SOP C19 Salmonella typhi/paratyphi · Incubation period for typhoid is 3 days to 3 months, most...
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Lead author – Bernadette Nazareth Page 1 of 6 C19 v2 SOP C19 Salmonella typhi/paratyphi Date Ratified: March 2013 Review Date: March 2015 Norfolk, Suffolk and Cambridgeshire HPU Rationale for public health action Undertake prompt action to prevent further cases associated with a primary source. Interrupt secondary transmission. Details of case Notification of case via microbiology, clinician or lab report. Obtain all relevant details including contact details, current location of case (home or hospital) and clinical condition. Guide to risk assessment Mostly associated with travel to and from countries with poor hygiene. Person to person spread in the UK is rare. Human reservoir only for typhoid; some association with cattle for paratyphoid. Transmission is mostly faeco-oral. Urine may also be infectious. Incubation period for typhoid is 3 days to 3 months, most commonly between 7 to 21 days. For paratyphoid it is 1-10 days In typhoid fever, bacilli are usually excreted in urine from 2 nd week of illness and in stools from 3 rd week of illness. Carrier state may occur, less with paratyphoid than typhoid. Microbiological clearance via negative faecal samples is required for cases and contacts in risk groups. In screening and excluding cases and contacts, incubation and infectious period are of relevance and need to be factored in. Initial Actions Inform relevant EHO of case and agree who will carry out actions below: Complete specific enteric fever questionnaire with case or parent/guardian Identify if index case &/or contacts are in risk groups, undertake risk activities or recently travelled to endemic area (see supporting information). If necessary perform further contact tracing including possible food sources Provide verbal good hygiene advice and exclusion advice to the family and any contacts on the day of notification and follow this up with written information Provide cases and contacts in risk groups with information on requirements for returning to work/school/childcare Review questionnaire information to identify if recent travel abroad or if possible UK source. See Supporting Information See PH Operational Guidelines for Enteric Fever V1.0 http://www.hpa.org.uk/Topic s/InfectiousDiseases/Infectio nsAZ/Typhoid/TyphoidGuide lines/ ***Discussion Alert*** Discuss screening strategy with case manager/duty CCDC for all cases. Communications Provide information and advice to the GP of case about any exclusion and screening for case and/or contacts. Inform laboratory about screening strategy. Records Record on HPZone as a case Record relevant details from questionnaire on HPZone. Enter possible sources (NB: likely sources should be entered under Context) under Events as contexts. Ensure any electronic and/or paper records comply with NSC records management protocol HPZone can be found at https://hpzone.org.uk Follow up Follow up case and contacts according to the operational guidelines. See Supporting Information
Transcript of SOP C19 Salmonella typhi/paratyphi · Incubation period for typhoid is 3 days to 3 months, most...
Lead author – Bernadette Nazareth Page 1 of 6 C19 v2
SOP C19
Salmonella typhi/paratyphi Date Ratified: March 2013
Review Date: March 2015 Norfolk, Suffolk and Cambridgeshire HPU
Rationale for public health action
Undertake prompt action to prevent further cases associated with a primary source.
Interrupt secondary transmission.
Details of case
Notification of case via microbiology, clinician or lab report.
Obtain all relevant details including contact details, current location of case (home or hospital) and clinical condition.
Guide to risk assessment
Mostly associated with travel to and from countries with poor hygiene. Person to person spread in the UK is rare. Human reservoir only for typhoid; some association with cattle for paratyphoid. Transmission is mostly faeco-oral. Urine may also be infectious.
Incubation period for typhoid is 3 days to 3 months, most commonly between 7 to 21 days. For paratyphoid it is 1-10 days
In typhoid fever, bacilli are usually excreted in urine from 2nd week of illness and in stools from 3rd week of illness. Carrier state may occur, less with paratyphoid than typhoid.
Microbiological clearance via negative faecal samples is required for cases and contacts in risk groups. In screening and excluding cases and contacts, incubation and infectious period are of relevance and need to be factored in.
Initial Actions
Inform relevant EHO of case and agree who will carry out actions below:
Complete specific enteric fever questionnaire with case or parent/guardian
Identify if index case &/or contacts are in risk groups, undertake risk activities or recently travelled to endemic area (see supporting information).
If necessary perform further contact tracing including possible food sources
Provide verbal good hygiene advice and exclusion advice to the family and any contacts on the day of notification and follow this up with written information
Provide cases and contacts in risk groups with information on requirements for returning to work/school/childcare
Review questionnaire information to identify if recent travel abroad or if possible UK source.
See Supporting Information See PH Operational Guidelines for Enteric Fever V1.0 http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Typhoid/TyphoidGuidelines/
***Discussion Alert***
Discuss screening strategy with case manager/duty CCDC for all cases.
Communications
Provide information and advice to the GP of case about any exclusion and screening for case and/or contacts.
Inform laboratory about screening strategy.
Records
Record on HPZone as a case
Record relevant details from questionnaire on HPZone. Enter possible sources (NB: likely sources should be entered under Context) under Events as contexts.
Ensure any electronic and/or paper records comply with NSC records management protocol
HPZone can be found at https://hpzone.org.uk
Follow up
Follow up case and contacts according to the operational guidelines.
See Supporting Information
See Appendix 5
See Appendix 5
See
Appendix 5
Lead author – Bernadette Nazareth Page 2 of 6 C19 v2
Risk Groups
Microbiological screening and clearance Cases
For diagnosis of possible cases and exclusion of cases not in risk groups: one faecal sample as soon as possible and exclusions for all cases as per routine gastro-intestinal ’48 hours after last symptom’ rule.
For clearance of probable/confirmed cases in risk groups: Three samples 48 hours apart, from at least one week after completion of treatment. Consider exclusion or redeployment until clearance. No clearance necessary for cases not in a risk group. Contacts
Travel related cases: All co-travelling contacts (someone who travelled with the case who is likely to have been exposed to the same source of infection) require one faecal sample as soon as possible for screening but no exclusion unless symptomatic; all other non-travelling contacts require “warn and inform” information but no screening samples or exclusion unless symptomatic. All contacts are to be managed in the same manner, irrespective of whether they are in a risk group.
Non-travel associated cases: Contacts will require “warn and inform” information and may require one faecal sample for screening purposes to investigate source.
If any contacts have a positive faecal sample or become symptomatic, manage as a case, with appropriate clearance/exclusions depending on the risk group/activities.
Supporting information
Lead author – Bernadette Nazareth Page 3 of 6 C19 v2
Case definitions
Lead author – Bernadette Nazareth Page 4 of 6 C19 v2
Public health management of cases & contacts
Lead author – Bernadette Nazareth Page 5 of 6 C19 v2
Lead author – Bernadette Nazareth Page 6 of 6 C19 v2
Public health management of cases with positive screening/clearance samples and those with previous documented history of enteric fever or identified through screening
