As a junior doctor, it is your statutory duty as a medical professional to alert the local public health team to a new or suspected diagnosis of a notifiable disease or condition. Often for infectious diseases, this is handled by the microbiology or infectious disease teams so do check the local policy at your hospital.
What are they?
Notifiable diseases refer to those conditions outlined by Public Health England, allowing them to monitor the number of cases & identify any potential outbreaks to mount a quick and effective public health response. This statutory duty is outlined in the Health Protection (Notification) Regulations 2010 and the Public Health (Control of Disease) Act 1984.
The local Public Health team should be informed about:(1) Any notifiable disease
(2) Any notifiable organism which could result in significant harm to health – this will likely be identified and flagged up by your local microbiology laboratory.
(3) Exposure to any hazards that could result in significant harm to health such as carbon monoxide, mercury, lead, radiation
|Disease||Whether likely to be routine or urgent|
|Acute infectious hepatitis||Urgent|
|Acute meningitis||Urgent if bacterial suspected, otherwise routine|
|Brucellosis||Routine (Urgent if acquired in the UK)|
|Enteric fever (typhoid or paratyphoid fever)||Urgent|
|Food poisoning||Routine (Urgent if a cluster or outbreak)|
|Haemolytic uraemic syndrome (HUS)||Urgent|
|Infectious bloody diarrhoea||Urgent|
|Invasive group A streptococcal disease||Urgent|
|Malaria||Routine (Urgent if acquired in the UK)|
|Severe Acute Respiratory Syndrome (SARS)||Urgent|
|Tetanus||Routine (Urgent if associated with IVDU)|
|Tuberculosis||Routine (Urgent if in healthcare worker, cluster or MDR)|
|Viral haemorrhagic fever (VHF)||Urgent|
|Whooping cough||Urgent if diagnosed in acute phase, Routine otherwise|
|Yellow fever||Routine (Urgent if acquired in the UK)|
|Other Hazards (Urgent)||Carbon Monoxide, Lead, Mercury, Radiation|
Cases occurring as a cluster: c difficile, norovirus
Cases where vulnerable contacts at risk:
healthcare workers, pregnant/immunocompromised
How do I notify?
Step 1: Decide if it is urgent or routine (use the above list to support you but you MUST discuss with your registrar or consultant)If your disease isn’t on the list, but you think PHE should be aware, discuss with your consultant. Factors to consider include:
- Ease of transmission
- Methods of spread
- Can the spread be easily prevented?
- Circumstances of the patient i.e. occupation, vulnerable contacts, age, medical history
Step 2: Gather information – Ensure you have to hand the required data:
- Name, DOB, NHS number
- Contact details inc. telephone number and address
- GP Details
- Place of work
- Overseas travel
Inform your patient you will notify Public Health England, always take consent and try to keep the patient informed to the best of your ability. If the patient does not want you to pass on any information, inform them that this is your statutory duty.
Step 3: Notify!
If the case is urgent, you will need to call your local public health team BY PHONE within 24hrs. It is imperative to act fast as it is these first 24hrs in that are critical for deciding upon and employing key public health safety measures. You can find your local public health team using your hospital postcode here.
After telephone notification, you must follow up by submitting the written form within 3 days.
For routine cases, inform public health by filling in a notification form ideally on clinical diagnosis or if this is not possible within 3 days. The form is available here.
What happens next?
PHE will then use this information to undertake a joint risk assessment – analysing any contacts who have been exposed, linked cases, vaccination history, any vulnerability of contacts, and any potential source of infection.
PHE will then provide advice on isolation, decontamination, post-exposure prophylaxis, control measures, and any further tests needed.
From this point, it is the responsibility of PHE to use the information you have given in a wider national context.
Scotland is protected by The Public Health etc. (Scotland) Act 2008, with a Part 2 (Notifiable Diseases, Notifiable Organisms and Health Risk States) which was initiated in 2010. All doctors must notify their local health board if they have a suspicion that a patient has a notifiable disease, without waiting for laboratory confirmation. This is done via the Scottish Care Information (SCI) gateway. Urgent notifications are made over the phone and followed up in writing within three days. If practitioners do not have access to the SCI gateway there is an alternative notifications form available on their website.
A registered medical professional must notify the proper officer of the relevant local authority if the patient has or is suspected to have a notifiable disease. Similar to England and Scotland, notification needs to be made in writing within three days. If the case is considered urgent, notification needs to be made immediately over the phone.
- PHE: Summary poster of notifiable diseases
- Gov.uk: Notifiable Diseases and causative organisms – how to report
- Gov.uk: Local Health Protection Team finder
- Health Protection Scotland, Notifiable Diseases Form
- Public Health Wales: About the Notification of Infectious Disease in Wales
- MDU: Notifiable infectious diseases
Written by Dr Varthani Kirupanandan (FY1)
Edits by Dr Seher Bashir (SHO)
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