After reading this chapter you should:
be able to follow the UK national guidelines on notification of communicable diseases
know the principles of infection control
be able to advise on immunisation in children with certain medical conditions
know about the appropriate use of antimicrobials
know the current infection control strategies for local, epidemic and pandemic infections
Notification of communicable diseases
Public health services in the UK provide a nationwide system of identifying and managing infectious diseases within the community. The aim is to detect possible outbreaks of disease and epidemics as early and as rapidly as is possible. It is recognised, however, that underreporting is widespread. Registered medical practitioners have a statutory duty to refer a patient to Public Health officials if they are considered to have one of the conditions listed on the UK schedule of Notifiable Disease. Additionally, if the patient is thought to be infected in a way that may cause significant harm to others, then the doctor must notify the local health protection team. Laboratories must also report to the Public Health Service if they isolate any of the listed causative organisms.
The list is updated periodically and does change with local disease outbreaks or worldwide health threats. In 2020 there were 33 infectious diseases which required notification.
|those preventable by routine vaccines||mumps, measles, rubella, diphtheria, whooping cough|
|those which spread quickly and for which a ‘source’ may be identifiable||food poisoning, haemolytic uraemic syndrome, Legionnaires’ disease|
|those from overseas||malaria, viral haemorrhagic fever, enteric fever|
|those which spread through populations and can be carried asymptomatically||tuberculosis, meningococcal septicaemia, SARS, COVID-19|
|other common paediatric conditions||acute encephalitis, acute meningitis, invasive Group A streptococcal disease, scarlet fever|
Knowledge of common infections in children, their routes of transmission, incubation periods and methods to prevent transmission is important and timely clinical diagnosis or suspicion of an infection is the first step in infection control. Microbiological samples should then be sent promptly for confirmation.
Modes of transmission
Droplets may be generated from the respiratory tract during coughing, sneezing, talking or singing. If droplets from an infected person come into contact with the mucous membranes or surface of the eye of a recipient, they can transmit infection. These droplets remain in the air for a short period of time and travel up to two metres, so physical distancing helps limit transmission.
Aerosols are smaller than droplets and can remain in the air for longer and, therefore, potentially transmit infection by mucous membrane contact or inhalation. Aerosol-generating procedures are therefore high risk for spreading infection.
Contact transmission may be direct or indirect. Infectious agents can be inadvertently passed directly from an infected person to a recipient who may then transfer the organism to the mucous membranes of their mouth, nose or eyes. Indirect contact transmission takes place when a recipient has contact with an object, such as furniture or equipment that an infected person may have contaminated by coughing or sneezing. Correct hand hygiene is, therefore, important in controlling the spread of disease.
The time period during which an infected person can transmit infection to someone else varies depending on the pathogen and person.
Standard precautions are work practices that are required to achieve a basic level of infection prevention and control and are recommended for the treatment and care of all patients. These precautions include hand hygiene with soap and water or alcohol gel, glove use and a ‘bare below the elbow’ policy for staff to allow effective hand-washing. The World Health Organisation promotes the principle of the ‘Five Moments of Hand Hygiene’ when hands should be washed:
before touching a patient
before a clean or aseptic procedure
after exposure to body fluids
after touching a patient
after touching the patient’s surroundings
Transmission-based precautions are recommended for patients known or suspected to be infected or colonised with infectious agents that can spread and may not be contained by standard precautions alone. Patients who require transmission-based precautions should be isolated in individual side rooms.
Personal protective equipment refers to a variety of barriers which must be used alone or in combination, to protect mucous membranes, airways, skin and clothing from contact with infectious agents and includes apron or gown, gloves and surgical mask. For procedures in patients with highly infectious disease which may generate an aerosol then protective eyewear, face shields or an FFP3 respirator should be considered. Local workplace infection control policies for general procedures and specific infections should be followed.
Contact tracing is an important part of limiting the spread of some infectious diseases. An assessment should be made regarding the risk of transmission of infection to any contacts in the household, at work, during social events and normal daily activity. For some infections such as meningococcal disease, antibiotic prophylaxis would be offered to significant contacts.
Frontline health staff should be up to date with immunisations and be aware of their own immunity to protect themselves from vaccine preventable infectious diseases. This would include MMR, BCG, Hepatitis B, Influenza and Varicella vaccinations.
Vaccination has made a massive positive impact on the global health burden, frequently quoted as being only second to that of the provision of clean water and sanitation. The UK childhood immunisation schedule provides protection against a range of conditions and a standard schedule is in place.
The immunisation programme is designed to protect the very young from dangerous diseases whilst ongoing boosters offer continuing coverage. The ages chosen for immunisation balances the risk of the disease against the ability to respond to the vaccine ( Table 13.1 ). The schedule may change at short notice and the most up-to-date listing is found on the UK government website.