National Infection Prevention and Control Manual: A-Z Pathogens

Lice — incubation period and methods of infection

Contents

The A-Z provides a description of pathogen, incubation period and infectivity along with transmission routes, notifiable status and alert organisms for diseases associated with the pathogen.

The A-Z also contains links to external UK/International guidance documents (non-Scottish); Health Protection Scotland is not responsible for the content of these guidance documents. Unless explicitly stated, external guidance has not been assessed and/or approved for use in Scottish care settings. External UK/International guidance should not override or replace HPS-approved guidance.

Appendix 11 of the NIPCM can be used alongside the A-Z and includes additional information including optimal patient placement and respiratory and facial protection for a range of pathogens.

Download print quality table Appendix 11 (November 2019)

Acinetobacter baumannii is a gram-negative bacterium that is found in the environment including drinking water, soil and sewage. It can also be found on the skin of some healthy individuals. A.baumannii infections in the community are very rare and almost exclusively occur in the hospital setting. It is an opportunistic pathogen affecting those with underlying health problems and infection is often associated with invasive or indwelling medical devices.

A.baumannii can cause pneumonia, bloodstream infections, meningitis, urinary tract infections and surgical site infections including necrotising fasciitis.

At risk groups include patients who are immunocompromised, have chronic lung disease, diabetes, or burn injuries.

Infections can be very difficult to treat as A.baumannii is intrinsically resistant to many antimicrobial agents and can acquire resistance easily. This includes increasing resistance to the carbapenem class of antibiotics which are often the last resort for treatment.

Disease : Acinetobacter baumannii infection or colonisation

On the HPS alert organism list 2019 : Yes

Notifiable

  • Notifiable under Public Health (Scotland) Act 2008 : No

Main route of transmission :

Guidance and supporting materials

UK
International

Adenoviruses are members of the family of viruses Adenoviridae.

Infections commonly affect the respiratory system; but may also cause various other illnesses and presentations, including cold-like symptoms, sore throat, bronchitis, pneumonia, diarrhoea, and conjunctivitis.

Adenovirus infection can occur in any age group, but infants and immunocompromised individuals are more likely than others to develop severe illness from adenoviruses.

Incubation Period :

Period of Infectivity :

Disease : Conjunctivitis

On the HPS alert organism list 2019 : No

Notifiable

  • Notifiable under Public Health (Scotland) Act 2008 : No

Main route of transmission :

Guidance and supporting materials

UK

Disease : Upper +/- lower respiratory tract infection

On the HPS alert organism list 2019 : Yes

Notifiable

  • Notifiable under Public Health (Scotland) Act 2008 : No

Main route of transmission :

Guidance and supporting materials

International

Aspergillus spp. a common fungi that can be found in the environment. Aspergillus fungi can often be found around plants and trees, including rotting leaves and compost; but also in air conditioning and heating systems, insulation material or dust.

It causes a disease called aspergillosis. Symptoms of aspergillosis vary, depending on the type and the part of the body that’s affected. Aspergillosis is not infectious and cannot be transmitted from person to person but occurs if an individual inhales tiny particles of the aspergillus fungi that hang in the air when the environment becomes disturbed.

Spore levels are increased during hospital building or renovation activities, with severely immunocompromised patients more at risk of developing aspergillosis.

Invasive pulmonary aspergillosis (IPA) is the most serious type and usually only affects those who are immunocompromised. Symptoms often include cough, chest pain or breathlessness.

Incubation Period :

Disease : Invasive Pulmonary Aspergillosis

On the HPS alert organism list 2019 : Yes

Notifiable

  • Notifiable under Public Health (Scotland) Act 2008 : No

Main route of transmission :

Guidance and supporting materials

Scottish
International

Anthrax is usually a disease of herbivorous mammals and is caused by the bacterium Bacillus anthracis. Anthrax is contracted through environmental exposure and cannot be transmitted from person to person.

In humans, anthrax can be contracted through direct or indirect contact with infected animals, including handling meat, hides, hair and wool. There are also concerns about the use of anthrax as a bioterrorism agent.

The symptoms of anthrax depend on route of infection and take four main forms: inhalation, gastrointestinal, cutaneous and injection.

  • Inhalation (pulmonary) anthrax can occur when a person inhales spores that are in the air (aerosolized) during the industrial processing of contaminated materials, such as wool, hides, or hair.

Following inhalation of spores, time to onset of symptoms is dependent on the number of spores inhaled. Symptoms may include mild pyrexia and malaise lasting a few days; followed by a flu-like illness, leading quickly to shock, collapse and death.

    Gastrointestinal anthrax can occur through ingestion of spores and leads to severe gastrointestinal disease with nausea, vomiting, anorexia and fever leading to shock, collapse and death.

  • Cutaneous anthrax (>90% cases) can occur when workers who handle contaminated animal products get spores in a cut or scrape on their skin.
  • Entry through a skin lesion leads to the development initially of a pimple which, within two to three days, develops to form a dry, black firmly adherent scab from two to several cm in diameter across. The lesion rarely causes much pain, but there is nearly always considerable oedema which may spread a long way from the site of the lesion and may take up to six weeks to resolve.

    • Injection anthrax is a novel form of infection seen in heroin users and most likely contracted from using heroin contaminated with anthrax spores.

    Symptoms are fever and chills, small blisters/ bumps at the injection site which change to a painless skin sore with a black centre, swelling around the sore often accompanied with abscesses at the injection site.

    All types of anthrax have the potential, if untreated, to spread throughout the body and cause severe illness and even death.

    Incubation Period :

    • Inhalation (pulmonary): 1 to 7 days (usually 48 hours)
    • Gastrointestinal: 1 to 7 days
    • Cutaneous: 1 to 7 days (rarely up to 7 weeks)

    Disease : Anthrax

    On the HPS alert organism list 2019 : Yes

    Notifiable

    • Notifiable under Public Health (Scotland) Act 2008 : Yes

    Main route of transmission :

    Guidance and supporting materials

    Scottish

    B. cereus in particular is a frequently recognised cause of toxin-induced acute gastroenteritis, symptoms often include abdominal pain, nausea, vomiting and diarrhoea. However this genus may also cause sepsis, pneumonia, endocarditis, central nervous system (CNS) and ocular infections.

    Bacillus cereus is known to cause bacteraemia in immunocompromised individuals.

    It is transmitted by contaminated cooked foods, especially rice, pastas and vegetables, as well as raw milk and meat products.

    Airborne dissemination of the organisms from environmental sources is considered to further facilitate contamination, environmental sources include: soil, sediments, vegetation.

    Dust and contaminated laundry have been implicated in the healthcare environment. The risk of person-to-person transmission is typically considered to be low.

    Incubation Period :

    Disease : Gastroenteritis

    On the HPS alert organism list 2019 : No

    Notifiable

    • Notifiable under Public Health (Scotland) Act 2008 : Yes

    Main route of transmission :

    Guidance and supporting materials

    Scottish

    Body lice (Pediculus humanus humanus or sometimes called Pediculus humanus corporis) are a type of tiny parasite. Infestations of body lice are known as Pediculosis corporis, Pediculosis vestimenti or Vagabond’s disease.

    The lice lay eggs in the seams of clothing, usually only moving onto skin to feed on blood via biting. Infestations with body lice can cause severe itching on the parts of the body affected and sometimes a rash caused by an allergic reaction to the bites can occur.

    Body lice are less common than head and pubic lice infestations, usually only occurring in vulnerable groups such as people who are homeless.

    Prolonged direct contact with infested individuals or their clothing/bed linens is required for transmission. Outbreaks can occur in situations that prevent the regular laundering of clothing or maintenance of good hygiene. However, unlike head and pubic lice, infestations with body lice can lead to more serious conditions as the lice can be a vector for diseases such as typhus, trench fever, louse-borne relapsing fever.

    Management of body lice involves regular bathing and laundering of clothes and bedding material at high temperatures to prevent re-infestation. Treatment with a pediculicide is only required if good hygiene practices cannot be introduced.

    Incubation Period :

    Exclusion Period :

    Period of Infectivity :

    Disease : Body lice infestation/ Pediculosis corporis/ Pediculosis vestimenti/ Vagabond’s disease

    On the HPS alert organism list 2019 : No

    Notifiable

    • Notifiable under Public Health (Scotland) Act 2008 : No

    Main route of transmission :

    Guidance and supporting materials

    International

    Pertussis is caused by the bacterium Bordetella pertussis.

    The initial symptoms (catarrhal stage) include: runny nose, fever, cough and apnoea (in babies).

    Later symptoms (paroxysmal stage) include: paroxysms of many rapid coughs in children this is followed by a high-pitched «whoop», often accompanied with vomiting and exhaustion after coughing fits.

    Adults do not exhibit the ‘whoop’ but present with a persistent cough which can last several weeks and may act as a reservoir for B. pertussis during this period.

    Unvaccinated children under 2 years of age are most at risk of complications.

    Incubation Period :

    Period of Infectivity :

    Disease : Pertussis/Whooping Cough

    On the HPS alert organism list 2019 : Yes

    Notifiable

    • Notifiable under Public Health (Scotland) Act 2008 : Yes

    Main route of transmission :

    Guidance and supporting materials

    Scottish

    Burkholderia cepacia complex is a group of Gram-negative bacteria commonly found in soil and water and are opportunistic pathogens in hospital environments.

    B. cepacia poses little risk to healthy people however people with weakened immune systems or chronic lung diseases such as cystic fibrosis are susceptible to infection.

    Infection typically involves the respiratory tract, with symptoms including fever, cough, shortness of breath and wheezing.

    B. cepacia are often resistant to common antibiotics and treatment typically requires a combination of antibiotics.

    B. cepacia can be transmitted to susceptible people by direct/indirect contact with contaminated surfaces and exposure to B. cepacia in the environment.

    Disease : Burkholderia cepacia complex

    On the HPS alert organism list 2019 : No

    Notifiable

    • Notifiable under Public Health (Scotland) Act 2008 : No

    Main route of transmission :

    Campylobacter are a genus of bacteria that commonly cause food poisoning associated with raw or undercooked meat in particular poultry; the two most common species implicated in human disease are C. jejuni and C. coli.

    Symptoms can include diarrhoea (sometimes bloody), nausea and vomiting, abdominal pain, malaise and fever, with symptoms lasting from 2-10 days.

    Sequelae can include Guillain-Barré syndrome.

    Incubation Period :

    Exclusion Period :

    Disease : Campylobacter Gastroenteritis

    On the HPS alert organism list 2019 : Yes

    Notifiable

    • Notifiable under Public Health (Scotland) Act 2008 : Yes

    Main route of transmission :

    Guidance and supporting materials

    UK

    Candida auris is a recently identified species of yeast (a type of fungus) from the Candida genus. Most Candida species are harmless commensals, however they can be invasive and cause disease, known as candidiasis.

    C. auris was first identified in 2009 and has been associated with prolonged outbreaks in healthcare settings as it is highly transmissible between patients and from contaminated environments. It can cause a wide range of infections, including blood stream infections (candidaemia), pericarditis, urinary tract infections (UTIs) and pneumonia. It is hard to identify with standard laboratory methods and is multi-drug resistant making diagnosis and treatment difficult.

    C. auris mainly affects critically unwell patients in high dependency or intensive care settings. Those with severe underlying co-morbidities and immunosuppression, including those with diabetes, chronic kidney disease, malignancies and Human Immunodeficiency Virus (HIV) are most at-risk.

    Exclusion Period :

    Period of Infectivity :

    Disease : Candida auris infection or colonisation

    On the HPS alert organism list 2019 : Yes

    Notifiable

    • Notifiable under Public Health (Scotland) Act 2008 : No

    Main route of transmission :

    Guidance and supporting materials

    Scottish
    International

    Enterobacteriaceae are part of a large family of Gram-negative, rod-shaped bacteria which include (amongst others) Escherichia coli, Klebsiella spp and Proteus spp.. Many types of Enterobacteriaceae are a part of the normal range of bacteria found in the gut, though they can cause infections such as bacteraemia, urinary tract infections and intra-abdominal infections.

    Carbapenemase-producing Enterobacteriaceae (CPE) are a type of Enterobacteriaceae that are extremely resistant to antibiotics.

    These bacteria carry a gene for a carbapenemase enzyme that breaks down carbapenem antibiotics. Carbapenems are a class of very broad-spectrum intravenous antibiotics which are used to treat serious infections or conditions where other therapeutic options have failed.

    CPE are predominantly healthcare associated, with immunocompromised patients and those with prolonged hospital stays most at risk of developing an infection.

    Infections caused by CPE are difficult to treat and are associated with high rates of morbidity and mortality. Risk factors for colonisation include receiving healthcare out with Scotland and close contact with someone infected or colonised with CPE.

    Disease : Carbapenemase-producing Enterobacteriaceae infection or colonisation

    On the HPS alert organism list 2019 : Yes

    Notifiable

    • Notifiable under Public Health (Scotland) Act 2008 : No

    Main route of transmission :

    Guidance and supporting materials

    Scottish
    International

    Chlamydia pneumoniae (also known as Chlamydophila pneumoniae) is a gram negative bacterium that is common cause of community acquired pneumonia (CAP). C.pneumonia often only causes mild upper respiratory tract infections (e.g. sore throat), but may also cause lower respiratory tract infections such as pneumonia.

    Symptoms of C.pneumonia infection include rhinitis, fatigue, fever, laryngitis, sore throat, prolonged cough and headache. Symptoms can also continue for several weeks after they start. Preceding laryngitis is a common feature of pneumonia caused by C.pneumonia.

    Vulnerable groups include those who live/work in crowded settings e.g. schools, military barracks, nursing homes, hospitals and prisons. Elderly people are at increased risk for developing pneumonia and other complications including exacerbation of asthma, encephalitis and myocarditis.

    See also:  The Difference Between Rats and Mice and Why It Matters

    Incubation Period :

    Period of Infectivity :

    Disease : Chlamydia pneumoniae pneumonia

    On the HPS alert organism list 2019 : No

    Notifiable

    • Notifiable under Public Health (Scotland) Act 2008 : No

    Main route of transmission :

    Guidance and supporting materials

    International

    Clostridioides difficile infection (CDI) , also known as Clostridium difficile, is a major cause of infectious diarrhoea due to the spore-forming bacterium, Clostridioides difficile. It is predominantly healthcare associated and accounts for about 20% of cases of antibiotic-associated diarrhoea.

    Disease is mediated by the production of toxins, and symptoms include watery diarrhoea, fever, nausea, and abdominal pain, which may lead to serious complications including pseudomembranous colitis, toxic megacolon, and death.

    Treatment with antibiotics or invasive surgical procedures, which disturb the normal intestinal flora, may lead to overgrowth of C. difficile, resulting in either asymptomatic colonisation or infection.

    Those at most risk of developing CDI include elderly people and immunocompromised patients. A small proportion of healthy adults may carry C. difficile as part of the normal gut flora.

    Incubation Period :

    Exclusion Period :

    Period of Infectivity :

    Disease : Clostridioides difficile infection

    On the HPS alert organism list 2019 : Yes

    Notifiable

    • Notifiable under Public Health (Scotland) Act 2008 : Yes

    Main route of transmission :

    Guidance and supporting materials

    Scottish
    Information leaflets
    Tools
    Surveillance

    Tetanus is a rare disease resulting from a neurotoxin that is produced during infection with Clostridium tetani. C.tetani is a common environmental bacterium that forms spores that are highly resistant to extreme hot and cold temperatures. The bacterium is present in soil and manure and usually enters the body through a wound, burn, puncture or scratch. Tetanus is not spread from person to person.

    People who inject drugs (PWID) are at increased risk of infection.

    There are three forms of tetanus (generalised, localised, and cephalic) however generalised tetanus is the most common presentation.

    Generalised tetanus is characterised by lockjaw, tonic muscle contractions and spasms. Tonic contractions and spasms may lead to dysphagia (trouble swallowing), opisthotonus (spasm of the muscles causing backwards arching of the head, neck and spine), and a rigid abdomen; in severe cases they may cause respiratory distress.

    Localised tetanus is rigidity and spasms confined to the area around the site of the infection and may be more common in partially immunised individuals. Localised symptoms can continue for weeks or may develop into generalised tetanus.

    Cephalic tetanus is localised tetanus after a head or neck injury, involving the muscles supplied by the cranial nerves.

    Treatment includes supportive care, wound debridement, and may involve administration of antimicrobials and anti-tetanus antibodies.

    Immunisation against tetanus is the most effective method of prevention and is included as part of the UK childhood immunisation schedule, with routine primary vaccination recommended at two, three, and four months of age, followed by a booster dose from age three years and four months, with a further booster at 13 to 18 years of age.

    Prophylactic immunisation is recommended following injuries involving tetanus-prone wounds if routine immunisation was not received or was received more than 10 years ago.

    Incubation Period :

    Disease : Tetanus

    On the HPS alert organism list 2019 : No

    Notifiable

    • Notifiable under Public Health (Scotland) Act 2008 : Yes

    Main route of transmission :

    Guidance and supporting materials

    Scottish

    Coronaviruses are a species of virus belonging to the subfamily Coronavirinae.

    Coronaviruses primarily infect the upper respiratory and gastrointestinal tract and are believed to cause a significant proportion of common colds in human adults.

    Occasionally, coronaviruses are able to cause more significant lower respiratory tract infections in humans with pneumonia; this is more likely in immunocompromised individuals, people with cardiopulmonary illnesses, as well as elderly people and young children.

    Middle East Respiratory Syndrome Coronavirus (MERS-CoV)

    This is a novel coronavirus that recently emerged in the Middle East and is classed as a high consequence infectious disease (HCID). It causes severe viral respiratory disease.

    Symptoms include fever and cough that commonly progresses to a severe pneumonia, sometimes requiring mechanical ventilation. Pneumonia is more likely in immunocompromised individuals, people with cardiopulmonary illnesses, as well as the elderly and young children. In some cases, a diarrhoeal illness has been the first symptom to appear.

    Those at risk of contracting MERS-CoV include travellers to the Arabian Peninsula (or those in close contact with travellers to this region). The camel is a host species for the virus and those in contact with camels or camel products may also be at risk of contracting the disease.

    Incubation Period :

    Period of Infectivity :

    Disease : Coronavirus infection (non-MERS-CoV)

    On the HPS alert organism list 2019 : No

    Notifiable

    • Notifiable under Public Health (Scotland) Act 2008 : No

    Main route of transmission :

    Disease : Middle East Respiratory Syndrome Coronavirus (MERS-CoV)

    On the HPS alert organism list 2019 : Yes

    Notifiable

    • Notifiable under Public Health (Scotland) Act 2008 : No

    Main route of transmission :

    Guidance and supporting materials

    Scottish

    UK

    Disease : Novel Coronavirus (COVID-19)

    Notifiable

    • Notifiable under Public Health (Scotland) Act 2008 : Yes
    • The Advisory Committee on Dangerous Pathogens (ACDP) took the decision on 13th March 2020 that COVID-19 infection should NOT be classified as a HCID.

    Main route of transmission :

    Guidance and supporting materials

    • See HPS Novel coronavirus (COVID-19) webpage for all guidance and information to be used in Scotland.
    • ​​​See COVID-19 Compendium for links to current national and international policy, guidance and resources on COVID-19 from key organisations which is updated daily during the COVID-19 pandemic.
    • Rapid Review of the literature: Assessing the infection prevention and control measures for the prevention and management of COVID-19 in healthcare settings

      This rapid review provides an assessment of the scientific evidence base to determine if the infection prevention and control measures applied in Scotland are suitable for the prevention and management of COVID-19 in healthcare settings.

      As this is a rapid review, the methodology differs from that of the NIPCM. The evidence will be updated real-time.

      Creutzfeldt-Jakob Disease (CJD)

      Cryptococcus spp. is a yeast commonly found in the environment in soil, decaying wood, and bird droppings.

      There are two Cryptococcus species that can cause disease in humans. C. gattii is confined mainly to tropical and subtropical regions and can cause disease in healthy individuals. C. neoformans is found worldwide but rarely infects healthy people; those who are immunocompromised are most at risk from infection.

      The lungs and the central nervous system are the most common infection sites, resulting in pneumonia and meningitis however any part of the body can be affected including the skin and eyes.

      Transmission from person to person is very rare.

      Incubation Period :

      Period of Infectivity :

      Disease : Cryptococcosis

      On the HPS alert organism list 2019 : No

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : No

      Main route of transmission :

      Cryptosporidium are protozoan parasites, with the species C. parvum and C. hominis causing the majority of cryptosporidium infections in humans. They can cause Cryptosporidiosis. The parasite is transmitted via microbial cysts (oocysts) that once ingested are released and result in infection. The most common route of infection is from contaminated material such as ingested unfiltered/untreated water or food, or contact with faeces from an infected person or animal.

      Infections usually affect the gastrointestinal (GI) system. Symptoms of GI infections include: diarrhoea, fever, abdominal pain, nausea and vomiting. Respiratory infections are less common, but can cause fever, cough, and shortness of breath. Vulnerable groups include children, childcare workers, occupations with exposure to animals (e.g. farmers, vets) and those likely to be in contact with untreated water (e.g. fresh water swimmers, travellers). People who are immunocompromised are at greater risk of severe disease and infections can be fatal in this group.

      Incubation Period :

      Exclusion Period :

      Period of Infectivity :

      Disease : Cryptosporidiosis

      On the HPS alert organism list 2019 : Yes

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : Yes

      Main route of transmission :

      Guidance and supporting materials

      UK

      Diphtheria is an acute bacterial disease resulting from toxigenic C. diphtheriae or C.ulcerans infection of the upper respiratory tract and occasionally the skin. Most complications of diphtheria are attributable to effects of the toxin produced by the bacteria during infection. Depending on the tissues involved there are two main types of clinical diphtheria: pharyngeal and cutaneous.

      Pharyngeal diphtheria mainly affects the pharynx and the tonsils. Early symptoms include malaise, sore throat, swollen (bull) neck, anorexia, and low-grade pyrexia. Severe complications can include respiratory failure, toxin-induced myocarditis and peripheral neuritis, and may lead to death.

      Cutaneous diphtheria usually affects the skin on legs, hands and feet although rare reports of stoma-associated infection have been recorded. Pus-filled spots develop and eventually form into large ulcers surrounded by a red patch of discoloured skin. Ulcers usually heal within two to three months.

      Diphtheria is a vaccine preventable disease and is part of the routine childhood immunisation schedule.

      Incubation Period :

      Exclusion Period :

      Period of Infectivity :

      Disease : Diphtheria — Pharyngeal

      On the HPS alert organism list 2019 : Yes

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : Yes

      Main route of transmission :

      Disease : Diphtheria — Cutaneous

      On the HPS alert organism list 2019 : Yes

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : Yes

      Main route of transmission :

      Guidance and supporting materials

      Scottish

      EV-D68 is one of more than 100 enteroviruses and belongs to the Picornaviridae family of viruses.

      EV-D68 can cause mild to severe respiratory illness. Symptoms may include rhinorrhoea, cough and myalgia, and in severe cases wheezing and difficulty breathing, resulting in hospitalisation.

      In addition, EV-D68 has been associated with neurological symptoms such as aseptic meningitis, acute flaccid myelitis (AFM), and potentially Guillain-Barré syndrome in adults. EV-D68 is spread via infectious respiratory secretions, such as saliva, nasal mucus and sputum. Vulnerable groups include children, teenagers and immunocompromised adults.

      Incubation Period :

      Period of Infectivity :

      Disease : Acute flaccid myelitis (AFM)

      On the HPS alert organism list 2019 : Yes

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : No

      Main route of transmission :

      Disease : Severe respiratory illness

      On the HPS alert organism list 2019 : No

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : No

      Main route of transmission :

      Guidance and supporting materials

      Scottish

      Escherichia coli O157, also known as Shigatoxigenic Escherichia coli (STEC, previously known as verotoxigenic or VTEC), is a serogroup of the family of bacteria Escherichia coli. STEC infection is a relatively rare cause of gastrointestinal illness.

      E. coli O157 is found in the gut and faeces of many animals, particularly cattle.

      Symptoms can range from mild gastroenteritis through to severe bloody diarrhoea and in rare cases serious conditions, including haemolytic uraemic syndrome (HUS) and thrombotic thrombocytopaenic purpura (TTP). Children and the elderly are most at risk of developing serious complications.

      Incubation Period :

      Exclusion Period :

      Period of Infectivity :

      Disease : Escherichia coli Gastroenteritis

      On the HPS alert organism list 2019 : Yes

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : Yes

      Main route of transmission :

      Guidance and supporting materials

      Scottish

      Extended-spectrum beta-lactamases (ESBLs) are enzymes produced by bacteria and confer resistance to a variety of beta-lactam antibiotics, such as penicillins and cephalosporins. Beta-lactam antibiotics are broad-spectrum and are used to treat a variety of infections. The genes coding for ESBL production can be spread between bacterial species and frequently carry genes that also encode resistance to other drug classes, therefore antibiotic options in the treatment of ESBL-producing organisms are limited. Carbapenem antibiotics are the treatment of choice for serious infections due to ESBL-producing organisms. However, carbapenem-resistant (primarily ertapenem resistant) isolates have been reported.

      The most common types of ESBL-producing bacteria are Escherichia coli and Klebsiella spp. causing infections including urinary tract infections (UTI), pneumonia and blood stream infections. Vulnerable groups at risk for colonisation or infection with ESBL-producing organisms include people who are immunocompromised, elderly people, those with previous exposure to antibiotics and long durations of hospitalisation.

      Period of Infectivity :

      Disease : Extended-spectrum beta-lactamase (ESBL) bacterium infection or colonisation

      On the HPS alert organism list 2019 : Yes

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : No

      Main route of transmission :

      Guidance and supporting materials

      No Pathogens

      Giardia lamblia is a flagellated parasite that colonises in the small intestine causing giardiasis (also known as giardia). Infection in humans usually occurs by ingestion of Giardia lamblia cysts (which can survive for months in cold water) from drinking contaminated water, such as from streams and ponds, as well as artificial lakes created by beaver dams hence its popular name “beaver fever”. It can also contaminate urban water supplies despite treatment, as the parasite cysts are resistant to conventional water treatment processes. Zoonotic transmission is also possible from contact with infected animals or ingestion of infected uncooked foods including meat products.

      Symptoms of giardia infection include diarrhoea, abdominal pain, weight loss and vomiting, however infection can be asymptomatic. Vulnerable groups include children in childcare settings, backpackers/campers who drink untreated waters, swimmers in outdoor recreational waters and those in close contact with someone with giardiasis.

      Incubation Period :

      Exclusion Period :

      Period of Infectivity :

      Disease : Giardiasis/Giardia

      On the HPS alert organism list 2019 : Yes

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : Yes

      Main route of transmission :

      Guidance and supporting materials

      Group A Streptococcus (GAS; Streptococcus pyogenes) is a bacterium which can colonise the throat, skin and anogenital tract. It causes a diverse range of skin, soft tissue and respiratory tract infections, including: tonsillitis, pharyngitis, scarlet fever, pneumonia. In rare cases, patients may go on to develop post-streptococcal complications, such as rheumatic fever or glomerulonephritis.

      In children aged 3 and younger respiratory disease caused by GAS rarely manifests as acute pharyngitis, but rather as mucopurulent rhinitis followed by fever, irritability, and anorexia (called “streptococcal fever” or “streptococcosis”). In contrast to typical acute group A strep pharyngitis, this presentation in young children is subacute and high fever is rare.

      Invasive GAS (iGAS) is an infection where the bacteria are isolated from a normally sterile body site, such as the blood. Any GAS manifestation can be associated with development of streptococcal toxic shock syndrome, although patients with necrotising fasciitis are at highest risk. Vulnerable groups at risk from contracting iGAS infections include perinatal women, neonates, elderly people, persons with diabetes, and those who are immunocompromised.

      Incubation Period :

      Exclusion Period :

      Impetigo: Until lesions are crusted or healed or 48 hours after commencing appropriate antibiotics.

      Scarlet fever: 24 hours after commencing appropriate antibiotics.

      Period of Infectivity :

      Disease : Respiratory

      On the HPS alert organism list 2019 : Yes

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : No

      Main route of transmission :

      Disease : Bacteraemia, Meningitis

      On the HPS alert organism list 2019 : Yes

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : Yes

      Main route of transmission :

      Guidance and supporting materials

      Scottish

      Disease : Scarlet Fever

      On the HPS alert organism list 2019 : Yes

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : No

      Main route of transmission :

      Guidance and supporting materials

      Haemophilus influenzae is a Gram-negative anaerobic bacterium. Serotype b (Hib) is the most common and pathogenic. Hib may cause invasive disease, the most common being meningitis and bacteraemia, and it may also cause epiglottitis and pneumonia. Less common presentations include septic arthritis, osteomyelitis, cellulitis and pericarditis. There is a vaccine available against Hib which is part of the childhood immunisation schedule in Scotland.

      H. influenzae bacteraemia can occur with or without pneumonia and symptoms include fever, fatigue, nausea, abdominal pain, difficulty breathing and confusion.

      H. influenzae meningitis may be accompanied by H. influenzae bacteraemia and symptoms include fever, headache, stiff neck, vomiting, photophobia and confusion. It is serious condition that can be fatal (in approximately 5% of cases) and may cause long term sequelae including deafness, seizures and intellectual impairment.

      H. influenzae epiglottitis is a life-threatening medical emergency. The infection causes the inflammation of the epiglottis and surrounding tissues leading to obstruction of the airway. Signs and symptoms include high fever, tachypnoea, stridor and excessive drooling. Intubation and tracheotomy may be required to prevent respiratory arrest and death.

      Vulnerable groups for all types of H. influenzae infections are children under 5 years of age, elderly people and people who are immunocompromised, including those with sickle cell disease. Individuals who have had close contact with someone infected with Hib are also at increased risk of contracting the infection, and as such may require antibiotic chemoprophylaxis.

      Disease : Epiglottitis

      On the HPS alert organism list 2019 : Yes

      *Only if resistant to any third-generation cephalosporin, carbapenems, fluoroquinolones

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : No

      Main route of transmission :

      Disease : Meningitis

      On the HPS alert organism list 2019 : Yes

      *Only if resistant to any third-generation cephalosporin, carbapenems, fluoroquinolones

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : Yes

      Main route of transmission :

      Guidance and supporting materials

      Hantavirus is a zoonotic infection caused by a group of viruses carried mainly by species of rodents such as rats, mice and voles. Animal vectors become infected early in life and can shed the virus over prolonged periods although they rarely show signs of disease.

      The virus is spread to humans when virus particles in the urine, faeces or saliva of infected rodents become aerosolised and are inhaled.

      Hantaviruses do not spread easily between people and there is a very low risk of transmission to the general population. Those most at risk include people who keep pet rodents and people with occupational exposure to rodents i.e. farm workers and pest control workers.

      Infection in humans can range from a mild flu-like illness, to severe disease. Forms of severe disease include haemorrhagic fever and kidney failure (known as haemorrhagic fever with renal syndrome (HFRS)) as seen in Europe and Asia, and severe lung disease (known as hantavirus pulmonary syndrome (HPS)) as seen in North and South America. Human hantavirus infections in the UK are very rare.

      Symptoms of HFRS include fever, headache, nausea, vomiting and kidney failure. There is no antiviral treatment.

      Incubation Period :

      Disease : Haemorrhagic fever with renal syndrome (HFRS), Hantavirus pulmonary syndrome (HPS)

      On the HPS alert organism list 2019 : Yes

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : Yes

      Main route of transmission :

      Guidance and supporting materials

      Head lice, Pediculus humanus capitis, are tiny parasitic insects that live in hair. They can cause infestation of the scalp known as Pediculosis capitis.

      Head lice hatch from eggs and the sacs left behind are known as ‘nits’ which attach firmly to the hair shaft. Nits are more visible to the naked eye than live lice.

      Symptoms include itching, a tickling feeling in hair, difficulty sleeping and sores on the head secondary to scratching. They are spread by direct head-to-head contact and are a common problem particularly in children aged 4 to 11. Child care settings e.g. schools, nurseries are high risk areas for transmission.

      Treatment with a pediculicide is recommended only in cases where live lice are seen.

      Incubation Period :

      Exclusion Period :

      Period of Infectivity :

      Disease : Head lice infestation — Pediculosis capitis

      On the HPS alert organism list 2019 : No

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : No

      Main route of transmission :

      Guidance and supporting materials

      Scottish

      Hepatitis A is a member of Picornaviridae family of viruses and causes infectious hepatitis.

      Those infected (especially children) may be asymptomatic, however symptoms can range in severity from non specific nausea and vomiting, through to hepatitis (liver inflammation, jaundice, or icterus); and in rare cases to liver failure.

      Symptoms can last 1 to 2 weeks in the case of mild disease and up to a year in the case of severe disease.

      Hepatitis A is transmitted from person to person, or through contact with contaminated food, water, contaminated surfaces or objects.

      Certain groups are at increased risk of acquiring Hep A including travellers to parts of the world with poor levels of sanitation, men who have sex with men, and people who inject drugs.

      Incubation Period :

      Exclusion Period :

      Period of Infectivity :

      Disease : Hepatitis A Virus Infection

      On the HPS alert organism list 2019 : Yes

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : Yes

      Main route of transmission :

      Guidance and supporting materials

      Hepatitis B Virus (HBV) is a virus that can cause chronic infection and affects the liver. It is transmitted through exposure to blood or other body fluids from an infected person. The initial acute infection may be asymptomatic, but can cause acute viral hepatitis (inflammation of the liver) with symptoms of nausea, vomiting, fever and jaundice which last for several weeks. Most people recover from this illness, but a few go on to develop fulminant hepatic failure. 90% of those infected with HBV at birth go on to develop chronic HBV infection, while less than 5% of those acutely infected as adults do. Chronic HBV infection may also be asymptomatic, but can be associated with chronic hepatitis which may lead to liver cirrhosis. It also increases the risk of the individual developing heptocellular carcinoma (HCC).

      In countries where HBV is endemic, the commonest route of spread of HBV is vertical transmission from mother to child at birth. However, in low prevalence countries the most likely route of exposure is from parenteral exposure to infected blood or body fluids, such as from sharing injecting drug equipment or occupational exposure to blood products e.g. needlestick injuries. HBV can also be spread via sexual contact with an infected person with the most at-risk populations being men who have sex with men (MSM), heterosexuals with multiple sex partners or sex workers.

      There is a vaccine available for HBV, as of August 2017 this vaccine is part of the routine childhood immunisation schedule in Scotland. The vaccine and hepatitis B immunoglobulin (HBIG) can be used as post-exposure prophylaxis.

      Incubation Period :

      Period of Infectivity :

      Disease : Hepatitis B Virus Infection

      On the HPS alert organism list 2019 : Yes

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : Yes

      Main route of transmission :

      Guidance and supporting materials

      Scotland

      UK

      Hepatitis C Virus (HCV) is a virus that often causes chronic infection which can lead to liver disease of varying severity. Acute HCV infection is usually asymptomatic though it may cause a range of vague symptoms including decreased appetite, fatigue, nausea, myalgia and weight loss. In rare instances, individuals may develop acute liver failure. Approximately 80% will go on to develop chronic HCV infection which may lead to cirrhosis of the liver or hepatocellular carcinoma (HCC) over a long period of time. Most people with chronic HCV infection are asymptomatic.

      HCV can be transmitted through exposure to infected blood or body fluids. Those most at-risk are those who share drug injecting equipment, receive transfusion of blood or blood products (though uncommon in developed countries due to screening processes) or are occupationally exposed to infected blood/body fluids e.g. needlestick injury from an infected patient. HCV can also be contracted via sexual contact with an infected person and/or vertical transmission (from mother to child), but the risks are far less compared with direct blood exposure.

      There is no vaccine or post exposure prophylaxis treatment for HCV. However, new advances in antiviral medications can cure up to 95% of those infected.

      Incubation Period :

      Period of Infectivity :

      Disease : Hepatitis C Virus Infection

      On the HPS alert organism list 2019 : Yes

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : Yes

      Main route of transmission :

      Guidance and supporting materials

      Scottish
      • Hepatitis C: guidance, data and analysis
      • Hepatitis C: Summary
      • Bloodborne viruses (BBVs) in healthcare workers
      • PHE Hepatitic C information, including:
        • Hepatitis C patient information (quick read)
        • Hepatitis C patient information sheet
        • Hepatitis C information for GPs
      International

      Hepatitis E is an illness of the liver caused by the hepatitis E virus (HEV), which can infect both animals and humans.

      HEV infection usually produces a mild disease however pregnant women are at greater risk of severe illness which can, in rare cases, be fatal. This is more likely to occur with the strains that are found in Africa and Asia and less common in strains commonly found in the UK. Infection will normally clear by itself within one to four weeks. Chronic infection of the liver (lasting over 6 months) is very rare and usually only reported in patients with a suppressed immune system.

      Symptoms include yellowing of the skin and eyes (jaundice), darkening of the urine and pale stools. Patients may also experience tiredness, fever, nausea, vomiting, abdominal pain and loss of appetite.

      Incubation Period :

      Exclusion Period :

      Period of Infectivity :

      Disease : Hepatitis E Virus (HEV)

      On the HPS alert organism list 2019 : No

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : Yes

      Main route of transmission :

      Guidance and supporting materials

      Scotland

      The human immunodeficiency virus (HIV) is a retrovirus that causes chronic infection, which results in progressive failure of the immune system, specifically the CD4 cells (sometimes called T cells).

      HIV infection is contracted through exposure to blood or body fluids from an infected person. Newly infected individuals may develop a flu-like illness 2 to 4 weeks post-exposure, called seroconversion illness. Symptoms include fever, lymphadenopathy, rash and headache. Following this, HIV infection becomes latent and asymptomatic and without treatment will develop into AIDS in 3 to 20 years.

      AIDS is defined as either when an HIV infected person’s CD4 count falls below 200 cells per µL or when specific HIV-associated infections or diseases develop such as pneumocystis pneumonia (PcP), oesophageal candidiasis or HIV wasting syndrome (cachexia). Survival once AIDS has been diagnosed is approximately 3 years if untreated.

      The most common route for HIV infection is via sexual contact with an infected partner, particularly among men who have sex with men (MSM), but the virus can also be spread by sharing drug injecting equipment, vertical transmission during childbirth or from breast milk, occupational exposure to infected blood/body fluids e.g. needlestick injury from an infected patient, or from blood and blood products transfusion (though uncommon in developed countries due to screening processes).

      Due to advances in medical treatment with antiretroviral drugs, people with HIV can have a near normal life span and may never develop AIDS. There is no vaccine for HIV infection however there is post exposure prophylaxis (PEP) available for those who have come into contact with, infected bodily fluids, which significantly reduces the risk of contracting the virus. Pre-exposure prophylaxis for those at risk may also reduce the risk of infection. In Scotland, PrEP is available to people who are considered to be at higher risk of contracting HIV (see https://prep.scot/ for further information, including eligibility criteria).

      Incubation Period :

      Period of Infectivity :

      Disease : Acquired Immunodeficiency Syndrome (AIDS)

      On the HPS alert organism list 2019 : Yes

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : No

      Main route of transmission :

      Disease : Human immunodeficiency virus (HIV) infection

      On the HPS alert organism list 2019 : Yes

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : No

      Main route of transmission :

      Guidance and supporting materials

      Scottish

      Human metapneumovirus is a virus belonging to the paramyxovirus family along with respiratory syncytial virus (RSV).

      Infection can cause upper and lower respiratory disease in people of all ages but especially the young and elderly. Symptoms include cough, fever, shortness of breath, and in more serious cases bronchitis and pneumonia which can be fatal especially in people with weakened immune systems. Transmission is highest during the winter months.

      There is currently no vaccine for metapneumovirus.

      Incubation Period :

      Period of Infectivity :

      Disease : Human metapneumovirus

      On the HPS alert organism list 2019 : No

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : No

      Main route of transmission :

      Pandemic influenza is a global outbreak of a novel influenza A virus strain. Flu pandemics are uncommon. However, such pandemics are serious as the virus can spread quickly due to lack of immunity to the novel strain in the population and immediate vaccination might not be available.

      Large numbers of people worldwide may be affected causing an excessive burden on healthcare services, as well as schools and businesses. The most recent flu pandemic was the 2009/10 ‘Swine flu’ pandemic which was caused by the influenza A virus strain H1N1.

      Incubation Period :

      Disease : Pandemic Influenza (flu)

      On the HPS alert organism list 2019 : Yes

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : Yes

      Main route of transmission :

      Guidance and supporting materials

      Scottish

      Influenza or ‘Flu’ is an acute viral infection affecting the respiratory tract. There are three main types or ‘genera’ of viruses that affect humans: Influenza virus A, Influenza virus B and Influenza virus C.

      Influenza A, which can infect many animal species, is the most common and virulent and is usually the cause of flu epidemics. In temperate zones, influenza is typically seasonal with most cases occurring during the winter months.

      Symptoms include fever, cough, sore throat, runny/stuffy nose, headache, myalgia and extreme fatigue. Diarrhoea and vomiting can occur in some cases. For most healthy individuals, influenza is a self-limiting illness with resolution within 7 days.

      Vulnerable groups at higher risk of complications (such as pneumonia) include children, pregnant women, elderly people, people who are morbidly obese, those with chronic medical conditions (e.g. COPD, diabetes) and people who are immunocompromised. An annual vaccination is available to those within these risk groups as well as healthcare workers.

      Incubation Period :

      Exclusion Period :

      Period of Infectivity :

      Disease : Influenza (Flu)

      On the HPS alert organism list 2019 : Yes

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : Yes

      Main route of transmission :

      Guidance and supporting materials

      Scottish

      No Pathogens

      No Pathogens

      Legionellosis is a collective term for diseases caused by Legionella bacteria, including the most serious Legionnaires’ disease, as well as the similar but less serious condition of Pontiac fever.

      Legionnaires’ disease is the pneumonic form of the disease causing a potentially fatal form of pneumonia.

      Pontiac fever causes an acute, self-limiting influenza-like illness with symptoms that include fever, headaches and muscle aches, but unlike Legionnaires’ disease, Pontiac fever does not cause pneumonia.

      Legionella bacteria are widely distributed in natural and artificial water supplies, and in soil. Exposure is airborne (either indoor or outdoor) usually through aerosolised water which is contaminated with Legionella.

      Hospital equipment implicated in outbreaks and identified as producing aerosols include: showers, cooling towers, water-cooled air conditioning systems and humidifiers.

      The bacteria are not transmissible from person to person.

      Those at risk of this infection include people over 50 years of age, smokers and heavy drinkers, people with kidney disease, diabetes, heart and lung disease and people who are immunocompromised.

      Incubation Period :

      Legionnaires’ Disease: 5 to -6 days, with a range of 2 to 10 days

      Pontiac Fever: 1 to 2 days, with a range of 0 to 3 days

      Period of Infectivity :

      Disease : Legionellosis

      On the HPS alert organism list 2019 : Yes

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : Yes

      Main route of transmission :

      Guidance and supporting materials

      Scottish

      UK

      Lyme disease (Borrelia burgdorferi)

      Lyme borreliosis or Lyme disease is a zoonotic infection caused by the bacterium Borrelia burgdorferi and is transmitted to humans through the bite of an infected tick.

      Ticks are small spider-like creatures that are found on bushes and undergrowth in countryside, parks and gardens. They feed on the blood of birds and mammals, including humans. If a tick bites an animal carrying Borrelia burgdorferi, the tick can also become infected and then transfer the bacteria to a human by biting them.

      Most tick bites do not transmit Lyme disease and prompt, correct removal of the tick reduces the risk of transmission. It is estimated that the risk of symptomatic infection after being bitten is 1 to 5% in Europe. There is no evidence of transmission between humans.

      Many people with early-stage Lyme disease develop a distinctive circular rash (known as erythema migrans) at the site of the tick bite, usually around 3 to 30 days after being bitten. Some people also experience flu-like symptoms such as fatigue, muscle pain, joint pain, headaches, fever, chills and neck stiffness.

      Late-stage disease can develop months or even years later if Lyme disease is left untreated or if treatment is delayed. Presentations may include inflammatory arthritis, nerve problems (numbness, limb pain, facial palsy and memory problems), cardiac problems, encephalitis and meningitis. A small number of people develop long-term health problems similar to fibromyalgia or chronic fatigue syndrome.

      Lyme disease is treated with antibiotics however there is no clear consensus on the best treatment for the long-term health problems that some people develop. There is currently no vaccine available for prevention.

      Main route of transmission: Zoonotic, not transmitted between humans

      Incubation Period :

      Disease : Lyme borreliosis or Lyme disease

      On the HPS alert organism list 2019 : No

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : Yes

      Main route of transmission :

      Guidance and supporting materials

      Scottish

      Measles is a highly infectious acute viral disease resulting from infection with measles virus.

      Initial symptoms include fever, conjunctivitis, cough, runny nose and sneezing. This is followed by small grey/white spots, called Koplik’s spots, on the inside of the mouth 1 to 2 days before rash onset which may last for 2 to 4 days.

      Measles rash appears red and blotchy, developing 2 to 4 days after the onset of fever, and spreading from the head to the body over the next 3 to 4 days.

      Vulnerable groups include unvaccinated children/pregnant women, immunocompromised patients and the chronically ill. These groups are more at risk of developing severe complications including pneumonia/bronchitis, convulsions, diarrhoea, meningitis/encephalitis, immune thrombocytopenic purpura (ITP) and late onset subacute sclerosing panencephalitis (SSPE).

      Incubation Period :

      Exclusion Period :

      Period of Infectivity :

      Disease : Measles (Rubeola)

      On the HPS alert organism list 2019 : Yes

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : Yes

      Main route of transmission :

      Guidance and supporting materials

      Scottish

      Meticillin resistant Staphylococcus aureus (MRSA)

      Middle Eastern Respiratory Syndrome Coronavirus (MERS-CoV)

      Monkeypox is a rare viral infection caused by the monkeypox virus and is classed as a high consequence infectious disease (HCID). African rodents are suspected to be the source of transmission. The first human case was recorded in 1970 in the Democratic Republic of Congo and since then has only twice been documented outside of Africa; in the United States in 2003 and in the UK in 2018.

      Symptoms include fever, headache, muscle aches, exhaustion, swollen lymph nodes and a rash consisting of raised lesions/vesicles that scab over and fall off.

      The illness is usually mild and self-limiting with most people recovering within a few weeks however severe illness can occur in some individuals.

      Infection is spread when a person comes into contact with an infected animal or human, or with contaminated clothing or linen. Monkeypox does not spread easily between people and there is a very low risk of transmission to the general population.

      Incubation Period :

      Exclusion Period :

      Period of Infectivity :

      Disease : Monkeypox

      On the HPS alert organism list 2019 : No

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : No

      Main route of transmission :

      Guidance and supporting materials

      Scottish

      UK

      Mumps is a disease caused by a paramyxovirus.

      The symptoms include swelling of the parotid glands (Parotitis) which may be painful, causing difficulty with swallowing. Parotitis may be preceded by several days of non-specific symptoms such as fever, headache, malaise, nausea, myalgia and anorexia; although asymptomatic mumps infection is common, particularly in children.

      Common complications may include swelling of the ovaries (oophoritis), swelling of the testes (orchitis), pancreatitis and viral meningitis. Rare complications include encephalitis and permanent hearing loss; Mumps is rarely fatal.

      Mumps is a vaccine preventable disease and is part of the normal childhood vaccination schedule.

      Incubation Period :

      Exclusion Period :

      Period of Infectivity :

      Disease : Mumps (infectious parotitis)

      On the HPS alert organism list 2019 : Yes

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : Yes

      Main route of transmission :

      Guidance and supporting materials

      Scottish

      Mycobacterium abscessus (M. abscessus) complex is a group of environmental mycobacteria that are commonly found in water, soil and dust. M. abscessus poses little risk to healthy people however those with weakened immune systems or chronic lung diseases such as cystic fibrosis are susceptible to infection.

      Healthcare associated infections (HAIs) due to M. abscessus include skin and soft tissue infection and respiratory infections. Treatment typically requires a combination of antibiotics as antibiotic resistance is common with M. abscessus.

      M.abscessus can be transmitted via contaminated medical devices and drugs in preparation. There is low risk of transmission from person to person.

      Incubation Period :

      Period of Infectivity :

      Disease : Mycobacterium abscessus infection or colonisation

      On the HPS alert organism list 2019 : No

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : No

      Main route of transmission :

      Guidance and supporting materials

      Tuberculosis (TB) is a disease caused by Mycobacterium tuberculosis, M. bovis, M. africanum, M. canetti or M. microti, which together form the Mycobacterium tuberculosis complex. There are two forms of tuberculosis:

      • TB affecting the lungs; and
      • TB causing infection elsewhere in the body, including the glands, bones and nervous system.

      Typical symptoms of TB can include extreme tiredness/fatigue, loss of appetite/weight, night sweating and fever.

      Additional symptoms for pulmonary TB include increasing breathlessness and a persistent productive cough lasting more than 3 weeks, which may be bloody.

      Additional symptoms of extrapulmonary TB vary but may include: persistently swollen glands, abdominal pain, pain and loss of movement in an affected bone or joint, confusion, persistent headache and seizures.

      TB is treated with antibiotics, however resistance to the antibiotics used for treatment is an increasing problem:

      • Multidrug-resistant tuberculosis (MDR TB)

      Multidrug-resistant TB (MDR TB) is caused by an organism that is resistant to at least isoniazid and rifampin, the two most potent TB drugs that are used in all cases for treatment.

      • Extensively drug resistant tuberculosis (XDR TB)

      Extensively drug resistant TB (XDR TB) is a rare type of MDR TB that is resistant to isoniazid and rifampin, plus any fluoroquinolone and at least one of three injectable second-line drugs (i.e., amikacin, kanamycin, or capreomycin). Because XDR TB is resistant to the most potent TB drugs, patients are left with treatment options that are much less effective. XDR TB is of particular concern for persons with HIV infection or other conditions that can weaken the immune system.

      Person to person transmission of TB predominantly occurs by inhalation of infected airborne particles (airborne route). In some cases after infection the bacteria can remain latent in the body for a long time (even lifelong), causing no symptoms of disease. People with latent TB infection (LTBI) are not infectious; however under favourable conditions i.e. immunosuppressed, the bacteria can start multiplying (reactivate) and cause clinical disease.

      Vulnerable groups include:those in close contact with a person with infectious TB disease; those who have immigrated from areas of the world with high rates of TB; children younger than 5 years of age who have a positive TB test; and groups with high rates of TB transmission, such as homeless persons, injection drug users, persons with HIV infection and persons who work or reside with people who are at high risk of contracting TB.

      The TB vaccine (BCG) is recommended for certain at risk groups.

      Incubation Period :

      Period of Infectivity :

      Disease : Extrapulmonary Tuberculosis

      On the HPS alert organism list 2019 : Yes

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : Yes

      Main route of transmission :

      Disease : Pulmonary or laryngeal Tuberculosis

      On the HPS alert organism list 2019 : Yes

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : Yes

      Main route of transmission :

      Guidance and supporting materials

      Scottish
      International

      M. pneumoniae is a bacterium that causes acute respiratory illness ranging in severity from mild illness to severe pneumonia.

      M. pneumoniae infection may cause a wide range of respiratory presentations such as bronchitis, bronchiolitis, pharyngitis and pneumonia. The most common type of illness, especially in children, is tracheobronchitis (chest cold); symptoms include fatigue, fever, headache and a slowly worsening cough that can last for weeks or months.

      M. pneumoniae infections are almost exclusively mild. Most people who are exposed for a short amount of time to someone with M. pneumoniae infection do not become ill, however, it is common for this illness to spread between family members who live together.

      M. pneumoniae infection can on rare occasion result in severe complications such as encephalitis, and can be fatal; high risk groups who are at risk of developing more serious illness include those recovering from respiratory illness, people with asthma and people who are immunocompromised.

      Incubation Period :

      Period of Infectivity :

      Disease : Pneumonia

      On the HPS alert organism list 2019 : No

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : No

      Main route of transmission :

      Meningococcal disease occurs as a result of a systemic bacterial infection with Neisseria meningitidis.

      Meningococci are considered to colonise the nasopharynx of approximately 10-35% of individuals and colonisation does not lead to infection in the majority of cases. Meningococcal disease can present as meningitis and/or septicaemia. Early symptoms include malaise, fever and vomiting. Headache, neck stiffness, photophobia, drowsiness or confusion and joint pains may also occur. In meningococcal septicaemia, a rash may develop, along with signs of advancing shock and isolated limb and/or joint pain. The rash may be non-specific early on, however, as the disease progresses it may become petechial or purpuric and may not blanch. In young infants the onset may be insidious and the signs may be non-specific without ‘classical’ features of meningitis. Clinical deterioration may be very rapid with poor peripheral perfusion, pallor, rapid breathing, rapid heart rate and the emergence of a meningococcal rash. In severe cases, patients may present with hypotension or be unresponsive. N. meningitidis infection can also lead to the development of other conditions including pneumonia, myocarditis, endocarditis, pericarditis, arthritis, conjunctivitis, urethritis, pharyngitis and cervicitis.

      There is a marked seasonal variation in meningococcal disease, with peak levels occurring in winter months. High risk groups for severe infection include children below 5 years of age and young people aged 15-19. Vaccines that protect against some serogroups of the bacteria are available to people in these groups.

      Incubation Period :

      Exclusion Period :

      Period of Infectivity :

      Disease : Meningococcal Disease

      On the HPS alert organism list 2019 : Yes

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : Yes

      Main route of transmission :

      Guidance and supporting materials

      Nipah virus is a member of the Paramyxoviridae family (genus Henipavirus) and is classed as a high consequence infectious disease (HCID). It is a zoonotic virus and fruit bats of the Pteropodidae family are considered to be the natural reservoir. Infections in humans were reported for the first time in 1998 in Nipah, Malaysia, following an outbreak originating from pig farms. The virus can be transmitted to humans from animals (particularly bats, pigs, horses), contaminated foods, and also directly from contact with infected humans.

      Although asymptomatic infection can occur, clinical illness typically consists of a sudden onset, flu-like or febrile illness, sometimes with gastrointestinal symptoms. Pneumonia and other severe respiratory symptoms can also occur, however the most serious complication is encephalitis, which may progress to coma. The mortality rate is high at 40 to 75%. Long term neurological sequelae have been reported and a small number of people relapse or develop delayed onset encephalitis. There is currently no vaccine available and treatment is limited to supportive care.

      Incubation Period :

      Period of Infectivity :

      Disease : Nipah virus

      On the HPS alert organism list 2019 : No

      Notifiable

      • Notifiable under Public Health (Scotland) Act 2008 : No

      Main route of transmission :

      Guidance and supporting materials

      International

      Nits are the empty egg cases/sacs attached to hair that Head/Body/Pubic lice hatch from.

      • See head/body/pubic lice

      Nontuberculous mycobacteria (NTM)

      Nontuberculous mycobacteria (NTM) are mycobacteria which do not cause tuberculosis or leprosy. NTM infections are most frequently located in the lungs, but may also be found in lymph nodes, skin, soft tissue, joints and bones. NTM cause pulmonary diseases that resemble tuberculosis: symptoms may include fever, tiredness, nausea/vomiting, night sweats, cough and weight loss, with the more severe cases requiring antibiotic and steroid therapy.

      NTM comprise a multispecies group of organisms common throughout the environment and are rarely associated with outbreaks in care settings. NTM is not considered contagious and is spread via environmental sources, typically water, but also contaminated medical equipment/devices.

      Fifteen species are recognized as pathogenic to humans, with some species showing high levels of antimicrobial resistance particularly M. abscessus.

      • M. abscessus: Healthcare-associated infections due to this bacterium are usually of the skin and the soft tissues under the skin, which usually become red, warm, tender to the touch, swollen, and/or painful. Infected areas can also develop boils or pus-filled vesicles. M. abscessus is also a cause of serious lung infections in persons with chronic lung diseases, such as cystic fibrosis. Infection with M. abscessus is usually caused by injections of substances contaminated with the bacterium or through invasive medical procedures employing contaminated equipment or material. Infection can also occur after accidental injury where the wound is contaminated by soil.
      • M. avium and M. fortuitum have been linked to hot tubs or spa baths, with NTM found in spa bath water and/or in the air of the homes of the people diagnosed with NTM infection. Infection may occur in the skin or soft tissues following trauma or surgery.
      • M. chimaera which belongs to the M. avium complex, has been recognised as a cause of endocarditis, severe disseminated infection and chronic sternal wound infection in patients who have undergone cardiothoracic surgery. This is likely to be transmitted from the heater cooler units of cardiopulmonary bypass equipment. M. chimaera may manifest many years after surgery. Vulnerable groups include HIV infected and immunocompromised persons, cystic fibrosis (CF) patients, and those who have had open heart surgery since January 2013.

      www.nipcm.hps.scot.nhs.uk

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