Authors: Emily J S Hubbard, Louisa Kent, Muhammad Abid
Publication date: 03 Mar 2010
Emily J S Hubbard and colleagues outline the role of junior doctors in reporting cases of infectious diseases
It’s a busy Saturday night in the emergency department, and you are the junior doctor on call. Baby Sam comes in with suspected meningococcal meningitis. He is being treated with intravenous antibiotics. His parents are distraught. Not only are they worried about Sam, but they have two other young children and are scared that they will get it too.
What do you do? How can we protect others? And what is your responsibility? The notification of specific infectious diseases is an integral part of medical practice. Although the information in this article relates to practice in the United Kingdom only, the importance of recognising and reporting suspected cases of a notifiable disease is universal (see the World Health Organization’s International Health Regulations, 2005).
The process of disease notification and the list of diseases that are notifiable will vary from country to country. For information on practice outside the UK, please contact your local public health offices or communicable disease centre for advice and guidance.
In the UK it is a legal requirement under the Public Health (Control of Disease) Act 1984 and the Public Health (Infectious Diseases) Regulations 1988 for the treating clinician to report a notifiable disease.
There are several important reasons to notify. Firstly, it initiates a response by the Health Protection Agency (HPA) to a particular case. This can allow the tracing of the source and the prevention of spread to others. It also allows for disease monitoring so that outbreaks can be detected early and acted upon. On a wider scale, the incidence of each disease can be monitored to assess its burden and to assess the effects of public health interventions, such as vaccination programmes and other interventions.
Junior doctors are often the first point of contact for patients who present to hospital with an infectious disease, and they therefore have a responsibility and legal duty to recognise and report notifiable diseases to the correct authority. Some hold the opinion that awareness of public health medicine is increasing among juniors while some senior doctors are less aware. The responsibility to notify may, therefore, fall to junior members of the team.
Recently, a survey of foundation doctors working in the Oxford Radcliffe Trust was carried out to assess knowledge of which diseases are notifiable and how to notify these diseases. For some diseases, as few as 11% of foundation doctors recognised the disease as notifiable and 45% did not know whom to contact to report a case.
This survey highlights the need for more accessible information and more user friendly guidelines for foundation doctors. Turn to the British National Formulary or the internet for help, and you are given the following guidance: “Doctors must notify the proper officer of the local authority when attending a patient suspected of suffering from certain infectious diseases.” So, what does this really mean?
What is a “proper officer”?
A proper officer is usually a consultant in communicable disease control who can be informed through your local Health Protection Unit (HPU). Your local HPU can be found on the HPA website (www.hpa.org.uk) by entering your postcode into the “HPA in your region” search box.
Which diseases are notifiable?
A list of notifiable diseases can be found in the British National Formulary, on the HPA website, in general practices, or from your local HPU.
Who is responsible for notification?
You are responsible for notification. As soon as you qualify as a doctor it is your legal duty to notify these infectious diseases when you attend a patient suspected of having any of the conditions given in the box.
Diseases notifiable (to local authority proper officers) under the Public Health (Infectious Diseases) Regulations 1988
Meningococcal septicaemia (without meningitis)
Viral haemorrhagic fever
How do I notify?
When you are caring for a patient with a clinically suspected or laboratory confirmed notifiable disease, you need to notify your local HPU. Patient consent is not required. When to contact your HPU depends on the disease suspected—for example, you should report suspected bacterial meningitis immediately, whereas a case of mumps can wait until the next working day. You can notify your HPU by telephone or by filling out a notification form and sending it by post or fax.
How do I find the notification form?
Copies of the form can be obtained from your local HPU, in general practices, from your infection control nurse, or on your trust’s clinical intranet.
What information is required by the HPU?
The most important thing is to make your HPU aware. The minimum details your HPU will require are the patient’s name, date of birth, occupation, and contact telephone number; details of the suspected or confirmed disease; date of onset of illness; and the patient’s general practitioner’s details. Other information that may be useful includes the patient’s vaccination history, travel history, and so on. The HPU will take your contact details and may get in touch for further information or to advise you on further action to protect yourself and others.
Back to baby Sam
The HPU would assess whether any close contacts of Sam require antibiotic prophylaxis to reduce carriage of Neisseria meningitidis, with the aim of preventing further cases. This would involve contacting other members of the household, his nursery, and so on, to determine the risk to those in contact with Sam.
To find more information about notifiable diseases, go to your local HPA website: www.hpa.org.uk.
Competing interests: None declared.
- Public Health (Control of Disease) Act 1984. HMSO.
- The Public Health (Infectious Diseases) Regulations 1988. HMSO.
- A McCormick. The notification of infectious diseases in England and Wales . CDR Review: vol 3, Review No 2. 29 January 1993. R19-R25.
- British National Formulary . 57th ed. British Medical Association and Royal Pharmaceutical Society of Great Britain, 2009.
- Thames Valley Health Protection Unit. On-call handbook . 2004.
Emily J S Hubbard foundation year 2 doctor
Royal Berkshire Trust, Royal Berkshire Hospital, Reading RG1 5AN
Louisa Kent specialist trainee year 1 doctor Oxford Radcliffe Trust, Oxford OX3 9DU
Muhammad Abid consultant in communicable disease control Thames Valley Health Protection Unit, Oxford OX11 0RQ
Correspondence to: E J S Hubbard firstname.lastname@example.org