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133 Molesworth Street
PO Box 5013
Wellington 6145
New Zealand
T+64 4 496 2000
19 December 2016
New infectious disease legislation with implications
On 4 January 2017 new infectious disease legislation comes into force which has
implications for primary health care providers. The Health (Protection) Amendment
Act 2016 becomes part of the Health Act 1956 and the Health (Infectious and
Notifiable Diseases) Regulations 2016 replace the 1966 regulations of the same
name.
The main changes which may affect your organisation are:
Changes to notification of infectious diseases
Anonymous notification of HIV infection, gonorrhoea and syphilis, in addition to AIDS
will be required. The main purpose is to improve information for programmes to
reduce these sexually transmitted infections (STIs) while protecting identity. The
reason for anonymity is to prevent people from avoiding diagnosis and treatment due
to fear of stigma and discrimination.
Chlamydia will be added to the Schedule as an “infectious disease” (although it will
not be notifiable). This means public health measures in new Part 3A of the Health
Act can apply – although most likely only in a serious outbreak.
New forms in the Regulations contain minimum information requirements for
laboratories and practitioners making disease notifications. Notifications must be
made electronically if possible. A new, secure, web-based information system is
being developed by ESR in collaboration with clinical laboratories, for practitioners to
provide relevant information such as disease details and risk factors, confidentially.
This will be rolled out in 2017, along with updated case definitions.
A diagram is attached (prepared by ESR) which explains the notification of disease
information flows.
The IT and related updates to notification processes will not all be fully functional by
4 January 2017, and a phased roll out is planned for the newly notifiable sexually
transmitted infections. In the interim AIDS will continue to be notified by clinicians to
the local medical officer of health; laboratories will report HIV infection directly to the
AIDS Epidemiology Group and gonorrhoea cases directly to ESR; and syphilis
reporting will be limited to Sexual Health and Family Planning Clinics. Primary
health care providers will be informed by their local medical officers of health as the
new arrangements are progressively introduced in early 2017.
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Under the new legislation, health practitioners with a relevant scope of practice,
rather than only medical practitioners, will have infectious disease notification
responsibilities - on reasonable suspicion. This extension is most likely to affect
nurse practitioners, and conceivably some midwives. It reflects modern workplace
realities.
Public health units may ask notifying practices for further information to help identify
sources and risks for the spread of disease. When the disease is one of the STIs
anonymously notified, on an exceptional basis when necessary to manage the public
health risk, a medical officer of health may ask for identifying information about the
case. This is the name, address, place of work or education or contact details.
A new, incremental suite of powers for medical officers of health to effectively
manage infectious diseases
The new powers replace a limited choice between voluntary compliance, compelled
examination and treatment, and open ended powers to isolate and detain. As well
as trying voluntary measures first, medical officers of health will have the choice of
imposing public health directions, applying to the court for a public health order,
imposing an administrative urgent public health order to detain the person in a
specified residence for a 72 hour period, and prosecution as a last resort.
The new powers are supported by human rights safeguards such as specified
timeframes, overarching principles (eg, proportionality, use of the least restrictive
alternative), reviews and appeal.
Mainstreaming tuberculosis notification and management.
Tuberculosis specific legislation1 is being replaced by Part 3A, and the updated
Schedule 1 in, the Health Act. BCG vaccinator approvals will be brought within the
scope of Director-General of Health/medical officer of health approved immunisation
programmes (under regulation 44A of the Medicines Regulations 1981).
Replacing outdated ‘venereal diseases’ provisions in the Health Act (sections
88 to 92) and Venereal Diseases Regulations 1982
The ‘venereal disease’ terminology is outdated, as are the regulations prescribing
measures for children under 16 who were suspected of having an STI.
Providing a statutory basis for formal contact tracing
There is a new statutory basis for requiring information about contacts from
individuals who have, or are suspected of having, an infectious disease listed on
Schedule 1 of the Act. Formal contact tracing is authorised only when the statutory
purpose of contact tracing is met, the option of the individual doing their own contact
tracing is not considered appropriate, reasons are given for requiring the information,
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Tuberculosis Act 1948 and Tuberculosis Regulations 1951.
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and identity is protected as far as practicable. The obligation to provide the
information is backed up by an offence provision.
Formal contact tracers will be medical officers of health, health protection officers or
suitably qualified health practitioners or community workers nominated by a medical
officer of health or DHB. Informal or voluntary contact tracing, which some primary
health practitioners and NGOs undertake now (eg, sexual health clinics, New
Zealand AIDS Foundation partner tracing), will continue unaffected.
The legislation prescribes process steps and requirements for formal contact tracing.
You need to know about this because occasionally a medical officer of health or
DHB may seek to nominate a primary health practitioner to do contact tracing on
their behalf (eg, GPs, nurses). If the nominee agrees to do so, then the procedural
steps in the legislation must be followed, and the power to require information from
the individual about their contacts will apply.
The aim of the formal contact tracing provisions is to provide PHUs with the
legislative “strength to their arm” in situations where the public health risk posed by a
case requires something more than gentle probing, particularly about prior sexual
partners, behaviour and activities. For example, where there is reckless and high
risk sexual behaviour bordering on criminal activity, PHUs may need the bolstered
information powers the legislation gives them. There is no intention or expectation
that primary care should start a flood of referrals to PHUs for contact tracing which
primary health practitioners and NGOs may still be better placed to undertake.
Implementation
Given the legislative changes, the Ministry’s Public Health Group has prepared
public health focussed guidance which some primary health practitioners may find
useful. It should be available for reference on the Ministry’s website by late January.
If you would like to know more in the interim, please contact Janet Lewin
([email protected]). The website at which you can access the new
legislation is: www.legislation.govt.nz.
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Diagram
Definitions:
AIDS Code = Based on initials, gender and date of birth.
EpiSurv = The national notifiable disease surveillance database operated by ESR on behalf of the
Ministry of Health. EpiSurv collates notifiable disease information on a real-time basis from the Public
Health Services in New Zealand. Data collected include case demographics, clinical features and risk
factors. EpiSurv incorporates an outbreak functionality that enables cases to be linked via a common
cause. Information can be viewed via customisable local and national reports and maps.
ESR = Institute of Environmental Science and Research
REDCap = (Research Electronic Data Capture) is a browser-based, metadata-driven EDC software
solution and workflow methodology for designing clinical and translational research databases. A
secure web based application in which data is received via email, fax, or post from sexual health
clinics. The data is extracted and analysed.
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