Cumbria & Lancashire Health Protection Unit
On-Call Guidelines
(Revised 28th June 2002)

Contents

1.1 Infectious Diseases

1.2 Chemical Incidents

1.3 Radiation Incidents

1.4 Other Environmental Health

 

1.1 Infectious Diseases

Meningitis (Back to top)

Meningococcal Meningitis: object of immediate action is to prevent further cases.

Brief Checklist:

Case definitions for Meningococcal disease:

Cases of Meningococcal disease can be classified as confirmed, probable and possible.

Contacts requiring prophylaxis:

Give prophylaxis to contacts of confirmed or probable cases as listed below.

Contacts not requiring prophylaxis:

Choice of prophylaxis:

Dosage of Rifampicin:

Adults (and children over 12 years of age)

Children

Contraindications to Rifampicin:

Alternative therapy for adults and children aged over 12 years:

Haemophilus Meningitis (Hib):

Prophylaxis is only indicated if there is another child in the household under the age of four years who is not fully vaccinated against Haemophilus Influenzae.

Action: Rifampicin chemoprophylaxis (NB different dosage than for meningococcal prophylaxis)

Note: Swabbing of contacts has no place in the control of infection.

Prophylaxis: Rifampicin is the drug of choice.

Only where there is another un-immunised or incompletely immunised child of three years or less in the index case household, then all household contacts, adults and children should receive prophylaxis.

Nursery/day care contacts only where two or more cases have occurred within 120 days (also immunisation needs to be considered).

Dosage of Rifampicin:

Click Here for Hib Policy (pdf)

Meningitis due to other organisms: No immediate public health action required for Meningitis due to pneumococcus, E-Coli, Tuberculous and Viral Meningitis.

 

Blood-borne Viruses (Back to top)

HIV

Note: Please also see guidance regarding Hep B (C) which may well be appropriate – see flowchart on following page.

Where contact exposed to risk of infection from a known HIV positive individual prophylaxis with AZT is advised and, ideally, should be given within two hours of exposure or as soon as possible thereafter. This should be discussed with the on-call consultant and ID physician who will arrange counselling and further follow up.

Parenteral Hepatitis Virus Transmission

 

Rabies (Back to top)

If called for advice regarding bites from possible rabid animals:

Action:

The following points will need to be considered:

Note: Rabies is endemic in many foreign countries. The Green Book divides them into no risk, low risk and high risk. Check with CDSC Colindale/TRAVAX as necessary.

 

Post Exposure

Vaccine: Rabies vaccine is given in 5 doses at 0, 3, 7, 14 and 30 days (previously un-immunised). Previously immunised individuals only need two doses on days 0 and 3 – 7 (see Green Book for further details).

Immunoglobulin: This is only indicated for unimmunised individuals who have had exposure to rabies in a country of high risk.

See Green Book for details.

Summary of post-exposure prophylaxis

Rabies risk in country of incident - or country of origin of animal Unimmunised/incompletely immunised individual* Fully immunised
individual
No Risk None None
Low Risk 5 doses HDCV 2 doses HDCV
High Risk 5 doses HDCV plus human rabies specific immunoglobulin 2 doses HDCV

*Persons who have been immunised by the intradermal route, or who have received fewer than three doses of vaccine, or whose last dose of vaccine was given more than two years previously.

For further details please refer to the Green Book, pages 186 – 191.

Gastro-Intestinal Illness (Back to top)

Objective

The objective is to contain the outbreak and, if possible, identify the cause.

In cases of suspected food poisoning outbreaks in the community or hospital:

Action

Respiratory Illness in Institutions (Back to top)

If Legionella infection is suspected:

Action

Note: If Legionnaires disease seems likely, liaise with local Environmental Health Department regarding possible sources of infection and collection of environmental samples.

Other respiratory infection:

Consider Amantadine, or zanamivir if several cases of influenza occur in an institution. This could be given by the GP. Discuss with 2nd on-call.

1.2 Chemical Incidents (Back to top)

Cumbria and Lancashire Health Protection Unit supports a multi-agency, county-wide approach to dealing with chemical incidents as set out in "Merlin" plan. Under this plan the on-duty public health physician may be contacted about an actual or potential chemical incident. ‘Triggers’ from the fire brigade are automatic, relating to the number of pumps attending and may not indicate public health risk.

The public health physician, the representative from environmental health and the A & E consultant comprise the core of a Chemical Health Hazard Team. In the first instance, discussions between these parties should clarify the existence of a public health risk from a chemical incident and should determine the scale of public health response. Advice on particular chemicals is available from the NPIS who will also be able to offer advice on control. Information is also available on the protected area of our website. Read the toolkit!

If the situation cannot be handled within existing resources, and a full scale "Merlin" incident develops, read "Merlin", read the DoH guidance (Planning for Major Incidents), refer to the "toolkit", contact NPIS and call in the designated officer. Relevant material is available in the restricted area of the website.

1.3 Radiation Incidents (Back to top)

Incidents involving ionising radiation

There are contingency plans to deal with casualties or the health effects of environmental contamination from any radiation incident involving:

The Health Services Response will be led by the DPH of the PCT in whose area the incident arises. They will be assisted and supported by the Health Protection Unit.

Duties of the HPU include:

 

1.5 Other Environmental Health

Airport Calls (Back to top)

Cases of suspected infectious disease on board aircraft bound for local airport may be referred via the airport management to you as Port Health Medical Officer.

Note:

Action:

Detention of aircraft

Port health procedure

Plane not detained

Plane detained

Disposal of Patients and Passengers

Possible infectious disease

- admit to appropriate hospital. (Phone duty registrar and ambulance.)

- home with note/phone call to GP.

Non-infectious disease

Food poisoning outbreak

- obtain food history from passengers.

- obtain food samples if available (EHO).

Control measures

Follow up

Reportable Water Failure (Back to top)

Most of our area is supplied by United Utilities plc (formerly North West Water). Small parts at the periphery are supplied by Yorkshire Water plc and Northumbrian Water plc.

The Water Supply (Water Quality) Regulations 1998/9 Regulation 3 places duties on water companies when supplying water to premises for domestic purposes to supply only water which is wholesome at the time of supply, and to safeguard against any general deterioration in the quality of their supplies.

To ensure that quality standards (bacteriological and chemical) are maintained, the water company (Parts IV and V of the Regulations) is required to collect and analyse multiple routine samples per year drawn from various sources in the water supply system including samples from properties selected at random.

Regulation 30(5) places a duty on the water company to notify the district health authority as well as the local authority of any event which may give rise to ‘a significant risk to health’.

What to do:

The following points will be of interest:

National Assistance Act 1948 (Back to top)

Background: Section 47 (1) of the National Assistance Act 1948, as amended in 1951, is a last resort and should only be used when all other avenues have been explored including a case conference. Your involvement should be preceded by the patient having been seen and assessed by the Social Worker, GP and psychiatrists if appropriate. An EHO would normally have inspected the premises.

The main points of the Law and what to do will be explained. If you have to use Section 47 to remove a person from his living quarters to a place where necessary care and attention can be given (usually a hospital). Note that the 1951 amendment is crucial as it allows a magistrate to empower us (as on-call designated Medical Officer of Health for the Local Authority) immediately, instead of on 7 days’ notice.

The Medical Officer of Health (MOH) has to certify in writing to the magistrate that he or she has been satisfied after thorough enquiry (in practice this means getting the GP who has seen the individual in his/her living quarters to appear before the magistrate with you) that the subject needs necessary care and attention on the grounds that they:

Removal has to be in the interests of the person concerned or to prevent injury to the health of or serious nuisance to others. Quite a few requests for Section 47 do fit the criteria as specified in the Act. ie an old person living alone and not eating: an old person unable to use the toilet: an old person with infected leg ulcers and requiring help. However, it is important to bear in mind that most of us have the right to self-determination and if someone does not really want to go to hospital, the magistrate normally needs convincing that an appropriate bit of all four together of the above 1 – 4 are met.

If the patient is thought to be suffering from a notifiable disease then Section 35 (Medical Examination), 36 (Medical Examination of Group), 37 (Removal to Hospital) or 38 (Detention in Hospital) of the Public Health Control of Disease Act 1984 could be applied. Consult James Button’s book "Communicable Disease Control – a Practical Guide to the Law for Health and Local Authorities".

What to do for Section 47: (Click Here for Section 47 Flow Charts - pdf)