Guidance

Managing outbreaks and incidents

Updated 21 February 2024

Advice for all outbreaks

Many infectious diseases can be managed by reinforcing the measures recommended in Preventing and controlling infections and by:

• encouraging all people who are unwell not to attend the setting or remain separate from others, wherever possible – further guidance on exclusion periods is available for specific infectious diseases
• ensuring all eligible groups are enabled and supported to take up the offer of immunisation programmes including coronavirus (COVID-19) and flu
• ensuring occupied spaces are well ventilated and let fresh air in
• reinforcing good hygiene practices such as frequent cleaning and hand hygiene
• requesting that parents, carers or students inform the setting of a diagnosis of any infectious disease

During an outbreak or incident, when there are either several cases, or indications of more serious disease, additional measures may be required.

These could include:

• considering communications to raise awareness among parents or carers and students (ensuring this is accessible for those who speak other languages or with lower levels of literacy)
• reinforcing key messages amongst children and young people, including the importance of hand and respiratory hygiene measures using materials such as the e-Bug resources
• discussing with health visitors (childcare settings), school nurses (all schools) or student health services (higher education settings) about the support they can offer, particularly where a child or young person may face barriers to accessing health care

When people should stay away from the setting

People who are showing the symptoms of an infectious disease or have been diagnosed by a health professional or diagnostic test could be advised to stay away from their setting for the minimum period recommended, if required, and until well enough.

To find out if, and how long, people should be advised to stay away, check the table for public health exclusions.

It is recognised that in residential settings this may be challenging and may require separate placement of the individual within the setting. Where separate placement is required but is not possible, the setting should seek advice from their health protection team (HPT). 

Individuals who are close contacts of people who are unwell with an infectious disease, or an infection do not usually need to be excluded from the setting. However, if this is required, your HPT will advise you on the specific precautions to be taken in response to managing a case or outbreak. They will contact you if this is required.

In most cases, parents and carers will agree that a child who is unwell and has symptoms of an infectious illness, such as a fever should not attend the setting, given the potential risk to others.

If a parent or carer insists on a child with symptoms attending the setting, where they have a confirmed or suspected case of an infectious illness, you can take the decision to refuse the child if, in your reasonable judgement, it is necessary to protect other children and staff from possible infection. For some infections, individuals may be advised to remain away from a setting for a longer period of time. This will be advised by your HPT.

This section refers to public health exclusions to indicate the time period an individual should not attend a setting to reduce the risk of transmission during the infectious stage. This is different to ‘exclusion’ as used in an educational sense.

Education is extremely important for a child or young person’s health and wellbeing and high-quality face-to-face education is always preferable. Where required, children and young people should have access to remote education as soon as reasonably practicable, though in proportion to the length of absence and disruption to their learning. You can find out more information in the Department for Education’s (DfE) guidance on Providing remote education: guidance for schools.

Exclusion may cause challenges for parents or carers, due to the unexpected time off. Where possible and required, signpost parents or carers to services to access further support.

If a child or young person is already known to be vulnerable to neglect, abuse, or exploitation, and exclusion may increase this vulnerability, notify the appropriate agencies or individuals involved in safeguarding the child or young person.

What to expect from contacting your HPT

If you need to contact your UKHSA HPT, they will conduct a risk assessment of the situation based on the information provided, and the type of infection.

The risk assessment will then inform the need for any further actions.

They will ask you to share information to help them assess the size and nature of the outbreak or incident and advise on any recommended actions.

Information will include:

• the type of setting, for example nursery or special school
• total numbers affected (children, young people and staff)
• total numbers attending (children, young people and staff)
• any food handlers affected
• the number of classes, rooms, year groups affected (including nursery if applicable)
• the symptoms experienced
• the date when symptoms started, including a brief overview of the sequence of numbers of new cases since the outbreak started
• any indications of severe disease such as overnight admissions to hospital
• if there were any events or trips in the week prior to the start of the outbreak
• if known, whether any tests or clinical assessments have taken place
• vaccination uptake (for example for MMR and other infections)
• if there are any individuals within the affected group at higher risk from severe disease

Your UKHSA HPT will advise on whether any actions are recommended.

These may include:

• reinforcement of baseline infection prevention and control measures
• communication to parents, carers and students
• exceptionally, temporary advice to reduce mixing among a targeted group
• exceptionally, the temporary use of face coverings in communal areas

They may consider holding an incident management team (IMT) meeting, which would bring together local stakeholders and the appropriate local authority. If, in exceptional circumstances and as a last resort, limiting the number of people attending the setting is considered necessary for public health reasons^{[footnote 1]}, this should be discussed at an IMT meeting before being implemented.

When to contact the HPT

There are some situations where you may need to contact your local UK Health Security Agency (UKHSA) HPT.

Find your local HPT contact details

Advice on when and when not to contact the HPT is included in guidance for specific infectious diseases.

Contact the relevant UKHSA HPT for advice if you’re concerned or have seen:

• a higher than previously experienced and/or rapidly increasing number of absences due to the same infection^{[footnote 2]}
• evidence of severe disease due to an infection, for example if an individual is admitted to hospital^{[footnote 3]}
• more than one infection circulating in the same group of people, for example chicken pox and scarlet fever
• an outbreak or serious or unusual illness for example:
  • E. coli O157 or E. coli STEC infection
  • food poisoning
  • hepatitis
  • measles, mumps, rubella (rubella is also called German measles)
  • meningococcal meningitis or septicemia
  • scarlet fever (if an outbreak or co-circulating chicken pox)
  • tuberculosis (TB)
  • typhoid
  • whooping cough (also called pertussis)

If you do need to contact your HPT, you should prepare information in advance to help them to support you. Find out what information you need in What to expect from contacting your HPT.

Confidentiality

It is important to note that health protection teams (HPTs) are bound to manage personal case details in strict confidence. Therefore, information given to settings from the team for distribution during an outbreak will never name cases or give out any personal details.

Organisations where cases are identified are also bound to manage personal case details in strict confidence.

Read further information on the UKHSA Privacy Notice.

It is acknowledged that all settings have a baseline level of absences and that it is not always possible to know what individuals are ill with but that a setting may be able to identify where there is a noticeable change in absences over a few days or successive weeks, for example, ‘a rapidly increasing number’ may look like a doubling of absences across the setting or in a year group in a short space of time.

Being admitted to hospital is generally an indication of severe illness where this requires at least an overnight stay (note: where you are informed that assessment and discharge from a hospital ward have occurred on the same day, this is not the same as being admitted and does not indicate a more severe illness).

Any decision for settings to temporarily limit attendance for business continuity reasons, such as staff shortages, is for the setting management and local authority. Any communication to parents, carers, staff and students should make clear that this decision has not been made on public health grounds.

Safeguarding

Everyone who works with children and young people has a responsibility for keeping them safe. It is important to keep them in focus when making decisions about their lives and working in partnership with them and their families. No single practitioner can have a full picture of a child or young person’s needs and circumstances and, if children and families are to receive the right help at the right time, everyone who comes into contact with them has a role to play in identifying concerns, sharing information and taking prompt action.

When recommending exclusion on public health grounds, settings together with their HPT, should consider any adverse effects or hidden harms the child may be exposed to by imposing isolation, for example domestic abuse within the home setting or neglect due to parental substance misuse.

Staff should be proactive in sharing information as early as possible to help identify, assess, and respond to risks or concerns about the safety and welfare of children. This may include a multi-agency meeting with the local authority safeguarding teams.

Referral

Anyone who has concerns about a child or young person’s welfare should make a referral to local authority children’s social care and should do so immediately if there is a concern that the child is suffering significant harm or is likely to do so. Staff who make a referral should always follow up their concerns if they are not satisfied with the response.

If staff have concerns that a child or young person may be a potential victim of modern slavery or human trafficking then a referral should be made to the National Referral Mechanism as soon as possible.

See further information on safeguarding.

What you need to do

All staff should know what to do if a child or young person tells them they are being abused, exploited, or neglected. Staff should know how to manage the requirement to maintain an appropriate level of confidentiality.

If a child with an infectious disease that requires exclusion has a child protection plan, ensure that the identified agencies are contacted. In the meantime, consider placement of the affected child within the setting and consult your HPT.

Ensure all staff are familiar with the setting’s own organisational safeguarding policies and procedures.

Ensure all staff have received the appropriate level of safeguarding training.

All staff should be aware of the process for making referrals to local authority Multi Agency Safeguarding Hubs (MASH).

1. Any decision for settings to temporarily limit attendance for business continuity reasons, such as staff shortages, is for the setting management and local authority. Any communication to parents, carers, staff, and students should make clear that this decision has not been made on public health grounds. ↩

2. It is acknowledged that all settings have a baseline level of absences and that it is not always possible to know what people are ill with but that a setting may be able to identify where there is a noticeable change in absences over a few days or successive weeks, for example, ‘a rapidly increasing number’ may look like a doubling of absences across the setting or in a year group in a short space of time. ↩

3. Being admitted to hospital is generally an indication of severe illness where this requires at least an overnight stay. Note, where you are informed that assessment and discharge from a hospital ward have occurred on the same day, this is not the same as being admitted and does not indicate a more severe illness. ↩