, mumps and rubella vac- CDSC HPACommunicableDiseaseSurveil- cine lanceCentre MRSA Methicillin-resistantStaphylococcus CICN Community infection control aureus nurse NCJDSU NationalCJDSurveillanceUnit CJD Creutzfeldt–Jakobdisease OPV Oralpoliovirusvaccine CNS Centralnervoussystem Pa Pertussisvaccine(acellular) CSF Cerebrospinalfluid PCR Polymerasechainreaction DNA Deoxyribonucleicacid PHLS Public Health Laboratory Service DTP Diphtheria,tetanusandpertussis (nowpartofHPA) ECDC EuropeanCentreforDiseasePreven- PT Phagetype tionandControl RCGP RoyalCollegeofGeneralPractition- EHO Environmentalhealthofficer ers ELISA Enzyme-linked immunosorbent as- RNA Ribonucleicacid say RSV Respiratorysyncytialvirus EM Electronmicroscopy SARS SevereAcuteRespiratorySyndrome EU EuropeanUnion SCIEH Scottish Centre for Infection and GI Gastrointestinal EnvironmentalHealth GP General practitioner (primary care sp. Species physician) STI Sexuallytransmittedinfection GUM Genitourinarymedicine TB Tuberculosis HA HealthAuthority TSE Transmissablespongiformenceph- HAI Hospital-acquiredinfection alopathy HBV HepatitisBvirus UK United Kingdom of Great Britain HCV HepatitisCvirus andNorthernIreland HCW HealthCareWorker VHF Viralhaemorrhagicfever Hib Haemophilusinfluenzaetypeb VRE VancomycinresistantEnterococcus HIV Humanimmunodeficiencyvirus VTEC Verocytotoxin producing Escheri- HNIG Humannormalimmunoglobulin chiacoli HP HealthProtection VZIG Varicella-zosterimmunoglobulin HPA HealthProtectionAgency WHO WorldHealthOrganization(OMS) xi