Notifiable diseases

We have attempted to summarise the new situation, as it has applied in England since 6 April, on this page. This should not be considered definitive, and may include errors. The the list at the PHE web site should be consulted, or the following definitive documents are available:

• Health Protection (Part 2A orders) Regulations
• Health Protection (Notification) Regulations
• Health Protection Legislation (England) Guidance from Department of Health, Health Protection Agency, and Chartered Institute of Environmental Health^[1]

Note that the usual rules on confidentiality are over-ridden by these Regulations: where a practitioner is obliged to notify a disease, they are not subject to the normal restrictions on maintaining patient confidentiality for the purposes of the notification.

Contents 1 Notifiable diseases, with explanatory notes and guidance on the need for urgent notification 1.1 Time frame and process for notifications 2 Data to be included 2.1 Table 1: Notifiable diseases, with explanatory notes and guidance on the need for urgent notification 3 Causative agents, with explanatory notes and guidance on the need for urgent notification 3.1 Table 2: Causative agents, with explanatory notes and guidance on the need for urgent notification 4 Notification for under 8s day care and childminding 5 History of disease notification 5.1 History of disease notification in England 5.2 History of disease notification elsewhere 6 External links 7 References

Notifiable diseases, with explanatory notes and guidance on the need for urgent notification

Time frame and process for notifications

The registered medical practitioner (RMP) should send a written notification to the proper officer of the local authority so that it is received within three days, beginning with the day on which the RMP forms the clinical suspicion or makes the clinical diagnosis.

However, if the RMP considers the case requires urgent notification, they need to notify it orally – usually by telephone – as soon as reasonably practicable and follow this up with written notification within three days. It is recommended that urgent notifications are made as soon as possible after the RMP forms the clinical suspicion or makes the clinical diagnosis, and always within 24 hours.

Guidance on the procedures for notification, and a notification form, are available on the PHE web site. (Notifiers may modify the form to suit their requirements. Some HPUs have altered the form for local use; other RMPs can alter the form if they choose (e.g. to create a template containing their details), but the amended form must continue to include all the fields on the official form.

There is an aspiration that GPs should be able to notify electronically, so that their computer systems automatically recognise a diagnosis of a notifiable disease, and automatically notify it to the proper officer. This will require considerable development work.

According to the guidance:

"Written notifications to the proper officer of the local authority are either paper-based or, if the receiving local authority consents and facilities are available, may be made electronically by secure online reporting, by secure e-mail or by secure fax.

"The details of notification arrangements will usually be available on the local authority’s website. The local authority may indicate its consent to receiving electronic notification on their website."^[2]

Data to be included

According to the guidance, the following data must have been included (to the best of the RMP's knowledge) for each case notified:^[3]

• name, date of birth and sex;
• home address including postcode;
• contact telephone number;
• current residence (if it is not the home address);
• NHS number;
• occupation (if the RMP considers it relevant);
• name, address and postcode of place of work or educational establishment (if the RMP considers it relevant);
• ethnicity;
• relevant overseas travel history;
• contact details of a parent (if the patient is a child);
• disease or infection which the patient has or is suspected of having or the nature of the patient’s contamination or suspected contamination;
• date of onset of symptoms; and
• date of diagnosis; and
• the name, address and telephone number of the RMP making the notification.

Table 1: Notifiable diseases, with explanatory notes and guidance on the need for urgent notification

Notifiable diseases, with explanatory notes and guidance on the need for urgent notification

Disease	Definition / comment	Likely to be urgent?
Acute encephalitis	Viral and bacterial	Yes, if suspected bacterial infection
Acute poliomyelitis		Yes
Acute infectious hepatitis	Close contacts of acute hepatitis A and hepatitis B cases need rapid prophylaxis. Urgent notification will facilitate prompt laboratory testing. Hepatitis C cases known to be acute need to be followed up rapidly as this may signify recent transmission from a source that could be controlled.	Yes
Anthrax		Yes
Botulism		Yes
Brucellosis		No – unless thought to be UK-acquired
Cholera		Yes
Diphtheria		Yes
Enteric fever (typhoid fever or paratyphoid fever)	Clinical diagnosis of a case before microbiological confirmation (e.g. case with fever, constipation, rose spots and travel history) would be an appropriate trigger for initial public health measures, such as exclusion of cases and contacts in high risk groups (e.g. food handlers).	Yes
Food poisoning	Any disease of infectious or toxic nature caused by, or thought to be caused by consumption of food or water (definition of the Advisory Committee on the Microbiological Safety of Food).	Clusters and outbreaks, yes. For specific organisms see Table 2
Haemolytic uraemic syndrome (HUS)		Yes
Infectious bloody diarrhoea	See also HUS in Table 1 (Schedule 1) and VTEC in Table 2 (Schedule 2).	Yes
Invasive group A streptococcal disease and scarlet fever		Yes, if IGAS. No, if scarlet fever
Legionnaires’ Disease		Yes
Leprosy		No
Malaria		No, unless thought to be UK-acquired
Measles		Yes
Meningococcal septicaemia		Yes
Mumps	Post-exposure immunization (MMR or HNIG) does not provide protection for contacts.	No
Plague		Yes
Rabies	A person bitten by a suspected rabid animal should be reported and managed urgently, but if a patient is diagnosed with symptoms of rabies, they will not pose a risk to human health.	Yes
Rubella	Post-exposure immunisation (MMR or HNIG) does not provide protection for contacts.	No
SARS		Yes
Smallpox		yes
Tetanus		No, unless associated with injecting drug use
Tuberculosis		No, unless healthcare worker or suspected cluster or multi drug resistance
Typhus		No
Viral haemorrhagic fever (VHF)		Yes
Whooping cough (Pertussis)		Yes, if diagnosed during acute phase
Yellow fever		No, unless thought to be UK-acquired

NB: RMPs are also required to notify suspected cases of other infections (“other relevant infection”) or contamination (“relevant contamination”) that present, or could present, significant harm to human health - see Health Protection Legislation (England) Guidance sections 3.2 and 3.3

Causative agents, with explanatory notes and guidance on the need for urgent notification

As regards urgency, the key consideration will be the likelihood that an intervention is needed to protect human health and the urgency of such an intervention. The likelihood of the diagnosis of an infection being considered urgent may also increase if it is part of a known or suspected cluster, or in someone with increased risk of transmission such as enteric infection in a food handler.

NB: The table below is only for guidance and each case should be considered individually.

Table 2: Causative agents, with explanatory notes and guidance on the need for urgent notification

Causative agents, with explanatory notes and guidance on the need for urgent notification

Notifiable organism	Definition / comment	Likely to be urgent?
Bacillus anthracis		Yes
Bacillus cereus	Only if associated with food poisoning	No, unless part of a known cluster
Bordetella pertussis		Yes if diagnosed during acute phase
Borrelia spp		No
Brucella spp		No, unless thought to be UK-acquired
Burkholderia mallei		Yes
Burkholderia pseudomallei		Yes
Campylobacter spp		No, unless part of a known cluster
Chikungunya virus		No, unless thought to be UK-acquired
Chlamydophila psittaci		Yes if diagnosed during acute phase or part of a known cluster
Clostridium botulinum		Yes
Clostridium perfringens	Only if associated with food poisoning	No, unless known to be part of a cluster
Clostridium tetani		No, unless associated with injecting drug use
Corynebacterium diphtheriae	Notify without delay, before results of toxigenicity tests are known	Yes
Corynebacterium ulcerans	Notify without delay, before results of toxigenicity tests are known	Yes
Coxiella burnetii		Yes if diagnosed during acute phase or part of a known cluster
Crimean-Congo haemorrhagic fever virus		Yes
Cryptosporidium spp		No, unless part of known cluster, known food handler or evidence of increase above expected numbers
Dengue virus		No, unless thought to be UK-acquired
Ebola virus		Yes
Entamoeba histolytica		No, unless known to be part of a cluster or known food handler
Francisella tularensis		Yes
Giardia lamblia		No, unless part of known cluster, known food handler or evidence of increase above expected numbers
Guanarito virus		Yes
Haemophilus influenzae	Invasive i.e. from blood, cerebrospinal fluid or other normally sterile site	Yes
Hanta virus		No, unless thought to be UK-acquired
Hepatitis A, B, C, delta, and E viruses	All acute and chronic cases	All acute cases and any chronic cases who might represent a high risk to others, such as healthcare workers who perform exposure-prone procedures
Influenza virus		No, unless known to be a new sub-type of the virus or associated with known cluster or closed communities such as care homes
Junin virus		Yes
Kyasanur Forest disease virus		Yes
Lassa virus		Yes
Legionella spp		Yes
Leptospira interrogans		No
Listeria monocytogenes		Yes
Machupo virus		Yes
Marburg virus		Yes
Measles virus		Yes
Mumps virus		No
Mycobacterium tuberculosis complex		No, unless healthcare worker or suspected cluster or multi-drug resistance
Neisseria meningitidis	Excluding asymptomatic cases (e.g. throat carriage)	Yes
Omsk haemorrhagic fever virus		Yes
Plasmodium falciparum, vivax, ovale, malariae, knowlesi		No, unless thought to be UK-acquired
Polio virus	Wild or vaccine types	Yes
Rabies virus	Classical rabies and rabies-related lyssaviruses	Yes
Rickettsia spp		No, unless thought to be UK-acquired
Rift Valley fever virus		Yes
Rubella virus		No
Sabia virus		Yes
Salmonella spp	Including S. Typhi and S. Paratyphi	Yes, if S. Typhi or S. Paratyphi or suspected outbreak or food handler or closed communities such as care homes No, if sporadic case of other Salmonella species
SARS coronavirus		Yes
Shigella spp		Yes, except Sh. sonnei unless suspected outbreak or food handler or closed communities such as care homes
Streptococcus pneumoniae	Invasive i.e. from blood, cerebrospinal fluid or other normally sterile site	No, unless part of a known cluster
Streptococcus pyogenes	Invasive i.e. from blood, cerebrospinal fluid or other normally sterile site, or associated with necrotising soft tissue infection	Yes
Varicella zoster virus		No
Variola virus		Yes
Verocytotoxigenic Escherichia coli	Including E. coli O157	Yes
Vibrio cholerae		Yes
West Nile virus		No, unless thought to be UK-acquired
Yellow fever virus		No, unless thought to be UK-acquired
Yersinia pestis		Yes
Zika virus		No, unless thought to be UK-acquired

Notification for under 8s day care and childminding

According to the HPA website, national standards for childminders and day care organisations for children aged under 8 now require childminders to inform OFSTED of any child with a notifiable disease.^[4]

History of disease notification

History of disease notification in England

Notification was first made mandatory (London 1891, rest of England 1899) the responsibility for notification fell both on the head of household - (or nearest relative - or person in charge of the building), as well as the attending phyisician. This situation existed right up until 1968, when it became sole responsibility of the attending physician

Please see Notifiable diseases in 1984 Public Health Act for the situation as it applied in the UK until 6 April, and as it may still apply in Scotland, Wales, and Northern Ireland since that date.

History of disease notification elsewhere

Template:Sweden According to this ProMED report,<refsec>ProMED-mail. MEASLES UPDATE (09). 20130303.1568573: ProMED-mail, Updated 3 March; Accessed: (3 March)</refsec> "Swedes are required by law to report falling ill to their doctor." It is not clear from the report which illnesses need to be reported, or how "illness" is defined.

External links

• Health Protection (LA powers) Regulations
• Health Protection (Part 2A orders) Regulations
• Health Protection (Notification) Regulations
• Health Protection Legislation (England) Guidance from Department of Health, Health Protection Agency, and Chartered Institute of Environmental Health^[5]
• "Notifications of Infectious Diseases (NOIDs)" page from Public Health England

References