Download Disease and Infection Management

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—
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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
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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.
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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
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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.
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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.
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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);
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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.
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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.
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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
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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.
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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.
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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
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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
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