5th Edition June 2011

Communicable Diseases
Control Manual
A clinician’s guide to the prevention and control of infectious diseases of public health importance

Please notify the following conditions urgently (by telephone) to your local public health unit
This will enable public health responses to begin promptly without unnecessary delay.*
Suspected invasive meningococcal disease Haemolytic uraemic syndrome
Suspected Haemophilus influenzae type b disease Ciguatera poisoning
Suspected dengue Acute flaccid paralysis
Suspected avian influenza Foodborne illness in a food handler
Suspected measles Foodborne or waterborne illness in two or more associated cases

Bite from a mammal (eg. wild or domestic cat, dog, monkey)

Suspected acute viral hepatitis
in a rabies-endemic area including Bali (potential rabies exposure)

Bite or scratch from any bat or flying fox (potential Australian

Exotic/rare conditions (diphtheria, smallpox, SARS)
bat lyssavirus exposure)

* Other conditions are also notifiable by clinicians to PHUs by phone or fax on a less urgent basis. These include
acute rheumatic fever, tetanus, adverse events following immunisation and suspected Creutzfeldt-Jakob disease.
Communicable Diseases Control Manual, 5th Edition June 2011
Published by the State of Queensland (Queensland Health)

This document is licensed under a Creative Commons Attribution 3.0 Australia licence.
To view a copy of this licence, visit creativecommons.org/licenses/by/3.0/au

© State of Queensland (Queensland Health) 2011.

You are free to copy, communicate and adapt the work,

as long as you attribute the State of Queensland (Queensland Health).

For more information contact:

Senior Director
Communicable Diseases Branch
Queensland Health
15 Butterfield Street
Herston QLD 4006
PO Box 2368
Fortitude Valley BC QLD 4006
Phone (07) 3328 9724

An electronic version of this document is available at www.health.qld.gov.au

Deaf, hearing-impaired or speech-impaired customers can contact the department

through the National Relay Service:
• TTY users phone 133 677
• Speak and Listen users phone 1300 555 727
• Internet relay users connect to the NRS at www.relayservice.com.au

Flowcharts........................................................... 2
Australian Bat Lyssavirus (Potential Exposure)...........2
Avian Influenza............................................................3
Measles.......................................................................4
Meningococcal Disease (Invasive)...............................5
Pertussis.....................................................................6
Disease information............................................. 7
Australian bat lyssavirus (ABL)...................................7
Avian influenza (AI).....................................................7
Brucellosis...................................................................7
Campylobacter enteritis..............................................8
Chickenpox/shingles...................................................8
Chlamydia...................................................................9
Cytomegalovirus (CMV) infections............................10
Cryptosporidiosis......................................................10
Dengue fever.............................................................11
Diphtheria.................................................................11
Erythema infectiosum...............................................11
Escherichia coli.........................................................12
Giardiasis..................................................................12
Gonorrhoea...............................................................13
Haemophilus influenzae type b (Hib) disease...........13
Hand, foot and mouth disease..................................14
Hendra virus infection...............................................14
Hepatitis A.................................................................15
Hepatitis B.................................................................15
Hepatitis C.................................................................16
Hepatitis E.................................................................16
HIV infection/Acquired Immunodeficiency
Syndrome (AIDS).......................................................17
Infectious monomucleosis........................................17
Influenza...................................................................18
Legionellosis.............................................................18
Leptospirosis.............................................................19
Listeriosis..................................................................19
Measles.....................................................................20
Melioidosis................................................................20
Meningococcal disease.............................................21
Mumps......................................................................21
Pertussis...................................................................22
Pneumococcal disease..............................................23
Q fever.......................................................................23
Contents
Roseola infantum......................................................24
Ross River virus (RRV) disease and
Barmah Forest virus (BFV) disease............................24
Rotaviral gastroenteritis............................................24
Rubella......................................................................25
Salmonella infection.................................................25
Shigella infection......................................................26
Streptococcal diseases.............................................26
Syphilis.....................................................................27
Tetanus......................................................................27
Toxoplasmosis...........................................................28
Tuberculosis..............................................................28
Typhoid and paratyphoid fever..................................29
Yersiniosis.................................................................29
Notifiable Conditions Report Form..................... 30
List of clinical and provisional
diagnosis notifiable conditions.......................... 31
Glossary of abbreviations.................................. 31
Contacts............................................................. 32
Australian Bat Lyssavirus (Potential exposure)
Australian bat lyssavirus is closely related but not identical to classical rabies virus. All bites, scratches and mucous
membrane exposures from all bats, regardless of the bat’s clinical status, should be managed as potential exposures.

Bat or flying fox bite or scratch or mucosal exposure to saliva?

• Immediately wash wound/s well with soap and water gently for at least 5 minutes
• Apply an iodine or alcohol-based antiseptic solution (if available)
• Check vaccination status for tetanus

Client details
• Previously vaccinated with rabies vaccine?
• Weight?

Urgently seek advice
Bat or Flying Fox
• To be retained for testing (if available)
• To be handled by rabies-vaccinated
• Client contact details? from public health unit bat handlers only

Post Exposure Prophylaxis (PEP)

• Administer rabies immunoglobulin and rabies vaccine as instructed by public health unit (PHU)
• Further information is available in the current edition of The Australian Immunisation Handbook or from the PHU
• Complete VIVAS Vaccination Record Form for vaccines administered

2 Communicable Diseases Control Manual

 Avian Influenza
Contact your local public health unit for current information on countries with
suspected or confirmed H5N1 infection in animals or humans.

Thinking Avian Influenza (AI)?

A suspected case must fulfil clinical and exposure criteria

Clinical criteria Exposure criteria

Unexplained acute One or more of the following exposures in the 7 days prior to symptom onset:
lower respiratory illness with: • Close contact (within 1 metre) with a person (eg. caring for, speaking with or touching) who is a suspected, probable,

+
fever, or history of fever ≥ 380C or confirmed H5N1 case.
+ • Exposure (eg. handling, slaughtering, de-feathering, butchering, preparation for consumption) to poultry or wild birds
cough or their remains, or to environments contaminated by their faeces, in an area where H5N1 infections in animals or humans
+ have been suspected or confirmed in the month prior to onset of symptoms.
shortness of breath or • Consumption of raw or undercooked poultry products in an area where H5N1 infections in animals or humans have been
difficulty breathing suspected or confirmed in the last month.
• Close contact with a confirmed H5N1 infected animal other than poultry or wild birds (eg. cat or pig).
• Handling samples (animal or human) suspected of containing H5N1 virus in a laboratory or other setting.

 Implement infection control precautions and immediately notify public health unit
(PHU will advise on appropriate management and laboratory testing)

Infection control precautions

Airborne, droplet, contact and standard precautions apply until a diagnosis of AI is excluded.
• Patient to wear a surgical mask • Isolate patient in a separate room
• Staff to wear full personal protective equipment (P2 mask, gown, gloves, eye protection) when providing care.

Communicable Diseases Control Manual 3

Measles
If you are considering a diagnosis of measles, then laboratory confirmation is imperative.

Skin rash? Thinking Measles?

Clinical case definition

Morbilliform rash + fever present at rash onset + cough
Differential diagnosis
• Rubella
Infection control Meets clinical case definition? • Roseola infantum
Place the patient • Human parvovirus
in a separate room to • Enteroviruses
avoid infecting others
Notify public health urgently  • Arboviruses
and arrange urgent laboratory tests for measles • Kawasaki syndrome
(PHU will liaise with testing laboratory to ensure appropriate • Drug hypersensitivity rash
infection control precautions) • Group A streptococcal disease
(scarlet fever)

Laboratory tests
0–3 days after rash onset – throat or nasopharyngeal swab for PCR
3–7 days after rash onset – throat or nasopharyngeal swab for PCR and blood for IgM
0–7 days after rash onset – urine for PCR
> 7 days after rash onset – blood for IgM
Note: freeze specimens for PCR if they can’t get to the laboratory within 24 hours

For further information please consult the text on page 20 or contact your local public health unit.

4 Communicable Diseases Control Manual

 Meningococcal Disease (Invasive)
Early recognition and prompt administration of appropriate antibiotic therapy can be lifesaving.

Thinking Meningococcal Disease?

Typical symptoms and signs may include:

• headache, drowsiness
• fever, prostration
• nausea, vomiting
• rash: usually petechial, but may be purpuric or, less commonly, a maculopapular rash
• in young children: irritability, refusing feeds, pallor and a high pitched moaning cry may be present.

 Urgently notify your • Ensure urgent admission to hospital

Immediately on clinical suspicion
local public health unit • Notify Registrar

Administer intravenous antibiotics before transfer to hospital

• Blood cultures should be taken wherever possible, but should not delay the initiation of therapy.
• If venipuncture is difficult, administer antibiotic by intramuscular route and omit the blood cultures.
• If patient is allergic to penicillin give IV ceftriaxone or cefotaxime (monitor closely due to risk of cross-reactivity).
• If allergic to penicillin and cephalosporins consult Therapeutic Guidelines: Antibiotic for alternatives.

Antibiotic doses
Ceftriaxone 50mg/kg (for all ages) up to 2g IV Benzylpenicillin (max IV admin rate 300 mg/min)
Children aged < 1 year: 300mg
Children aged 1 to 9 years: 600mg
Adults and children aged 10 years and over: 1200mg

Communicable Diseases Control Manual 5

Pertussis
Thinking Pertussis?

Typical clinical presentation Laboratory tests for pertussis

• Paroxysmal or persistent cough Cough present for:
• Post-tussive vomiting or inspiratory whoop (infants) ≤ 2 weeks............PCR (nasopharyngeal swab)
2–4 weeks..........PCR and serology (IgA)
• May report contact with known or suspected pertussis case
> 4 weeks............Serology (IgA)

Management
Symptoms ≤ 3 weeks
• Exclude from school, pre-school or childcare till completed 5 days antibiotics or 21 days from onset of cough.
• Treat if cough ≤ 2 weeks. Queensland Health recommends the following antibiotics in order of preference:
• Clarithromycin* (but not if pregnant or baby aged < 1 month), azithromycin, erythromycin (but not if baby aged < 1 month), trimethoprim/
sulfamethoxazole. Roxithromycin is not recommended.
• Contact management – treat high-risk (see below) household contacts, inform Public Health Unit of any other high-risk contacts.
Cough present 3–5 weeks
• Exclusion not necessary, treatment not necessary. Contact management as above.
Cough present > 5 weeks
• Exclusion not necessary, treatment not necessary. Contact tracing not required.
*Azithromycin is first preference in Queensland Health facilities as clarithromycin is not on the Queensland Health List of Approved Medicines.

Contacts
High-risk contacts for antibiotics:
• Household of case: if household contains any child < 24 months with < 3 doses vaccine, treat all people in same household
• Last month of pregnancy: contact within 1 metre of case for > 1 hour: treat regardless of vaccination status.
Antibiotics for contacts same as for cases. Start antibiotics only if within 21 days of last contact with infectious case.

 Notify your local public health unit of high risk settings (childcare centre or maternity/infant ward)

6 Communicable Diseases Control Manual


Disease/organism Transmission
Australian bat lyssavirus (ABL)
Vaccine preventable • Inoculation of infected
saliva by bite or scratch
Refer to flowchart • There have been
on page 2. from a bat or flying fox, or
mucosal exposure to saliva.
• Infected animals may not
appear sick. All bats and
flying foxes should be
considered potentially
infected.
Avian influenza (AI)
Avian influenza • Usually close contact
viruses; influenza A with dead or sick
virus from avian birds or environments
reservoir hosts. contaminated by their
faeces. Inhalation of
Currently H5N1
infectious droplets;
influenza A virus is
direct and indirect
causing outbreaks
contact. Person-to-person
in birds overseas
transmission very rare.
with sporadic human
infections.
Refer to flowchart
on page 3.
Brucellosis
Mainly Brucella suis, • Contact with blood, urine,
usually from feral products of conception,
pigs. etc, especially of feral
pigs via breaks in skin.
Also unpasteurised
dairy products; airborne
in animal enclosures,
abattoirs and laboratories;
needle stick injuries.
*
‘Time out’ refers to minimum exclusion period for school or child care – see www.health.qld.gov.au/ph/documents/cdb/timeout_poster.pdf
Infectious period and
Incubation
exclusion period*
• Uncertain. • Person-to-person
transmission theoretically
possible but extremely
2 fatal human cases
unlikely.
in Australia: one
with an incubation • Period of infectivity for
of 3 weeks and bats unknown. Bat should
the other of over be retained for laboratory
2 years. testing providing further
injury can be avoided.
Time out: Nil.
• May be longer than • 1 day before to 7 days after
for seasonal human onset of symptoms in adults;
influenza viruses: and for up to 3 weeks after
for H5N1 usually onset of symptoms in < 12
2–4 days but may year olds.
be up to 8 days.
Time out: Isolate from time
diagnosis suspected until
end of infectious period or
until alternative diagnosis
established.
• Highly variable: • Person-to-person
usually 5–60 days; transmission rare.
occasionally several
months. Time out: Nil.
Diagnosis and
notification
• Detection of virus in
brain tissue by direct
immunofluorescence, PCR
or viral culture. Urgently
notify PHU by phone of all
bat bites or scratches.
• Notifiable by laboratory
on request for antibody
testing.
• H5 AI virus detection
on PCR of respiratory
secretions.
• H5 AI culture from
respiratory tract specimen.
• Urgently notify PHU by
phone on provisional
clinical diagnosis.
• Isolation from blood.
• PCR from blood.
• Serology: 4 fold rise in
antibody titre in paired
sera.
• Routine laboratory
notification.
Disease information
Prevention
• Avoid contact with bats. Bat handlers should
receive pre-exposure rabies immunisation
and use protective gear. Promptly clean bites
and scratches gently with soap and water for
5 minutes and apply a virucidal antiseptic
such as povidone-iodine.
• If bat is available, PHU will arrange retrieval
and testing.
• PHU will advise on post exposure immunisation
for each case. Aim to begin immunisation within
48 hours following injury.
• Avoid contact with birds, especially dead/sick
birds or environments contaminated with their
faeces in countries where H5N1 is circulating.
• Contacts may require antiviral prophylaxis.
• Latest WHO tracking information on human
cases: www.who.int/csr/disease/avian_
influenza/en/index.html
• Current list of countries with animal cases:
www.oie.int/eng/info_ev/en_AI_
avianinfluenza.htm
• Educate pig shooters and other animal workers
to exercise caution in handling possibly
infective material.
• Avoid unpasteurised milk.
• Use standard infection control precautions
for human cases.
Communicable Diseases Control Manual 7
Disease information
Disease/organism Transmission
Campylobacter enteritis
Campylobacter jejuni • Ingestion of undercooked
Campylobacter coli chicken and offal,
unpasteurised milk and
untreated water.
• Contact with infected pets
(especially puppies and
kittens), poultry and birds.
• Reservoir: cattle, sheep,
pigs and wild and domestic
birds.
Chickenpox/shingles
Varicella-zoster virus • Direct contact; droplet,
airborne spread or from
Up to 2% risk of
articles contaminated with
malformations with
respiratory tract secretions
infection before
or fluid from vesicles.
20 weeks gestation.
• Airborne spread probably
Up to 30% severe
not important for shingles.
disease in neonates
whose mothers • 80–90% risk of infection
develop disease after household exposure
5 days before to in non-immune people.
2 days after delivery.
Routine childhood
vaccination.
8 Communicable Diseases Control Manual
Infectious period and
Incubation
exclusion period*
• 1–10 days; • Usually between several
usually 2–5 days. days and several weeks.
Time out: Until 24 hours after
last loose stool, or 48 hours if
case is a food handler or carer.
• 10–21 days; • From 5 days prior to rash to
commonly until all vesicles are crusted
14–16 days. (usually about 5 days).
• Consider susceptible
contacts to be infectious
10–21 days following
exposure.
Time out: Until all blisters
have dried.
*
‘Time out’ refers to minimum exclusion period for school or child care – see www.health.qld.gov.au/ph/documents/cdb/timeout_poster.pdf
Diagnosis and
notification
• Isolation from faeces.
• Routine laboratory
notification.
• Notify PHU by phone or fax
if 2 or more related cases
or if case is a food handler.
• Predominantly clinical.
• Routine laboratory
notification.
Prevention
• Hand washing and good personal hygiene.
• Avoid cross contamination during storage
and preparation of food.
• Thoroughly cook all animal foodstuffs
and avoid unpasteurised milk.
• Recognise pets as sources of infection.
• Where possible, non-immunes (people without
definite history of chickenpox or serological
evidence of immunity) should avoid contact
with cases.
• Vaccine is effective in preventing or modifying
illness if given to non-immunes within 3 days
of exposure.
• Zoster immune globulin (ZIG) indicated for
high risk contacts – immunosuppressed,
non-immune pregnant women, and neonates
exposed in first 4 weeks of life if mother
non-immune – within 96 hours of significant
exposure, as per current edition of The
Australian Immunisation Handbook. If over
96 hours, acyclovir may be indicated – discuss
with treating specialist or infectious diseases
physician.
 Disease information

Infectious period and Diagnosis and

Disease/organism Transmission Incubation Prevention
exclusion period* notification
Chlamydia
Chlamydia • Sexual contact main route • Not well defined; • Unknown, reinfection • PCR. • Anogenital: Prompt treatment with
trachomatis of transmission for probably 7–14 days common. azithromycin 1g (single oral dose) and further
• Routine laboratory
anogenital infection. or longer. testing for other STIs. Avoid unprotected sex
Infection often notification.
Time out: Nil unless for a minimum of 3 days following treatment.
asymptomatic when • Vertical transmission
conjunctivitis and then • Trachoma is a clinical
transmitted. during childbirth with • A test for reinfection at 3–6 months is
exclude until discharge from diagnosis.
eye infection and/or recommended.
The Public Health Act eyes has ceased.
pneumonia in the neonate.
2005 (sections 191 • More information available at:
and 192) identifies • Trachoma results from www.health.qld.gov.au/sexhealth/
that it is mandatory recurrent eye infections documents/cm_guidelines.asp
in Queensland with particular strains Sexual health clinics can also provide
for doctors and via direct contact with treatment/clinical advice.
registered nurses to secretions or indirect
• NB. Anogenital infection increases risk of
report reasonable contact with contaminated
acquiring and transmitting HIV infection.
suspicions of child fomites (towels, clothes
abuse and neglect etc). • Contact tracing and treatment.
directly to the Child
Safety Services, • General STI prevention measures, especially
Department of condom use.
Communities. • Opportunistic screening important for those
who are sexually active particularly those
aged 15–24 years where there is the highest
prevalence.
• Trachoma: Hygiene education.

*
‘Time out’ refers to minimum exclusion period for school or child care – see www.health.qld.gov.au/ph/documents/cdb/timeout_poster.pdf Communicable Diseases Control Manual 9
Disease information
Disease/organism Transmission
Cytomegalovirus (CMV) infections
Congenital • Mucosal contact with
cytomegalovirus secretions.
disease
• Blood transfusion.
Cytomegalovirus
• Vertical transmission
In utero infection before and during birth.
occurs in 0.3–1% of
• CMV is commonly
all births. 5–10% of
transmitted through urine
these infants develop
and respiratory secretions
symptomatic disease;
and rarely through breast
of these, 15–25%
milk and sexual secretions.
develop neurosensory
disability.
Cryptosporidiosis
Cryptosporidium • Faecal-oral, person-to-
parvum person (easily transmitted
in places such as childcare
centres), animal to
person (eg. from farms
or petting zoos), or from
water (inadequate or
untreated drinking or
recreational supplies:
oocysts resistant to usual
chemical disinfectants) and
food borne (uncommon).
Most widespread
outbreaks associated
with contaminated water
(particularly swimming
pools).
10 Communicable Diseases Control Manual
Infectious period and Diagnosis and
Incubation Prevention
exclusion period* notification
• Unknown for • Often prolonged (months). • Serology: 4 fold rise in • Good hygiene measures; hand washing after
horizontal antibody titre in paired changing nappies; standard precautions in
• After neonatal infection may
transmitted sera. daycare centres and pre-schools.
be shed in urine and saliva
infection in
up to 6 years of age. • Virus isolation from • Pregnant women should be especially
households.
infected target organ. PCR. careful; it may be advisable for them to avoid
• Asymptomatic infection with
• 3–12 weeks for unnecessary contact with infants.
excretion of virus is common. • Not notifiable.
infections acquired
during delivery.
Time out: Nil.
• 3–8 weeks for
illness following
transplant or blood
transfusion.
• 1–12 days • From onset of symptoms • Identification of oocytes • Good hygiene measures, sanitary disposal
(average 7 days). (via excreted oocytes) in faeces. of faeces.
Not precisely known to several weeks after
• Routine laboratory
symptoms have resolved.
notification.
Oocytes may survive for
6 months or more outside
body in moist environments.
Time out: Until 24 hours after
last loose stool, or 48 hours if
case is a food handler or carer.
Avoid swimming pools for 2
weeks after diarrhoea ceased.
*
‘Time out’ refers to minimum exclusion period for school or child care – see www.health.qld.gov.au/ph/documents/cdb/timeout_poster.pdf
 Disease information

Infectious period and Diagnosis and

Disease/organism Transmission
Dengue fever
Dengue virus • Bite from day-biting
(a flavivirus) mosquito: Aedes aegypti
Types 1 – 4 (which is mostly overseas
and in north Queensland,
but also parts of
central and south west
Queensland).
Incubation Prevention
exclusion period* notification
• 3–14 days, • No direct person-to-person • PCR or NS1 antigen in first • Avoid mosquito bites; environmental mosquito
commonly transmission; infected week of illness. control measures (fresh water container
4–7 days. human is infectious to breeder, also likes indoors).
• Serology.
mosquito from shortly before
to up to 12 days from onset • Notify PHU by phone or fax
of symptoms. on clinical suspicion.
Time out: Nil.

Diphtheria
Corynebacterium • Respiratory droplet; direct
diphtheriae spread from nose/throat
secretions, skin lesions,
Routine vaccination
contaminated articles;
unpasteurised milk.
• 2–5 days, • Up to 4 weeks but usually
occasionally longer. less than 2 weeks: ceases
promptly with antibiotics
(rare carrier to 6 months).
Time out: Exclude cases and
contacts until cleared by PHU.
• Clinical. • All contacts should have throat and nasal
swabs and antimicrobial prophylaxis.
• Isolation of organism
Check immunisation status of all contacts.
(culture).
• Discuss with your PHU.
• Urgently notify PHU by
phone or fax on clinical
suspicion.

Erythema infectiosum
(Human parvovirus, • Primarily through contact • 4–20 days to • Usually only before onset • Serology. • Severe complications uncommon.
fifth disease, slapped with infected respiratory development of rash.
• Not notifiable. • Advise hand washing.
cheek syndrome) secretions; mother to of rash.
• People with aplastic crisis
foetus possible.
Parvovirus B19 infectious for a further week.
• By transfusion (rare).
Can cause chronic • Immunosuppressed may
anaemia in immune become chronic carriers
suppressed and (months to years).
aplastic crisis in sickle
cell disease. Time out: Nil.
Risk to foetus from
intrauterine infection.

*
‘Time out’ refers to minimum exclusion period for school or child care – see www.health.qld.gov.au/ph/documents/cdb/timeout_poster.pdf Communicable Diseases Control Manual 11
Disease information

Infectious period and Diagnosis and

Disease/organism Transmission Incubation Prevention
exclusion period* notification
Escherichia coli
Shiga toxin producing • Faecal-oral, person/animal • 2–10 days • 7 days in adults; 3 weeks • Isolation of STEC from • Early identification of source with avoidance
E. coli (STEC); to person. (median 3–4 days). in a third of children. faeces. of undercooked contaminated foods,
unpasteurised milk and contaminated water.
Entero-haemorrhagic • Also from contaminated • Isolation of Shiga toxin
E. coli (EHEC); Vero food (especially Time out: Until 24 hours after from isolate of E. coli. • Hygiene measures important around animal
toxin producing E. coli undercooked beef), last loose stool. Food handlers, reservoirs and their environments.
carers and childcare attendees • PCR of gene producing
(VTEC). unpasteurised milk
need to be discussed with Shiga toxin from E. coli • Prevention of person-to-person transmission
and water.
NB. Consider if PHU. or faeces. by education re: hygiene and exclusion as
bloody diarrhoea in • Reservoir in cattle. appropriate.
• Urgently notify PHU by
child under 5 years
phone or fax on clinical • Discuss with your PHU.
of age: up to 10%
suspicion of HUS.
risk of haemolytic
uraemic syndrome
(HUS) following STEC
infection.

Giardiasis
Giardia lamblia • Faecal–oral, usually • 3–25 days, • Entire period of infection. • Positive stool microscopy. • Education in personal hygiene, hand washing.
directly person-to-person. average 7–10 days.
• Not notifiable.
Spread via contaminated Time out: Until 24 hours after
water and food occurs, last loose stool, or 48 hours if
but is not common. case is a food handler or carer.

12 Communicable Diseases Control Manual *

‘Time out’ refers to minimum exclusion period for school or child care – see www.health.qld.gov.au/ph/documents/cdb/timeout_poster.pdf
 Disease information

Infectious period and Diagnosis and

Disease/organism
Gonorrhoea
Neisseria • Sexual contact main route
gonorrhoeae
The Public Health Act
2005 (sections 191
and 192) identifies • Vertical transmission
that it is mandatory
in Queensland
for doctors and
registered nurses to
report reasonable
suspicions of child
abuse and neglect
directly to Child Safety
Services, Department
of Communities.
Transmission
• 1–14 days;
of transmission for ano-
genital, pharyngeal and
conjunctival infection.
during childbirth with
conjunctival or anogenital
infection in the neonate.
Incubation
exclusion period*
• Untreated: may remain
may be longer. infectious for months.
Non-infectious after
appropriate antibiotic
treatment.
Time out: Nil unless
conjunctivitis and then exclude
until discharge from eyes has
ceased.
notification
• Bacterial swab of urethral,
ocular, pharyngeal or
endocervical discharge
for culture and sensitivity
(important due to
increasing resistance):
also air-dried slide.
• PCR urine and sites listed
above.
• Often clinically
indistinguishable from
other causes of urethral
infection. Co-infection
with chlamydia common.
• Routine laboratory
notification.
Prevention
• Prompt empirical treatment for both chlamydia
(azithromycin 1g single oral dose) and
gonorrhoea (ceftriaxone 250mg IM single
dose) and further testing for other STIs.
• More information available at:
www.health.qld.gov.au/sexhealth/
documents/cm_guidelines.asp
Sexual health clinics can also provide
treatment/clinical advice.
• NB. Anogenital infection increases risk
of acquiring and transmitting HIV infection.
• Contact tracing and treatment. General STI
prevention measures especially condom use.
• Conjunctival: hygiene education.

Haemophilus influenzae type b (Hib) disease

Haemophilus • Respiratory droplet/direct • Unknown, probably • While Hib present in nose • Isolation from blood, urine • Manage case in respiratory isolation for
influenzae type b spread from nose/throat 2–4 days. and throat; eradicated within or CSF. 24 hours after commencing antibiotics.
secretions. 24–48 hours of starting
Routine childhood • Detection of Hib antigen in • Rifampicin prophylaxis to some contacts.
rifampicin.
vaccination CSF with clinical meningitis.
• Discuss with your PHU.
Time out: Until 4 days of • Urgently notify PHU by
rifampicin therapy completed phone or fax on clinical
for childcare attendees/ suspicion.
workers.

*
‘Time out’ refers to minimum exclusion period for school or child care – see www.health.qld.gov.au/ph/documents/cdb/timeout_poster.pdf Communicable Diseases Control Manual 13
Disease information
Disease/organism
Hand, foot and mouth disease
Enteroviruses • Direct contact with nose
predominantly of the
Coxsackie virus type.
Enterovirus 71 (EV71)
is a cause of hand
foot and mouth
disease, and can
also uncommonly
cause meningitis,
encephalitis and
acute flaccid
paralysis.
Hendra virus infection
Hendra virus (HeV) • All known human cases
Clinical features in
humans have included
• self-limiting
influenza like illness
• pneumonic illness
• Flying foxes are the natural
• encephalitis at
seroconversion
• aseptic meningitis
with apparent
recovery, then • No current evidence
encephalitis
13 months later.
4 of the 7 known • Bat to horse transmission
human cases have
died as a result
of the disease.
14 Communicable Diseases Control Manual
Transmission
• 3–5 days.
and throat discharges,
fluid from blisters and
faeces of infected persons
(faecal-oral route).
• Current limited
acquired disease from a
HeV-infected horse (whilst
alive or at autopsy) by
direct, close, unprotected
contact with body fluids.
host of HeV but no current
evidence of bat-to-human
transmission.
of human-to-human
transmission.
thought to be by ingestion
of infected bat urine or
reproductive products.
Infectious period and
Incubation
exclusion period*
• During acute illness; virus
may also persist in faeces
for several weeks.
Time out: Until all blisters
have dried.
• Exclude children with EV71
neurological disease until
virus no longer excreted
and a medical certificate
provided stating this. If
>2 cases of neurological
disease, school or childcare
may be closed.
• Unknown.
evidence suggests
• Horses should be considered
5–16 days, but
potentially infectious from
could be up to
72 hours prior to onset of
21 days in humans.
symptoms until safe disposal
of the carcass of the animal
has been completed (after
death from disease or
euthanasia).
*
‘Time out’ refers to minimum exclusion period for school or child care – see www.health.qld.gov.au/ph/documents/cdb/timeout_poster.pdf
Diagnosis and
Prevention
notification
• HFMD: clinical. • Reduce person-to-person contact; promote
hand washing and hygiene.
• EV71 neurological disease:
PCR of CSF, vesicle fluid, • Cleaning of household surfaces with warm
faeces. soapy water.
• Urgently notify PHU by
phone or fax for all clinical
diagnoses of acute flaccid
paralysis. Reporting to PHU
by clinicians encouraged if
EV71 neurological disease
suspected.
• Isolation or PCR of • Stress the importance of hygiene when
nasopharyngeal/bronchial humans interact with horses and the use
secretions, CSF, urine or of appropriate personal protective equipment
blood. when there is any human contact with
sick horses or their carcasses. See:
• Detection of HeV antibodies
www.dpi.qld.gov.au/4790_2900.htm
in blood.
• Contacts of HeV-infected horses require
• Notifiable by laboratories
assessment by PHU.
on request for testing.
• Any concerns should be discussed with
your PHU.

Disease/organism Transmission
Hepatitis A
Hepatitis A virus • Person-to-person by faecal-
(HAV) oral route.
Vaccine preventable • Outbreaks occur in child
care centres, travellers,
and men who have sex
with men. Associated with
contaminated produce,
water and shellfish.
Hepatitis B
Hepatitis B virus • Percutaneous or
(HBV) permucosal exposure
to blood or secretions
Routine vaccination
via abrasions, sharing
needles/syringes, needle
stick injury.
• Sexual contact.
• Perinatal transmission.
*
‘Time out’ refers to minimum exclusion period for school or child care – see www.health.qld.gov.au/ph/documents/cdb/timeout_poster.pdf
Infectious period and
Incubation
exclusion period*
• 15–50 days, • Last half of incubation
average period, (usually taken as
28–30 days. 15 days before onset of
symptoms) to 1 week after
onset of jaundice.
Time out: Until 7 days after
onset of jaundice. Medical
certificate of recovery required.
• 45–180 days, • Many weeks prior to
average illness and for whole of
60–90 days. clinical illness or until the
disappearance of HBsAg –
• HBsAg may appear
may persist for life in chronic
within 2 weeks,
carriers.
or take up to
9 months. • HBeAg or high titre HBV DNA
– highly infectious.
Time out: Nil.
Disease information
Diagnosis and
Prevention
notification
• Positive IgM. • Give hepatitis A vaccine or immunoglobulin
to specific contacts. Special measures in child
• Urgently notify PHU by
care settings and pre-schools.
phone or fax on clinical
suspicion of acute viral • Discuss with your PHU.
hepatitis.
• Promote hand hygiene and other hygiene
• Prompt notification may measures.
allow effective public
• Promote vaccination for travellers including
health intervention.
those planning short holidays in resorts in Asia
and the Pacific.
• Positive serology (HBsAg). • Assess immune status of household and
sexual contacts and those with percutaneous
• Urgently notify PHU by
or permucosal exposure to infective
phone or fax on clinical
body secretions. Hepatitis B vaccine and
suspicion of acute viral
immunoglobulin as per current edition of
hepatitis.
The Australian Immunisation Handbook.
• Prompt notification may
• NB. HBV stable outside body for 7 days,
allow effective public
transmission through objects such as razors
health intervention.
and toothbrushes possible – advise against
sharing.
• Screen people born in high and intermediate
prevalence countries.
• Contact Hepatitis Queensland 1300 437 222
for appropriate support and referral
information.
• Discuss management of cases and contacts
with local public hospital liver/hepatitis clinic
or sexual health clinic.
Communicable Diseases Control Manual 15
Disease information
Disease/organism Transmission
Hepatitis C
Hepatitis C virus • Percutaneous exposure to
(HCV) blood or blood products.
• Sexual transmission rare,
although reports suggest
some men who have sex
with men may be at risk.
• Sharing needles and
injecting equipment is
greatest risk factor.
• Perinatal transmission
approximately 5%; occurs
at higher rate in women
co-infected with HIV.
Hepatitis E
Hepatitis E virus • Faecal-oral route,
(HEV) principally from
contaminated drinking
Case fatality rate up
water.
to 20% in pregnant
women infected in 3rd • Person-to-person
trimester. transmission possible.
Otherwise clinical
course similar to
hepatitis A with no
evidence of chronic
form.
16 Communicable Diseases Control Manual
Infectious period and Diagnosis and
Incubation Prevention
exclusion period* notification
• 2–26 weeks, • 1 or more weeks before • Positive serology. • Educate re: risk factors particularly injecting
commonly symptoms to indefinitely practices (eg. use clean injecting equipment,
• PCR.
6–9 weeks. (as long as PCR is positive). needle and syringe programs) and household
• Routine laboratory risks (eg. avoid sharing razors, toothbrushes).
• Initial infection may
Time out: Nil. notification.
be asymptomatic • If not immune to hepatitis A and B, offer
with around 75% immunisation.
developing chronic
• Contact Hepatitis Queensland 1300 437 222
infection.
for appropriate support and referral
information.
• Discuss management of cases and contacts
with the local public hospital liver/hepatitis
clinic.
• 15–64 days, • Not known. • PCR (detection in stools/ • Education re: hand washing and other hygiene
mean 26–42 days. blood). practices.
• Faecal shedding from
4 weeks after exposure, • Serology.
lasting until 14 days from
• Urgently notify PHU by
onset of jaundice.
phone or fax on clinical
suspicion of acute viral
Time out: While shedding. hepatitis.
*
‘Time out’ refers to minimum exclusion period for school or child care – see www.health.qld.gov.au/ph/documents/cdb/timeout_poster.pdf

Disease/organism Transmission
HIV infection/Acquired Immunodeficiency Syndrome (AIDS)
Human • Sexual contact – risk
immunodeficiency increased by presence
virus – types 1 and 2 of other STIs, especially
genital ulcerative disease.
• Sharing needles and
injecting equipment.
• Transfusion.
• Transplant of HIV infected
organs.
• Transmission from mother
to infant during pregnancy,
delivery and breast
feeding.
Infectious monomucleosis
Epstein-Barr virus • Person-to-person.
(EBV)
• oropharyngeal spread via
Seronegative saliva (‘kissing disease’).
immunosuppressed
individuals may
develop fatal
immunoproliferative
disorders.
*
‘Time out’ refers to minimum exclusion period for school or child care – see www.health.qld.gov.au/ph/documents/cdb/timeout_poster.pdf
Disease information
Infectious period and Diagnosis and
Incubation Prevention
exclusion period* notification
• Variable. Window • Begins early after onset of • HIV: Positive serology • Education re: risk factors for HIV infection
period (time from HIV infection and extends (other methods largely and safe sex and injecting practices.
initial infection throughout life. The used in research settings).
• Discuss management of HIV cases
to detectable transmission rate increases
• AIDS: clinical. and contacts with AIDS Medical Unit,
antibodies) is with viral load and also
Ph: 07 38375622.
usually 1–3 months. during concurrent infection • Routine laboratory
with other STIs. notification (HIV). • More information available at:
• Conversion
www.health.qld.gov.au/sexhealth/
illness may occur • Clinicians to notify AIDS
Time out: Nil. documents/cm_guidelines.asp
1–6 weeks after Medical Unit of AIDS
infection. diagnoses.
• Progression from
HIV to AIDS varies
from < 1 year to
> 15 years without
treatment.
• 4–6 weeks. • Prolonged – up to 12 months. • Positive Monotest or EBV • Minimise contact with saliva; hygiene
serology. and hand washing.
• Many people can carry
and spread the virus • Not notifiable.
intermittently for life.
Time out: Nil.
Communicable Diseases Control Manual 17
Disease information

Infectious period and Diagnosis and

Disease/organism Transmission Incubation Prevention
exclusion period* notification
Influenza
Influenza virus, types • Respiratory droplet or • 1–4 days, • 3–5 days (up to 21 days in • Isolation of virus. • Immunisation of at risk people and carers
A, B and C direct contact (can persist average 2 days. children) from clinical onset. in autumn.
• PCR from nasopharyngeal
for hours in low temps and
Vaccine preventable – cells or blood. • Good hand hygiene and cough/sneeze
low humidity). Time out: Exclude until well.
routine for Indigenous etiquette will reduce spread.
• Serology.
Australians yearly • Potential for airborne
• Antiviral agents may be used for prophylaxis
from 15 years old, transmission is • Routine laboratory
and treatment of influenza A and B.
for all Australians controversial. notification.
≥ 65 years and for
medically at risk
and others as per
the current edition
of The Australian
Immunisation
Handbook.

Legionellosis
Legionella • Airborne transmission. • Legionellosis: • No person-to-person • Isolation of organism. • Maintain water cooling systems, spa pools
pneumophila, 2–10 days, transmission recorded. etc to avoid the conditions that enhance the
• L pneumophila: air • PCR detection of Legionella
Legionella usually 5–6 days. growth of Legionella.
conditioning cooling urinary antigen.
longbeachae and Time out: Nil.
towers, spas, hot water • Pontiac fever: • Use respiratory precautions and wash hands
other Legionella • Fourfold rise in antibody
systems, humidifiers, etc. 5–72 hours, when using potting mix (particularly if elderly
species. titre in paired sera.
usually 24–48 or immunosuppressed).
• L longbeachae: potting mix.
1. Legionnaires hours. • Urgent laboratory
disease • Other species are also notification.
2. Pontiac fever associated with aqueous/
soil environments.

18 Communicable Diseases Control Manual *

‘Time out’ refers to minimum exclusion period for school or child care – see www.health.qld.gov.au/ph/documents/cdb/timeout_poster.pdf
 Disease information

Infectious period and Diagnosis and

Disease/organism Transmission
Leptospirosis
Leptospira species • Contact of broken skin
or mucous membranes
Different serovars
with urine, contaminated
associated with
soil, water or vegetation.
specific animals.
Inhalation of aerosols.
Ingestion of food
contaminated by infected
urine.
• Livestock, dogs and rats
are commonest sources.
Incubation
exclusion period*
• 2–30 days, • Person-to-person
usually 5–14 days. transmission very rare.
• Leptospires excreted in
urine for 1 month after acute
illness (but can continue
for years).
• Animals may excrete for life.
Time out: Nil.
Prevention
notification
• Isolation of pathogenic • Rodent control.
Leptospires.
• Vaccination of dairy herds is of some value.
• PCR.
• Protective gear reduces occupational
• Serology in convalescence. exposure. Cover open sores, wash exposed
body parts (hands, feet etc) thoroughly.
• Routine laboratory
notification. • Avoid swimming/wading in potentially
contaminated water.

Listeriosis
Listeria • Foodborne: unpasteurised • 3–70 days, • Asymptomatic shedding in • Isolation from site • Promote hand washing and hygiene.
monocytogenes dairy products, shellfish, median 3 weeks. stools for several months. of infection.
• Pregnant women and the
soft cheeses, pâté, raw
Invasive disease in • Vaginal shedding and in • Routine laboratory immunocompromised should avoid high risk
meat and vegetables.
pregnant women: urine of mothers of infected notification. foods including: pâté, smoked seafood, soft
spontaneous • Reservoirs in soil, water, babies for 7–10 days post cheeses, cold cooked diced chicken, cold
abortion, pre-term domestic and wild animals partum. roast and processed meats, stored salads or
delivery and foetal and feed. fruit salad, raw seafood and unpasteurised
infection. Time out: Nil except if cases of dairy products and avoid contact with aborted
• Inhalation and direct
gastrointestinal disease then animal foetuses on farms.
Newborn infants have inoculation of skin rare.
case fatality rates of until 24 hours after last loose • Ensure reheated leftovers are steaming hot.
• Transplacental to foetus. stool, or 48 hours for food
30–50%.
• Some exposure to these handlers and carers.
Meningoencephalitis
bacteria is unavoidable.
is more common in
older adults and the
immunocompromised.
Can also cause
gastrointestinal
disease.

*
‘Time out’ refers to minimum exclusion period for school or child care – see www.health.qld.gov.au/ph/documents/cdb/timeout_poster.pdf Communicable Diseases Control Manual 19
Disease information

Infectious period and Diagnosis and

Disease/organism Transmission Incubation Prevention
exclusion period* notification
Measles
Measles virus • Airborne droplet/direct • 7–18 (average 10) • Up to 7 days before, to • Clinical diagnosis. • Urgent public health response required
spread from nose/throat days to initial fever. 4 days after rash appears. in special settings, eg. childcare facilities,
Routine vaccination • Confirmed by
secretions (one of the most schools, colleges.
• Usually 14 days nasopharyngeal aspirate,
Refer to flowchart contagious infectious Time out:
on page 4. to rash onset nasopharyngeal/throat • Discuss all suspected cases with your PHU.
diseases).
(up to 19–21 days). Case: Exclude for 4 days after swab, blood or urine for
• MMR vaccination or normal human
onset of rash. Written medical PCR.
immunoglobulin may be indicated for
clearance from doctor or PHU • Serology is useful but a contacts.
is required to return child to positive IgM may not mean
childcare/school. • Consultation room and waiting room if used
measles in the absence of
by suspected case must remain vacant for
Contacts: Contact PHU for an epidemic.
2 hours after suspected case has left – people
advice regarding partially
• Urgently notify PHU by in these rooms with suspected case, or up to
immunised unimmunised
phone on provisional and including 2 hours after room vacated must
contacts.
clinical diagnosis. be treated as contacts.

Melioidosis
Burkholderia • Direct contact with
pseudomallei contaminated soil or water,
aspiration/ingestion of
contaminated water, or
inhalation of soil/dust.
• 2 days to many • Person-to-person • Isolation of organism from • Pneumonia/septicaemic patients can die
years. transmission can occur rarely any site. rapidly. Discuss with infectious diseases
via contact with body fluids. physician.
Time out: Nil.

20 Communicable Diseases Control Manual *

‘Time out’ refers to minimum exclusion period for school or child care – see www.health.qld.gov.au/ph/documents/cdb/timeout_poster.pdf
 Disease information

Infectious period and Diagnosis and

Disease/organism Transmission Incubation Prevention
exclusion period* notification
Meningococcal disease
Neisseria meningitidis • Direct contact and • 2–10 days, average • While meningococcus in • Clinical (presumptive). • Rifampicin or other appropriate clearance
respiratory droplet 3–4 days. nasopharynx; eradicated antibiotics to certain contacts to prevent
Routine childhood • Confirmed by PCR or
spread from nose/throat within 24 hours of starting spread to others (includes contacts of those
vaccination for • Treat suspected isolation from blood, CSF or
secretions of an infected effective antibiotic therapy. with conjunctival infection).
serogroup C cases immediately other normally sterile site
person who is likely to be
– prior to or from conjunctival swab. • Vaccine also recommended for certain
Refer to flowchart an asymptomatic carrier. Time out: Exclude until
on page 5. hospitalisation contacts when case has a vaccine preventable
24 hours of effective • Urgently notify PHU
– give parenteral serogroup.
antibiotics completed. by phone on clinical
(preferably IV)
suspicion. • Discuss with PHU.
ceftriaxone,
cefotaxime or • Vaccination:
penicillin. If –– Promote high uptake of meningococcal C
possible, collect conjugate vaccine in all infants at 12 months.
blood for PCR/
culture at the same –– Polysaccharide vaccine covering serogroups
time. A, C, Y, W135 of use in travellers and in
certain other situations.

Mumps
Mumps virus • Airborne/droplet spread • 12–25 days, • 7 days prior to onset of • Isolation of virus. • Vaccination and exclusion.
or direct contact with saliva usually 16–18 days. parotitis to 9 days after
Routine vaccination • Serology.
of an infected person. onset of illness. Maximum
infectiousness from 2 days • PCR.
prior to 4 days after onset.
• Routine laboratory
notification.
Time out: Exclude for 9 days
after onset of swelling • Reporting by clinician
to PHU encouraged on
clinical diagnosis if
2 or more linked cases.

*
‘Time out’ refers to minimum exclusion period for school or child care – see www.health.qld.gov.au/ph/documents/cdb/timeout_poster.pdf Communicable Diseases Control Manual 21
Disease information

Infectious period and Diagnosis and

Disease/organism Transmission
Pertussis
Bordetella pertussis • Direct and droplet spread
of respiratory secretions.
Routine vaccination
• Outbreaks still occur every
Refer to flowchart of cough.
on page 6. 3–4 years in vaccinated
populations, but with
greatly reduced mortality
and morbidity.
Incubation
exclusion period*
• Average 9–10 days; • Very infectious in catarrhal
range 6–20 days. stage; gradual decrease
over 3 weeks from onset
Time out:
Case: Exclude for first 5 days
of a 7 day course of antibiotics.
If no antibiotics exclude for
21 days from onset of
coughing. Written medical
clearance is required from
doctor or PHU for child to
return to care/school.
Contact: Exclude unimmunised
contacts from childcare until
received 5 days of appropriate
antibiotics. If no antibiotics,
then exclude for 14 days from
last exposure to the case.
Discuss with PHU.
Prevention
notification
• Culture or PCR from • Vaccination and exclusion of case and certain
nasopharyngeal secretions contacts.
in catarrhal stage are
• Some contacts will require antibiotic
diagnostic.
prophylaxis. Discuss management of contacts
• Serology can be non­ and pertussis in childcare with your local PHU.
specific. A positive IgA
is notifiable.
• Routine laboratory
notification.
• Reporting from clinicians
to PHU on clinical suspicion
encouraged where case
attends high risk setting
(childcare centre or
maternity/infant ward).

22 Communicable Diseases Control Manual *

‘Time out’ refers to minimum exclusion period for school or child care – see www.health.qld.gov.au/ph/documents/cdb/timeout_poster.pdf
 Disease information

Infectious period and Diagnosis and

Disease/organism Transmission Incubation Prevention
exclusion period* notification
Pneumococcal disease
Streptococcus • Respiratory droplet spread. • Varies by type of • Unknown; presumably • Isolation of bacteria or PCR • No prophylaxis for contacts.
pneumoniae infection; may be as until respiratory and oral from a normally sterile site.
• Person-to-person • Routine vaccination for children and special
short as 1–3 days. discharges no longer contain
Important cause of transmission common but • Routine laboratory groups as per current edition of The Australian
virulent pneumococci.
death in Indigenous illness in casual contacts • Pneumococci notification. Immunisation Handbook.
Non-infectious within
people, infants, the infrequent. commonly
24 hours of commencing
elderly and others found in upper
effective antibiotic therapy.
with risk factors. respiratory tract
of healthy people.
Clinical Time out: Nil.
Invasive infection
manifestations
uncommon in long
include acute otitis
term carriers.
media, pneumonia,
septicaemia,
meningitis and
sinusitis.
Routine vaccination

Q fever
Coxiella burnetii • Inhalation of infected
aerosols or dust which may
Vaccination available
travel up to a kilometre.
Increasingly Infected products of
recognised as cause conception high risk.
of chronic disability. Cattle, sheep, and goats
are commonest source.
Feral pigs, kangaroos and
other animals are possibly
infectious.
• Commonly • Direct transmission from • Serology. • Vaccine preventable.
2–3 weeks, person-to-person rare.
• Isolation of organism (but • NB. Strict pre-vaccination protocol.
depending on size
hazardous to lab workers). High occupational risk for meat workers,
of infectious dose. Time out: Nil. vets, shearers, wool processors, pig and
• PCR.
roo-shooters, graziers and others with
• Routine laboratory animal contact. Rural residence a risk factor.
notification.

*
‘Time out’ refers to minimum exclusion period for school or child care – see www.health.qld.gov.au/ph/documents/cdb/timeout_poster.pdf Communicable Diseases Control Manual 23
Disease information

Infectious period and Diagnosis and

Disease/organism Transmission Incubation Prevention
exclusion period* notification
Roseola infantum
(Sixth disease) • Unknown. Most likely • Average 10 days; • Unknown. • Serology. • None.
via contact with saliva range 5–15 days.
Herpesvirus 6 (HHV-6) • Virus can be isolated from
or respiratory secretions. Time out: Nil.
• May occur 2–4 saliva and blood of healthy
• 70% infants acquire weeks post individuals – not helpful as
infection in 1st year. transplant. diagnostic test.
• Serological • Not notifiable.
reactivation can
occur after primary
infection.

Ross River virus (RRV) disease and Barmah Forest virus (BFV) disease
Arboviruses: of the • Mosquito bite. • 3–11 days. • No person-to-person • Isolation of virus. • Avoid mosquito bites.
alphavirus group transmission.
• PCR. • Environmental control of mosquitoes and
breeding sites (difficult for species which
Time out: Nil. • Serology.
breed in puddles in paddocks and have long
• Routine laboratory flight paths).
notification.

Rotaviral gastroenteritis
Rotavirus • Probable faecal-oral
spread.
Routine childhood
vaccination • May spread by direct
contact and respiratory
route.
• 24–72 hours. • While virus shedding occurs,
usually non-infectious after
8th day of infection.
• Immunocompromised
patient can excrete virus
for 30 days or more.
Time out: Until 24 hours after
last loose stool.
• PCR from vomitus • Vaccination.
or faeces.
• Good hygiene measures; hand washing after
• Routine laboratory changing nappies.
notification.
• Virus can survive for long periods on hard
• Reporting to PHU by surfaces, in contaminated water and on hands.
clinicians encouraged if 2
• Chlorine inactivates the virus and should be
or more linked cases in a
used for cleaning.
child care centre or nursing
home.

24 Communicable Diseases Control Manual *

‘Time out’ refers to minimum exclusion period for school or child care – see www.health.qld.gov.au/ph/documents/cdb/timeout_poster.pdf
 Disease information

Infectious period and Diagnosis and

Disease/organism Transmission Incubation Prevention
exclusion period* notification
Rubella
Rubella virus • Direct and droplet • 14–21 days, • 1 week before to at least • Confirm clinical diagnosis • Advise preconception serology.
transmission of respiratory usually 14–17 days. 4 days after rash onset. with serology.
Routine vaccination • Offer all seronegative women of reproductive
secretions.
• Isolation/PCR for virus age vaccination if not pregnant.
Congenital rubella Time out: Exclude until fully
syndrome occurs in recovered or until at least • Routine laboratory • Check antibody status early in each pregnancy.
up to 90% of infants 4 days after onset of rash. notification.
• Vaccinate non-immune male and female
born to women who
health care workers.
acquire rubella in
the first trimester of
pregnancy. These
malformations and
foetal death may
occur following
inapparent maternal
rubella.

Salmonella infection
(Excluding typhoid • Faecal-oral. Usually via • 6–72 hours, usually • Several days to several • Isolation from faeces. • Food hygiene, strict personal hygiene
fever) contaminated food. 12–36 hours. weeks. 1% of adults and and education of food handlers.
• Routine laboratory
5% of children under 5 years
Salmonella (numerous • Reservoir in many animals, • Lower infectious notification. • Avoid unpasteurised milk.
excrete for > 12 months.
serotypes) particularly poultry. doses may be
Antibiotics may prolong • Clinicians to urgently notify
associated with
carrier state. PHU by phone or fax if 2
longer incubation
or more related cases or
periods (up to 16
Time out: Until 24 hours after infection in a food handler.
days).
last loose stool, or 48 hours
if a food handler or carer.

*
‘Time out’ refers to minimum exclusion period for school or child care – see www.health.qld.gov.au/ph/documents/cdb/timeout_poster.pdf Communicable Diseases Control Manual 25
Disease information

Infectious period and Diagnosis and

Disease/organism Transmission
Shigella infection
Shigella species • Faecal-oral route: either
(sonnei, dysenteriae, directly person-to-person
flexneri etc) (including oro-anal sexual
contact) or indirectly
through food and water.
• Infective dose is very small.
• Reservoir: humans.
Incubation Prevention
exclusion period* notification
• 12–96 hours, • Usually up to 4 weeks • Isolation from faeces. • Food hygiene, strict personal hygiene and
usually 1–3 days, after acute illness though education of food handlers. Fly control.
• Routine laboratory
but may be up asymptomatic carriers may
notification. • Exclude symptomatic contacts as per cases.
to 1 week for transmit infection. Carrier
S. dysenteriae 1. state may persist for months, • Clinicians to urgently notify
but antibiotics shorten this PHU by phone or fax if 2
to days. or more related cases or
infection in a food handler.
Time out: Until 24 hours after
last loose stool. Food handlers
and carers excluded until 2
negative faecal specimens
collected 24 hours apart, at
least 48 hours after finishing
antimicrobial therapy.

Streptococcal diseases
Streptococcus • Large respiratory • Usually 1–3 days. • 10–21 days in untreated • Clinical. • Long term antibiotic chemoprophylaxis
pyogenes Group A droplets or direct contact. uncomplicated cases. required for all patients with history of ARF
• Isolation of organism.
(beta haemolytic) Those with acute upper or rheumatic heart disease (RHD) to prevent
• Weeks or months if
streptococci respiratory tract (nasal) • Serology (high titres may further ARF episodes, along with regular
untreated with purulent
infection are most likely persist for months). clinical follow-up and a specialist management
Tonsillitis/pharyngitis, discharge.
to transmit disease. plan.
scarlet fever, skin • Routine laboratory
• Less than 24 hours when
infection, erysipelas, • Food borne – milk, milk notification. • Influenza and pneumococcal vaccination
treated with effective
toxic shock syndrome, products and egg salad recommended for anyone with RHD.
antibiotics. • Clinicians to notify PHU
necrotizing fasciitis has been implicated in
by phone or fax on clinical • Education about relationship between
etc. outbreaks of streptococcal • Nasal, anal, vaginal, skin
diagnosis of ARF on the streptococcal infection and APSGN.
sore throat. and pharyngeal carriers
Post streptococcal: basis of Modified Jones
occur. Eradication of carrier • Skin hygiene programs aiming to reduce
• acute rheumatic • Fomite transmission rare. Criteria – including both
state often difficult. prevalence of scabies and skin sores.
fever (ARF) major and minor criteria.
• Scabies is associated with
• acute post- • PHU may initiate mass antibiotic prophylaxis
skin infection and AGN. Time out: Exclude until well
streptococcal of children aged 2 to 12 years to control APSGN
glomerulonephritis and has received antibiotic outbreaks.
(APSGN) treatment for at least
24 hours.

26 Communicable Diseases Control Manual *

‘Time out’ refers to minimum exclusion period for school or child care – see www.health.qld.gov.au/ph/documents/cdb/timeout_poster.pdf

Disease/organism
Syphilis
Treponema pallidum • Direct contact with
The Public Health Act
2005 (sections 191
and 192) identifies
that it is mandatory
in Queensland
for doctors and • Congenital infection occurs
registered nurses to
report reasonable
suspicions of child
abuse and neglect
directly to Child Safety
Services, Department
of Communities.
Tetanus
Clostridium tetani • Primarily via wounds/burns
Routine vaccination
*
‘Time out’ refers to minimum exclusion period for school or child care – see www.health.qld.gov.au/ph/documents/cdb/timeout_poster.pdf
Transmission
• 10 days to
infectious exudates and
primary or secondary
• Usually 3 weeks.
muco-cutaneous lesions of
infected persons, usually
through sexual contact.
through placental transfer
in utero or at delivery.
• 3–21 days, most
contaminated with soil,
dust or manure (apparent
and inapparent, minor or
major).
Infectious period and
Incubation
exclusion period*
• Mostly during primary and
3 months. secondary stages when
moist muco-cutaneous
lesions are present.
• Congenital transmission
does not occur before the 4th
month, and is most probable
during early maternal
syphilis. Penicillin therapy
usually ends infectivity
within 7 days.
Time out: Nil.
• No person-to-person
within 14 days; transmission.
range 1 day to
several months
Disease information
Diagnosis and
Prevention
notification
• Serology: specific tests • General STI prevention measures.
remain positive for life.
• Contact tracing.
• Titres in non-specific tests
• Congenital syphilis – screen all pregnant
decline with effective
women at the first antenatal visit in each
therapy.
pregnancy.
• Microscopy: Demonstration
• Discuss positive serology with a sexual health
of T. Pallidum.
or infectious disease physician.
• PCR of genital or mucous
• Previous serology and previous treatment
membrane ulcer swab.
information may be available from the
• Routine laboratory Queensland Syphilis Surveillance Centre
notification. on 1800 032 238.
• Largely clinical. • Tetanus vaccination +/- tetanus
immunoglobulin (according to current edition
• Isolation on bacterium
of The Australian Immunisation Handbook)
not definitive as are
at time of presentation with suspect wound.
non-toxigenic strains.
• Vaccinate according to schedule with particular
• Notify PHU by phone or
attention to adult boosters.
fax on clinical diagnosis.
• Appropriate wound management.
Communicable Diseases Control Manual 27
Disease information

Infectious period and Diagnosis and

Disease/organism Transmission Incubation Prevention
exclusion period* notification
Toxoplasmosis
Toxoplasma gondii • Faecal-oral from cats • 10–23 days • No person-to-person • Clinical syndrome. • Hand hygiene.
to people. after eating transmission except in utero.
Primary infection in • Serology. • Cover children’s sand pits when not in use.
contaminated meat;
early pregnancy may • Eating under cooked meat; • Oocytes excreted by cats
5–20 days from • Isolation of organism. • Hygienic disposal of cat faeces.
lead to severe foetal ingestion of contaminated can remain infective for up to
cat contact.
disease. water or goat/cow’s milk. 12 months in water or moist • Not notifiable. • Pregnant women should avoid cleaning cat
soil. litter pans and contact with cats unless they
Immunosuppressed • Transplacental usually
have antibodies to T. gondii.
persons are during primary infection
susceptible to cerebral of mother. Time out: Nil. • Avoid eating undercooked meat. Wash all
toxoplasmosis. utensils after contact with raw meat.

Tuberculosis
Mycobacterium • Airborne droplet spread • 2–10 weeks to • As long as viable bacilli • Direct microscopy – • Prevention is primarily by case finding and
tuberculosis complex is the predominant mode primary lesions discharged in sputum until ‘smear positive’ disease treatment.
of transmission. or tuberculin 2–4 weeks after appropriate is responsible for most
• Subsidiary strategies include:
reactivity. chemotherapy has begun. spread.
• Other modes of –– BCG vaccination restricted to certain high risk
transmission such as • Latent (dormant) • In patients with fully drug • Culture. populations
invasion through mucous infection may exist susceptible TB who are on –– Identifying and treating latent TB infection
• PCR.
membranes or damaged for a lifetime. supervised treatment and (active disease must be excluded before
skin are extremely rare. who are clinically responding • Notify QTBCC by phone diagnosing disease as latent – this strategy
• Immune
to treatment, the patient or fax on clinical suspicion. should only be used by clinicians skilled
• Historically was suppression may
can usually be regarded as in the diagnosis of TB).
transmitted through reactivate disease. • Collect sputum before
non-infectious after 2 weeks
unpasteurised milk. commencing treatment to • For management of case and their contacts
• Majority of cases treatment, regardless of
smear positivity. determine infectiousness, discuss with:
• Low incidence of occur within first
unless both normal chest –– Queensland TB Control Centre
tuberculosis in Australia 1–2 years after
X-ray and no respiratory Ph: 07 3986 3963
compared to most other infection with Time out: Until written symptoms, regardless of
countries. risk diminishing clearance given by Queensland • or your regional TB control unit:
primary site of disease.
significantly after Tuberculosis Control Centre –– Toowoomba Chest Clinic Ph: 07 4616 6445
7 years. (QTBCC) medical officer. • Telephone or fax
notification by laboratory –– Rockhampton Chest Clinic Ph: 07 4920 6330
for smear positive disease. –– Townsville Respiratory Unit Ph: 07 4796 2860
–– Cairns Thoracic Medicine Ph: 07 4226 6240

28 Communicable Diseases Control Manual *

‘Time out’ refers to minimum exclusion period for school or child care – see www.health.qld.gov.au/ph/documents/cdb/timeout_poster.pdf

Disease/organism Transmission
Typhoid and paratyphoid fever
Salmonella Typhi • Faecal-oral route.
Salmonella Paratyphi
• Contaminated water
A, B, or C
or food.
Typhoid vaccine
• Flies may contribute.
available for travel
to high risk areas. • Rarely by direct contact.
• Humans are principal
reservoir (Paratyphi also
found in domestic animals).
Yersiniosis
Yersinia enterocolitica • Faecal-oral, through
Yersinia consumption of
pseudotuberculosis contaminated water and
food, especially raw pork
and pork products. Can
grow when refrigerated.
• Nosocomial and blood
transfusion (very rare).
• Person-to-person spread
uncommon.
*
‘Time out’ refers to minimum exclusion period for school or child care – see www.health.qld.gov.au/ph/documents/cdb/timeout_poster.pdf
Infectious period and
Incubation
exclusion period*
• Depends on • Infectious from onset until
inoculum dose stool clearance.
and host factors.
• Untreated typhoid: 10%
• Typhoid: carry for > 3 months, 2–5%
3–60 days, become permanent carriers.
usually 8–14 days.
• Paratyphoid: Time out: Exclude from child
1–10 days. care/school/food handling and
health care workplaces until
written medical clearance from
doctor or PHU when stools are
clear – culture negative status
required.
• Probably 3–7 days, • While symptomatic,
usually less than 2–3 weeks. Untreated may
10 days. shed for 2–3 months.
Time out: Until 24 hours after
diarrhoea has ceased, or
48 hours for food handlers
and carers.
Diagnosis and
notification
• Isolation from any clinical
specimen.
• Telephone or fax
notification by laboratory.
• Isolation of organism
from stool and detection
of virulence plasmid.
• Serology.
• PCR.
• Routine laboratory
notification.
Disease information
Prevention
• Advice to travellers re: vaccination and food
and hand hygiene.
• Exclude contacts in sensitive occupations
(eg. food handlers and childcare) until 2 stools
are clear.
• Hand washing prior to food handling and
eating, after handling raw pork, and after
animal contact.
Communicable Diseases Control Manual 29
30
Notifiable Conditions Report Form

QUEENSLAND HEALTH
FORM PHA S70 - NOTIFIABLE
CONDITIONS REPORT FORM (1)
for Queensland Clinicians
(Clinical and Provisional Diagnoses)
This is an approved form as specified in the Queensland Public Health Act 2005 (Chapter 3 Part 2,
Division 2 - Notices about Notifiable Conditions) and the Public Health Regulation 2005 (Schedules 1 and 2)

Communicable Diseases Control Manual

PATIENT DETAILS: (please print or place patient details sticky label here)
First
Name: Surname: Female: Male:

Address: DOB:

Town: Postcode:

Phone: Mobile:

Torres
Aboriginal: Strait Both Neither
Islander  Aboriginal  Aboriginal 
 (TSI): and TSI: nor TSI:
A list of notifiable conditions that are diagnosed mainly on clinical/provisional grounds is attached.
Some conditions require urgent notification (indicated by the  symbol on the attached list), to enable prompt public health action. For
example, in the case of invasive meningococcal disease, public health units will undertake contact tracing and provide clearance
antibiotics for eligible contacts.
Clinical diagnosis notifiable condition means a notifiable condition—
which is diagnosed either fully or predominantly on the basis of clinical evidence, including clinical history and signs and symptoms.

Provisional diagnosis notifiable condition means a notifiable condition—

which can be provisionally diagnosed on the basis of clinical evidence, including clinical history and signs and symptoms; while
awaiting laboratory confirmation.
Notifiable Condition:

Date of onset: Country where acquired:

Workplace, school, childcare, preschool or other institution attended: Likely source of exposure:

Pathology taken? Yes  No 

Laboratory QML  SNP  Path. Qld
 Other …………………………………….
Doctor’s name, address and phone number (or stamp) Signature:

Date:

PLEASE SEND COMPLETED FORM TO YOUR NEAREST PUBLIC HEALTH UNIT

(for AIDS, send to the Queensland AIDS Medical Unit; for TB send to the Queensland Tuberculosis Control Centre)

Form PHA S70 Notifiable Conditions Report Form for Clinicians Version 1.6

29
List of clinical and provisional diagnosis notifiable conditions Glossary of abbreviations
Public Health Regulation 2005 – as at 30 October 2009
# (C) Acquired immunodeficiency syndrome (AIDS) ABL Australian bat lyssavirus
 (C) Acute flaccid paralysis AI Avian influenza
(C) Acute rheumatic fever AIDS Acquired immunodeficiency syndrome
(P) Acute viral hepatitis Ag antigen
(C) Adverse event following immunisation BCG Bacillus Calmette-Guérin vaccine
 (C) Australian bat lyssavirus – potential exposure CSF cerebrospinal fluid
(ie. bat bite, scratch or mucous membrane exposure)
DNA deoxyribonucleic acid
 (P) Avian influenza
EV71 Enterovirus 71
 (C) Ciguatera poisoning
Hib Haemophilus influenzae type b
(P) Creutzfeldt-Jakob disease
HIV human immunodeficiency virus
 (P) Dengue
Ig immunoglobulin
 (P) Diphtheria
IV intravenous
 (C) Food or water-borne illness in 2 or more cases
kg kilogram
 (C) Food or water-borne illness in food handler
mg milligram
 (C) Haemolytic uraemic syndrome (HUS)
MSM men who have sex with men
 (P) Haemophilus influenzae type b disease (invasive) PCR polymerase chain reaction (nuclear amplification test
 (P) Measles or nucleic acid test)
 (P) Meningococcal disease (invasive) PHU public health unit
 (P) Severe acute respiratory syndrome (SARS) PPE personal protective equipment
 (P) Smallpox QH Queensland Health
(C) Tetanus SARS severe acute respiratory syndrome
* (P) Tuberculosis STI sexually transmitted infection
 (P) Viral haemorrhagic fevers TB tuberculosis
(Crimean-Congo, Ebola, Lassa fever and Marburg viruses) VIVAS vaccine information and vaccine administration system
# To be notified to the AIDS Medical Unit ZIG zoster immunoglobulin
* To be notified to the Queensland TB Control Centre
(C) Requires notification on clinical diagnosis
(P) Requires notification by clinicians on clinical/provisional grounds while awaiting laboratory confirmation
 Requires immediate notification by phone or fax to the local public health unit

Communicable Diseases Control Manual 31

Contacts

Public Health Units Specialist Disease Control Units

Southern Public Health Units AIDS Medical Unit Sexual Health Clinics/Services
(Brisbane Sexual Health and HIV Service)
Brisbane South Ph: 3000 9148 Fax: 3000 9130 Brisbane North Ph: 3837 5611 Fax: 3837 5640
Logan Ph: 3412 2989 Fax: 3412 2986 PO Box 15239 Ph: 3837 5622 Fax: 3837 5672 Brisbane South Ph: 3176 5881 Fax: 3176 5540
Brisbane City East
West Moreton Ph: 3413 1200 Fax: 3413 1221 QLD 4002 Gold Coast Ph: 5576 9033 Fax: 5576 9030
Gold Coast Ph: 5668 3700 Fax: 5562 2703 Ipswich Ph: 3817 2428 Fax: 3281 0565
Queensland Tuberculosis Control Centre
Darling Downs Ph: 4631 9888 Fax: 4632 8563 Toowoomba Ph: 4616 6446 Fax: 4616 6456
Locked Bag 66 Ph: 3896 3963 Fax: 3896 3984
Central Public Health Units Coorparoo DC Sunshine Coast Ph: 5470 5244 Fax: 5470 5115
QLD 4151
Brisbane North Ph: 3624 1111 Fax: 3624 1199 Wide Bay Ph: 4150 2754 Fax: 4150 2769

Moreton Bay Ph: 3142 1800 Fax: 3142 1826 Regional Tuberculosis Control Units Rockhampton Ph: 4920 5555 Fax: 4920 5557

Sunshine Coast Ph: 5409 6600 Fax: 5409 6635 Toowoomba Ph: 4616 6445 Fax: 4616 6456 Mackay Ph: 4968 3919 Fax: 4968 3885

Hervey Bay Ph: 4184 1800 Fax: 4184 1809 Rockhampton Ph: 4920 6300 Fax: 4920 6301 Mt Isa Ph: 4744 4805 Fax: 4745 4590

Rockhampton Ph: 4920 6989 Fax: 4920 6865 Townsville Ph: 4796 2860 Fax: 4796 2861 Townsville Ph: 4778 9600 Fax: 4778 9641

Bundaberg Ph: 4150 2780 Fax: 4150 2729 Cairns Ph: 4226 4769 Fax: 4226 4771
Cairns Ph: 4226 6240 Fax: 4226 6281
Tropical Public Health Units Liver/Hepatitis Clinics (Public Hospitals)
Queensland Syphilis Surveillance Centre
Mackay Ph: 4911 0400 Fax: 4953 2031 Cairns Ph: 4226 6669
Ph: Free call 1800 032 238
Townsville Ph: 4753 9000 Fax: 4753 9001 or Townsville Ph: 4796 2382

Mt Isa Ph: 4744 9100 Fax: 4744 9124 Brisbane Ph: 3837 5628 Fax: 3837 5626 Mackay Ph: 4885 5070

Cairns Ph: 4226 5555 Fax: 4031 1440 Cairns Ph: 4050 3682 Fax: 4051 5227 Rockhampton Ph: 4920 5561
Nambour Ph: 5470 6600
NB. Area code 07 for all phone and fax numbers
Royal Brisbane
Ph: 3636 8111
and Women’s
Princess Alexandra Ph: 3167 1059
Mater Ph: 3163 8111
Toowoomba Ph: 4616 6446
Gold Coast Ph: 5519 7171

32 Communicable Diseases Control Manual