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QUEENSLAND CORRECTIVE SERVICES APPENDIX – DISEASE AND INFECTION MANAGEMENT Availability: Public Implement Date: 28 August 2006 1. Human Immunodeficiency Virus (HIV) / Acquired Immune Deficiency Syndrome (AIDS) Testing for HIV is voluntary. A prisoner should be offered a HIV test at the time blood is taken for a syphilis and Hepatitis B test. A prisoner who declines a HIV test on reception should be advised that they may request a HIV test at any time during their sentence. Transmission Incubation Infectious and Exclusion Period Person to person via blood and body fluids through freshly abraded skin and mucus membranes, through sharing needles, needle stick injury, sexual contact etc. Variable. Window period (time from initial infection to detectable antibodies) is usually 1-3 months. Unknown—presumed to begin early after onset of HIV infection and extend throughout life. The transmission rate increases with the viral load and also increases with genital ulcers. 2. Conversion illness may be 16 weeks after infection. Diagnosis and Notification Serology Laboratory notification Prevention Education re risk factors for HIV infection and safe sex and injecting practices. Discuss management of cases and contacts with AIDS Medical Unit (AMU) tel. (07)3224 5526 Hepatitis A Management of outbreaks Control of Hepatitis A outbreaks is achieved by enforcement of hygienic measures designed to limit faecal-oral spread. These include appropriate care with food preparation and sources of water, faecal disposal and hand washing. Vaccination Within the Department, Hepatitis A vaccination is recommended for those at high risk of exposure, for example— Disease and Infection Management 840983511 Version 02 Page 1of 12 a) b) c) d) e) a person living in a remote Aboriginal or Torres Strait Islander community; a person working directly with sewage; a person with chronic liver disease, for example, who has had a liver transplant. Many injecting drug users will have pre-existing liver disease from Hepatitis B or Hepatitis C infection and may therefore be considered for Hepatitis A vaccination. a person who is a recipient of blood products, for example, a haemophiliac; a person who is Hepatitis C positive. This should be considered by the visiting doctor on a case-by-case basis. Transmission Faecal-oral outbreaks occur in child-care, in travelers and is associated with salads, water and shell fish. NB can last on fomites and in water for several weeks. 3. Incubation 15-50 days Average 28-30 days. Infectious and Exclusion Period Diagnosis and Notification Prevention Last half of incubation period, (usually taken as 15 days before onset of symptoms) to one week after onset of jaundice. Timeout: Until seven days after onset of jaundice. Positive IgM Telephone or fax—prompt notification may allow effective public health intervention. Give immunoglobulin to contacts. Special measures in child day care centres. Promote hand washing and other hygienic measures. Discuss with local PHU. Hepatitis B Hepatitis B testing must include adequate pre and post test counselling. A person with antibodies to Hepatitis B surface antigen (antiHBS) who has previously been infected with Hepatitis B is considered immune. The person will not require further testing or immunisation. If a person is found to be immune, cease further immunisation and note on vaccination record. Vaccination Vaccination for Hepatitis B is recommended and available to all prisoners, irrespective of sentence length, and all departmental staff within corrective service facilities. Screening and vaccination is to be offered to all prisoners on reception and to all prisoners who do not have immunity to Hepatitis B. Vaccination regime— a) Three injections into the deltoid muscle of the arm. The sequence of the injections to be 0, four weeks (i.e. 28 days after the first Disease and Infection Management 840983511 Version 02 Page 2of 12 b) c) injection) and 12 weeks (i.e. three months after the first injection). Booster injections will be offered every five years. Routine testing for seroconversion is not to be undertaken for either prisoners or staff. A visiting doctor can check seroconversion status in a prisoner if there is a clinical indication for this. In such cases, if seroconversion has not displayed adequate antibody levels then a fourth vaccine should be offered. The department will fund no more than four vaccines. New prisoner In the case of first time receptions, routine testing should occur unless the prisoner advises they have previously been vaccinated for Hepatitis B from a source that is able to provide confirmation of this. In such cases vaccination history must be confirmed. Previous incarceration Hepatitis B vaccination status is to be checked on reception. If vaccination schedule has not been completed further vaccinations should be given to complete the schedule. If no vaccinations were administered during previous periods of incarceration, the standard vaccination regime should commence as detailed above. If the first injection has been previously administered, the second injection may be given as soon as possible (minimum of four weeks after the first) and the third 12 weeks after the first. There is no requirement to restart the vaccination regime. If the first two vaccinations have been previously administered, the third injection should be given as soon as possible (minimum of 12 weeks after the first). There are no requirements to repeat the third injection. Discharge When a non-immune prisoner is released prior to completion of the course of vaccination, details of vaccinations given must be included on the medical ~Discharge Health Report. The prisoner should be advised to have any remaining vaccinations provided through their usual health professional. Prisoner refusing screening A prisoner refusing to have blood taken for screening, despite counselling by Health and Medical staff, should have the Hepatitis B Vaccination schedule commenced in the absence of serology results. No harm ensues when vaccination is provided to a previously immune individual. Disease and Infection Management 840983511 Version 02 Page 3of 12 Prisoner Immunity A prisoner deemed immune for Hepatitis B should have this noted on the Immunisation Summary. The reason for immunity must be stated. The most common reasons are— a) b) c) d) completion of the Department vaccination protocol; evidence of completion of vaccination by external health provider; natural immunity (previous exposure to Hepatitis B); advice from the prisoner that vaccination has been completed. If immunity is assumed on the basis of prisoner history alone, blood should be taken for confirmation. If the screening test shows that the prisoner is Hepatitis B Surface Antigen negative, then a full vaccination course should be implemented. A prisoner who has completed the Hepatitis B Vaccination protocol should have serology checked after five years. If this further test advises non-immunity, one further injection may be offered. Irrespective of the outcome of this further injection, no further vaccinations should be offered as individuals should still mount an antibody response when exposed to surface antigen despite being below the threshold for the screening test. Transmission Incubation Infectious and Exclusion Period Person to person via blood and body fluids through freshly abraded skin and mucus membranes; through sharing needles, needle stick injury, sexual contact etc. 45-180 days Average 60-90 days. HbsAg may appear within 2 weeks, or take up to 9 months. Many weeks prior to illness and for whole of clinical illness or until the disappearance of HBsAg HBeAg - highly infectious Diagnosis and Notification Positive serology (HBsAg) Routine laboratory notification Timeout: Nil Disease and Infection Management 840983511 Version 02 Prevention Assess immune status of household and sexual contacts and those with percutaneous or permucosal exposure to infective body secretions. HBIG and/or HB vaccine maybe indicated. Page 4of 12 4. Hepatitis C Hepatitis C testing must include adequate pre and post test counselling. If a prisoner request tests for Hepatitis C at any time in their sentence, whether or not such tests have been done at reception, these should be provided. History of risk behaviour is not required. Indications for testing are— a) b) c) acute viral hepatitis (baseline role). If all of the viral tests are negative, anti-HCV testing should be repeated at 3 and 6 months; as part of the investigation of suspected chronic hepatitis; and a request by a person who has — i. ii. ever used an injectable drug; or been transfused with blood or blood products prior to February 1990. Consent for testing for HCV should be obtained and noted. Transmission Percutaneous blood. exposure Incubation to Sexual transmission rare. Sharing needles is greatest risk factor. Infectious and Exclusion Period 2-26 weeks. 1 week before symptoms to indefinitely; as long as PCR is positive. Commonly 6-9 weeks. Note: acute disease occurs in less than 25% of infections. Diagnosis and Notification Positive serology. Routine notification. Timeout: Nil laboratory Prevention Needle availability, education re risk factors particularly injecting practices, & household risks. If not immune to Hep A and B, offer immunisation. Contact Hep C Council of Queensland 1800648 491, or local STI clinic, for info. Disease and Infection Management 840983511 Version 02 Page 5of 12 5. Tuberculosis Tuberculosis is a chronic infection caused by the mycobacterium tuberculosis bacteria, primarily involving the lungs but capable of attacking most organs of the body. Any suspicion of tuberculosis must be referred to the local health authority. BCG given to at risk groups. Transmission Incubation Droplet spread Invasion through mucous membranes or damaged skin may occur but is extremely rare. 4-12 weeks to primary lesions or tuberculin reactivity. Latent (dormant) infection may exist for many years prior to development of typical syndromes. Immunosuppression may reactivate disease. 6. Infectious and Exclusion Period Diagnosis and Notification Prevention May be for years, especially in partly treated cases. Risk of transmission significantly reduced within 2 weeks of starting therapy. Direct microscopy - "smear positive" disease is responsible for most spread Culture Prevention is by case finding and treatment. Contact Brisbane Chest Clinic ph 07 3896 3937 or local Chest Clinic for management of case and contacts. Low incidence of tuberculosis in Australia. Timeout: Until sputum is clear and clearance given by tuberculosis medical officer. Routine laboratory notification Discuss clinical diagnosis with Chest Clinics Severe Acute Respiratory Syndrome (SARS) Incidence Severe Acute Respiratory Syndrome (SARS) is a viral infection of the lung or a form of pneumonia. The illness is characterised by atypical pneumonia caused by a novel coronavirus. SARS is not a common disease and there are several infections that affect the respiratory tract that may produce symptoms of a cough and fever. If a suspected SARS patient is to be transported to a local hospital, the receiving hospital must be notified prior to transport and the hospital’s instructions followed Symptoms A person affected by the SARS generally presents with— a) a high fever (> 38 degrees Celsius); Disease and Infection Management 840983511 Version 02 Page 6of 12 b) c) shortness of breath and a dry cough; Headache, body ache, pain, confusion and a general feeling of being unwell are also commonly reported symptoms. Most people infected with the SARS virus become symptomatic 2 – 7 days following exposure to the virus. Notification If SARS is suspected the local hospital is to be notified and the hospital’s instructions followed. Transmission— a) b) c) d) droplet form (e.g. sneezing) and direct contact; airborne and indirect contact; through fomites (any substance supposed to be capable of absorbing, retaining, and transporting contagious or infectious germs; e.g. woollen clothes are said to be active fomites); and oral faecal transmission. The SARS virus is commonly transmitted from an infected person to close contacts. Close contacts are persons having cared for, lived with, or had direct contact with respiratory secretions / body fluids of a person infected with the SARS virus. Health care workers and close contacts of cases appear to be at greatest risk of transmission. Hygiene Regular hand washing using a liquid soap and disposable hand towels recommended. For updated information on SARS refer www.health.gov.au/sars.htm 7. Q Fever Symptoms There is no typical form of acute Q fever. The infection can resemble nearly any infectious disease. Symptoms may include a flu-like illness with fever, headache, muscle aches and pains, isolated fever, pneumonia and liver and heart complications. Many people who become infected with Q fever do not get any symptoms. Disease and Infection Management 840983511 Version 02 Page 7of 12 Transmission The most commonly identified sources of human infection are farm animals, mainly cattle, goats and sheep. There are many other identified animal carriers, including marsupials, rodents, birds, fish and arthropods. Infected animals generally do not have any symptoms, but shed the organism in urine, faeces, and milk and in high concentrations in birth products. The organism is resistant to drying out and can survive for long periods in the environment. While direct contact with infected animals is the most common mode of infection, indirect contact with infected animals or contaminated straw, manure, dust or clothing has been reported as possible sources of human infection. The disease is rarely, if ever, transmitted from person to person. Vaccination Q Fever is a vaccine preventable condition. Staff and offenders exposed to farm animals, as a part of their work duties should be vaccinated for Q Fever on workplace health and safety grounds. If vaccinated, persons who are already immune from either exposure to Q Fever or previous vaccination can suffer unpleasant reactions. For this reason, an approved practitioner should screen individuals prior to vaccination for Q Fever. There are two components of pre vaccination screening— a) b) blood test to determine the presence of antibodies to Coxiella burnetti. Blood tests can be taken at any corrective services facility surgery; skin test. Skin tests are required to be performed by trained health professionals. Hygiene Protective clothing in the form of gloves, overalls and face masks should be worn when slaughtering animals or dressing carcasses. Hands and arms should be thoroughly washed in soapy water after handling animals or carcasses. Wash all urine, faeces, blood and other body fluids off the body. Thoroughly disinfect using either a 1:1000 dilution of household bleach with tap water, 5:1000 dilution of peroxide with tap water or 1:1000 of Lysol with tap water. Disease and Infection Management 840983511 Version 02 Page 8of 12 Minimise dust and rodents in slaughter areas and animal housing areas. Yard facilities for sheep and cattle should be sited well away from domestic living areas. In the case of abattoirs, the recommended distance is one kilometre. Transmission Inhalation of infected aerosols or dust which may travel up to a km. Infected products of conception high risk. Cattle, sheep, and goats are commonest source. Feral pigs and other animals are possibly infectious. 8. Incubation Usually 2-3 weeks. Infectious and Exclusion Period Direct transmission from person to person very rare, if ever. Timeout: Nil Diagnosis and Notification Serology Vaccine preventable (Culture of organism hazardous to lab workers) Routine notification. Prevention is laboratory NB strict pre-vaccination protocol. High occupation risk for meat workers, vets, shearers, wool processors, pig and roo shooters, graziers and others with animal contact. Rural residence a risk factor. Tetanus Prophylaxis in Wound Management Tetanus vaccine is available in the management of appropriate wounds. Where no contra indications exist, such as previous allergy/anaphylaxis to Adult Diphtheria Tetanus (ADT), Toxoid or Tetanus Immunoglobulin (TIG), and a doctor is not readily available, tetanus prophylaxis may be given by nursing staff. Where contra indications exist the advice of the Visiting Doctor should be sought. In such cases it is unlikely that prophylaxis can be given. Tetanus prone wounds are those that are either deep, contused, soil contaminated or that contain foreign bodies. Adult Diphtheria Tetanus (ADT) vaccine is to be used in preference to tetanus toxoid alone. 9. Influenza Disease and Infection Management 840983511 Version 02 Page 9of 12 In most years, minor or major outbreaks of type A or Type B influenza occur. The formulation of influenza vaccine is reviewed annually so that changes in the composition can be made to adjust to antigenic shifts and antigenic drift. The vaccine should be stored in a fridge but should not be frozen. Vaccination Influenza vaccine should be given routinely on an annual basis to— a) b) a person over 65 years of age, particularly if they also have chronic cardiac or lung disease; Aboriginal or Torres Strait Islander adults over 50 years of age. Annual vaccination should be considered for individuals in the following groups— a) b) adults with chronic debilitating diseases, especially chronic cardiac, pulmonary, renal and metabolic disorders; adults and children receiving immunosuppressive therapy. The vaccine should be administered by deep subcutaneous or intramuscular injection. A person with anaphylactic hypersensitivity to eggs should not be given influenza vaccine. Transmission Airborne or direct contact (can persist for hours in low temps). Incubation 1-3 days. Infectious and Exclusion Period Diagnosis and Notification Prevention 3-5 days (7 days in children) from clinical onset. Isolation of virus or viral antigens in nasopharyngeal cells or blood. Immunisation of at risk people and carers in autumn. Timeout: Nil Laboratory notification only. 10. Good hand washing technique will reduce spread. Pneumovax 23 Pneumovax provides a degree of protection against pneumococcal infection. The duration of protective effect is presently unknown, but studies have shown that antibody induced by the vaccine may persist for as long as 5 years. Disease and Infection Management 840983511 Version 02 Page 10of 12 Pneumovax is provided free of charge for Indigenous people. Records of administration need to be kept to allow accounts to be sent to the Commonwealth and to facilitate booster doses after 5 years. Vaccine, and further information in relation to the program, can be obtained by contacting the State Immunisation Coordinator at Queensland Health on (07) 3234 0098. Indications Pneumovax 23 vaccination is indicated for the following persons over two years of age— a) b) c) d) e) indigenous people aged 15 years or older; a person over the age of 65 years; with anatomical asplenia or splenic dysfunction; with chronic illness with an increased risk of pneumococcal disease; with other chronic illness in which pneumococcal illness may be more severe— i. ii. iii. iv. v. chronic heart; lung disease; liver disease; renal disease; and diabetes mellitus. Disease and Infection Management 840983511 Version 02 Page 11of 12 List of Notifiable Diseases a) b) c) d) e) f) g) h) i) j) k) l) m) n) o) p) q) r) s) t) u) v) w) x) y) z) aa) bb) cc) dd) ee) Acquired Immune Deficiency Syndrome (AIDS) Amoebiasis (includes amoebic dysentery) Anthrax Arbovirus infection (including dengue fever) Atypical mycobacterium infection Brucellosis Cancer Chancroid Chlamydia trachomatis Cholera Cryptococcosis Diphtheria Donovanosis Encephalitis Genital herpes (initial diagnosis only) Gonorrhoea Gonococcal ophthalmia neonatorum Hepatitis, viral types A, B, C, D and E Human Immunodeficiency virus Hydatid disease Lead poisoning Legionnaires disease Leprosy (Hansen=s disease) Lymphogranuloma venereum Malaria Measles Melioidosis Meningitis Ornithosis (psittacosis) Plague Poliomyelitis Disease and Infection Management 840983511 ff) gg) hh) ii) jj) kk) ll) mm) nn) oo) pp) Q fever Salmonella infections Severe Acute Respiratory Syndrome (SARS) Shigella infections Smallpox Syphilis Taeniasis Tuberculosis Typhoid fever Viral haemorrhagic fever Yellow fever Reference: Communicable Diseases Control Manual 3rd Ed Revised June 2003. Queensland Health Version 02 Page 12of 12