Public Health England (PHE) protects and improves the nation’s health and well-being, and reduces health inequalities. PHE is an executive agency of the Department of Health. One of the most important functions of PHE is to protect the public from infectious disease outbreaks.
What is an outbreak?
An outbreak is the occurrence of more cases of disease than would be expected within a specific place or group of people over a given period of time. The purpose of outbreak management is to protect public health by identifying the source and implementing control measures to prevent further spread or recurrence of the infection.
Who manages outbreaks?
PHE provides the surveillance, epidemiology and expertise in outbreak management (the management responsibility usually lies with the provider service organisation – however PHE may lead an outbreak that crosses boundaries, Directors of Public Health are responsible for the health of their population).This really would depend on the outbreak (any infectious disease should be reported to the “Proper Officer” who can be found via the PHE Centre Health Protection Team) Code of Practice 2010 updated July 2015.
Registered providers, excluding personal care providers, should ensure that advice is received from suitably informed practitioners and that, if advised, registered providers should inform their local health protection team of any outbreaks or serious incidents relating to infection in a timely manner.
Health Protection Regulations (2010) require attending doctors (registered medical practitioners) to notify the Proper Officer of the local authority of cases of specified infectious disease or of other infectious disease or contamination, which present, or could present, significant harm to human health, to allow prompt investigation and response.
The regulations also require diagnostic laboratories testing human samples to notify Public Health England of the identification of specified causative agents of infectious disease.
Local health protection teams (HPTs) lead Public Health England’s response to all health related incidents:
- providing specialist public health advice and operational support to NHS, local authorities and other agencies
- monitoring and investigating infectious disease outbreaks.
HPTs are located within regional PHE Centres across England. Teams are made up of small groups of consultants, health protection nurses and practitioners, and surveillance staff.
The role of centres is to:
- provide local health protection services, expertise, response and advice to the local NHS, local authorities and other partners Centres. ble diseases and causative organisms.
Centres can have one or more local health protection team, depending on their size and geography. These teams can assist with specific health protection enquiries, such as reporting notifiable diseases and causative organisms.
How are outbreaks detected?
The most common way that outbreaks are detected is through notifications from a health provider or citizen. Local HPTs provide an acute response service and calls are answered through the acute response desk.
The role of health protection nurses and practitioners is to receive notifications about potential incidents or outbreaks and then interpret, prioritise and act on them.When reports of an outbreak are received, the following information is gathered:
- the person reporting the outbreak & geographical area and environment involved
- characteristics of the suspected outbreak
- persons directly affected by the outbreak
- population at risk of exposure.
These details are entered into HP zone; the web based surveillance and case management tool used by HPTs throughout England. This decision support software enables the team to:
- view a summary of all current activity
- run queries
- extract timely and comprehensive information on incidents and outbreaks.
There are two different types of surveillance systems that may be used to identify an outbreak:
- event-based surveillance is based on the direct reporting, typically by clinical staff, of outbreaks or exceptional events. It is most commonly used to detect locally confined, acute onset outbreaks, for example food poisoning and emerging disease problems, for example drug resistance to bacteria
- case-based surveillance is based on the analysis, typically using statistical tools, of collated reports of individual cases. It is best suited to detecting geographically dispersed outbreaks with lower rates of transmission, for example tuberculosis and hepatitis B.
The PHE have published operational guidance for the management of outbreaks of communicable disease.