Public Healthandthe HPA

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					    Public Health & the
           HPA
Dr Laura Ingle
GP ST1
GP teaching; 1st June
                  Outline
 Who is the HPA?
 Case discussion 1
 Case discussion 2
 How to notify an infectious disease
 Useful contacts
                    Role of HPA
   1 – Protecting public health
       Advice
       Contact tracing
       Screening programmes
       Managing outbreaks


   2 – Surveillance
       Local / national
Thames Valley Health Protection Unit
What can they do?     What can’t they do?
• Give advice on imms • Make a clinical
  / treatment           diagnosis for you
• Contact-trace       • Break a diagnosis to
• Manage outbreaks      a patient
Case 1
                      Case 1
 28yr lady, new to the area
 Registered at your surgery 3 wks ago
 18/40 pregnant
 Booking bloods done last week
 Lab report today:
       “Hep B s antigen DETECTED”
   What other info do you want to find out?
                              Serology
 • Booking bloods: serology / antigens
Marker                       Interpretation
Hep B surface antigen        Current infection (acute or chronic)
Hep B core antigen           Current infection (acute or chronic)
Hep B envelope antigen       Current infection, higher infectivity (acute or chronic)

Anti-surface IgG antibody    Previous infection OR previous vaccination
Anti-core IgM antibody       Current acute infection (within last 4-6 months)
Anti-core IgG antibody       Current OR previous infection (acute or chronic)
Anti-envelope IgG antibody   Associated with lower infectivity
 Is diagnosis known?
 Indications for bloods?
 Symptomatic / abnormal LFTS?
 RFs for Hep B?
 Occupation?
 Household?
   What actions do you want to take now?
                  Case 1 - actions
   Notify TV HPU!
   Inform about diagnosis (+ offer written info)
   Screen: household contacts / sexual partners /
    children
        accelerated course imms
   Barrier contraception
   Refer to gastro
   If pregnant: inform midwife
   If occupation = EPP: Pt to inform employers
   ?GUM clinic
Case 2
                  Case 2
 3yr girl attends your surgery
 Mum says: unwell, grizzly, feels hot
 Rash: behind ears  head  trunk
 Red eyes
   What other info do you want to find out?
                   Case 2
   More Hx:
       symptoms
       signs
       duration
                       Measles
   Symptoms:
       Fever
       Rash
       One of: cough/coryza/conjunctivitis
 Immunisation Hx?
 Contact with confirmed case?
 Travel Hx?
 Member of unvaccinated community?
 Contact with anyone at risk?
       infant / pregnant / immunocompromised
   What actions do you want to take now?
                         Case 2
 Notify TV HPU!
 Advise on exclusion time
       Infective for 5 days after rash appears
 (TV HPU will send spit kit)
 Consider immunisation of contacts if non-
  immune: 3-day window
 Consider: at risk contacts?  inform HPU
Notifiable diseases?
•   Acute encephalitis               • Leprosy
•   Acute meningitis                 • Malaria
•   Acute poliomyelitis              • Measles
•   Acute infectious hepatitis       • Meningococcal septicaemia
•   Anthrax                          • Mumps
•   Botulism                         • Plague
•   Brucellosis                      • Rabies
•   Cholera                          • Rubella
•   Diphtheria                       • SARS
•   Enteric fever (typhoid or        • Smallpox
    paratyphoid)                     • Tetanus
•   Food poisoning                   • TB
•   Haemolytic uraemia syndrome      • Typhus
•   Infectious bloody diarrhoea      • Viral haemorrhagic fever
•   Invasive group A streptococcal     (WHF)
    disease and scarlet fever        • Whooping cough
•   Legionnaire’s disease            • Yellow fever
           How to notify a NOID
Inform  TV HPU
“Notifiable Disease form”  new version in
 Feb 2010.
   Telephone 0845 279 9879
   Fax 0845 279 9881

   Email tvhpu@hpa.org.uk

   Snail-mail  address changed in Feb 2010:

TV HPU, Centre for Radiation, Chemical and Environmental
 Hazards, Health Protection Unit, Chilton, Didcot, Oxon, OX11
 0RQ
        Useful contacts
   Thames Valley Health Protection Unit
      Tel 0845 279 9879 (24hr service)
      Fax 0845 279 9881
   Vaccsline 0845 279 9878

   Duty Team tvhpu@hpa.org.uk
   HPA website www.hpa.org.uk
   The Green Book (located in DoH website
    www.doh.gov.uk)
   Nathnac www.nathnac.org

				
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posted:11/3/2012
language:English
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