Guidance

High consequence infectious diseases (HCID)

Guidance and information about high consequence infectious diseases and their management in England.

Definition of HCID

In England, a high consequence infectious disease (HCID) is defined according to the following criteria:

  • acute infectious disease
  • ability to spread in the community and within healthcare settings
  • high case fatality rate
  • difficult to recognise and detect rapidly
  • lack of effective, specific treatments
  • requires coordination at a national level to ensure an effective and consistent response

Classification of HCIDs

HCIDs are further divided into contact and airborne groups:

  • contact HCIDs are usually spread by direct contact with an infected patient or infected fluids, tissues and other materials, or by indirect contact with contaminated materials and fomites

  • airborne HCIDs are spread by respiratory droplets or aerosol transmission, in addition to contact routes of transmission

List of high consequence infectious diseases

A list of HCIDs has been agreed by a joint Public Health England (PHE) and NHS England HCID Programme:

Contact HCID Airborne HCID
Argentine haemorrhagic fever (Junin virus) Andes virus infection (hantavirus)
Bolivian haemorrhagic fever (Machupo virus) Avian influenza A H7N9 and H5N1
Crimean Congo haemorrhagic fever (CCHF) Avian influenza A H5N6 and H7N7
Ebola virus disease (EVD) Middle East respiratory syndrome (MERS)
Lassa fever Monkeypox
Lujo virus disease Nipah virus infection
Marburg virus disease (MVD) Pneumonic plague (Yersinia pestis)
Severe fever with thrombocytopaenia syndrome (SFTS) Severe acute respiratory syndrome (SARS)*

*No cases reported since 2004, but SARS remains a notifiable disease under the International Health Regulations (2005), hence its inclusion here.

This list of HCIDs will be updated by PHE if new HCIDs emerge that are of relevance to the UK

HCIDs in the UK

HCIDs are rare in the UK. When cases do occur, they tend to be sporadic and are typically associated with recent travel to an area where the infection is known to be endemic or where an outbreak is occurring. None of the HCIDs listed above are endemic in the UK, and the known animal reservoirs are not found in the UK.

As of October 2018, the UK has experience of managing confirmed cases of Lassa fever, EVD, CCHF, MERS and monkeypox. The vast majority of these patients acquired their infections overseas, but rare incidents of secondary transmission of MERS and monkeypox have occurred in the UK.

Infection prevention and control in healthcare settings

Specific infection prevention and control (IPC) measures are required for suspected and confirmed HCID cases, in all healthcare settings (specialist and non-specialist).

IPC guidance appropriate for suspected and confirmed cases of Lassa fever, EVD, CCHF, MVD, Lujo virus disease, Argentinian haemorrhagic fever, Bolivian haemorrhagic fever and SFTS, is available in the ACDP guidance.

IPC guidance for MERS, avian influenza, Nipah virus infection, monkeypox and pneumonic plague, can be found in the relevant PHE guidance listed below.

Monthly summaries of global HCID events

PHE’s epidemic intelligence activities monitor global HCID events. These are published in a monthly summary.

Specialist advice for healthcare professionals

The Imported Fever Service (IFS) provides 24-hour, 7-days a week telephone access to expert clinical and microbiological advice. Hospital doctors across the UK can contact the IFS after discussion with the local microbiology, virology or infectious disease consultant.

Hospital management of confirmed HCID cases

Once an HCID has been confirmed by appropriate laboratory testing, cases in England should be transferred rapidly to a designated HCID Treatment Centre. Occasionally, highly probable cases may be moved to an HCID Treatment Centre before laboratory results are available.

Contact HCIDs

There are 2 principal Contact HCID Treatment Centres in England:

  • the Royal Free London High Level Isolation Unit (HLIU)

  • the Newcastle Royal Victoria Infirmary HLIU.

Further support for managing confirmed contact HCID cases is provided by the Royal Liverpool Hospital and the Royal Hallamshire Hospital, Sheffield.

Airborne HCIDs

There are 4 interim Airborne HCID Treatment Centres in England. Adult and paediatric services are provided by 6 NHS Trusts:

  • Guy’s and St Thomas’ NHS Foundation Trust (adult and paediatric services)
  • Royal Free London NHS Foundation Trust, with a paediatric service provided by Imperial College Healthcare NHS Foundation Trust
  • Royal Liverpool and Broadgreen University Hospitals NHS Trust, with a paediatric service provided by Alder Hey Children’s NHS Foundation Trust
  • Newcastle upon Tyne Hospitals NHS Foundation Trust (adult and paediatric services)

Case transfer arrangements

Hospital clinicians seeking to transfer confirmed HCID cases, or discuss the transfer of highly probable HCID cases, should contact the NHS England EPRR Duty Officer. It is expected that each case will have been discussed with the Imported Fever Service before discussing transfer.

Travel health advice for HCIDs

The National Travel Health Network and Centre (NaTHNaC) provides travel health information about a number of HCIDs, for healthcare professionals and travellers. Advice can be accessed via the Travel Health Pro website.

Published 22 October 2018