Communicable Disease Control
·
Reasons for notification:
o High morbidity and mortality (in epidemiology terms, ie deaths per
100,000 of well population).
o Intervention available
o Other:
§ High public interest. Eg CJD – is
both rare and untreatable
§ Historical. Eg decompression
sickness
·
Notifiable Diseases:
o Under Health Act 1956
§ Section A: infectious diseases notifiable to a medical officer of Health and Local Authority
§ [involve water or food transmission]: acute gastro-enteritis (where common source or person in high risk occupation), cholera, giardiasis, legionellosis, primary amoebic meningoencephalitis, shigellosis, yersiniosis, campylobacteriosis, cryptosporidiosis, Hepatitis A, Listeriosis, salmonellosis, typhoid and paratyphoid fever
§ Section B: infectious diseases notifiable to Medical Officer of Health: AIDS, CJD, HIB, Hepatitis C, Hydatid disease, Leptospirosis, measles, Neisseria meningitidis, plague, rabies, rickettsial diseases, tetanus, yellow fever, anthrax, brucellosis, diphtheria, Hepatitis B, Leprosy, malaria, mumps, pertussis, poliomyelitis, rheumatic fever, rubella
§ Notifiable non-infectious diseases: cysticercosis, taeniasis,
trichinosis, decompression sickness, lead poisoning, poisoning from
contamination of the environment
o All forms of TB (under TB Act 1948)
o Venereal Diseases Act (1986?): covers gonorrhoea and syphilis, and
contract tracing
·
Classification of notifiable
diseases:
§ Vaccine preventable diseases
§ Blood borne and sexually transmitted diseases
§ Food and water borne diseases
§ Vector borne eg Malaria
§ Zoonoses (ie animal stage) eg Brucellosis, Hydatids, Rabies
§ Other Infectious diseases: eg CJD, Hepatitis, Leprosy, TB
§ Non-infectious diseases: Decompression illness, Lead poisoning,
environmental contamination
· Process of notification:
o Is a legal requirement, although compliance is poor with common things
like campylobacter. Only a small proportion contact doctor, only a few of these
tested, only a few of these reported, etc
o When to notify:
§ If serious on suspicion (eg meningitis)
§ If not serious (eg gastroenteritis) then on confirmation
·
Possible interventions:
o Food borne – isolate source and close it down
o If AIDS and spread by blood products ® screen blood
o If AIDS and confined to a locality ® education campaign
·
Surveillance system:
o Report to medical officer of health
o Clinical labs also report to medical officer of health (if a special case then refer sample to the CDC Reference Lab – ESR).
o These all report to the CDC Epidemiology Group (also at Porirua), produce the Public Health Report
o In turn report to the Ministry of Health and MAF, so they can form
surveillance and disease control policy (eg vaccination and screening policy,
promotion, etc)
o Other surveillance systems: coroner, Births, Deaths and Marriage, OSH,
Cancer Registry
·
Epidemics:
o An outbreak or epidemic is relative, is „more than you would expect‟
o An outbreak investigation involves analysis of the time over which illnesses have occurred, the places and the characteristics of the people affected
o Patterns of epidemic:
§ Point source out-break (eg food poisoning) – short duration
§ Multiple source out-break: eg measles, index case spreads to multiple
cases – long duration with fluctuating incidence
o Want to find:
§ Agent
§ Vector
§ Source
§ Can affect rate without known the agent. Eg cholera was controlled
through clean water in London before the bug was discovered
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