Notifiable Diseases
Notifiable diseases are infections that must be reported to the local authority proper officer by the attending registered medical practitioner, enabling public health surveillance, outbreak detection, and timely implementation of control measures.
Key Facts
Notification is a statutory duty under the Health Protection (Notification) Regulations 2010 in England The registered medical practitioner with clinical suspicion must notify — laboratory confirmation is NOT required Notification goes to the local authority proper officer (usually the Consultant in Communicable Disease Control) Urgent notification (by phone) required for certain high-risk diseases; routine notification (written, within 3 days) for others There are 33 notifiable diseases in England (list includes measles, meningococcal disease, food poisoning, TB, cholera, plague, viral haemorrhagic fever) Laboratory reporting to UKHSA via SGSS is a separate parallel system; does not replace clinical notification Notification enables surveillance, outbreak detection, contact tracing, and population-level control measures Failure to notify is a criminal offence; penalty up to £200 fine
Overview
Key Facts
Notification of infectious diseases is a cornerstone of public health surveillance. It enables early detection of outbreaks, implementation of control measures, and monitoring of disease trends. The duty to notify rests with the clinician who suspects the diagnosis.
Legal Basis
- Health Protection (Notification) Regulations 2010
- Public Health (Control of Disease) Act 1984 (amended 2008)
- Applies to England; similar regulations in devolved nations
Notification Process
- Clinician suspects notifiable disease
- Notify local authority proper officer (usually CCDC via local health protection team)
- Urgent diseases: notify immediately by phone
- Routine diseases: written notification within 3 days
- Include: patient demographics, diagnosis, date of onset, relevant risk factors
- Laboratory confirmation is NOT required for notification
Purpose of Notification
- Surveillance: monitoring disease trends, detecting changes in incidence
- Outbreak detection: identifying clusters requiring investigation
- Contact tracing: identifying and protecting exposed contacts
- Public health action: prophylaxis, vaccination, exclusion, environmental measures
- Policy: informing vaccination programme decisions, travel advice
- International: reporting to WHO under International Health Regulations
Clinical Presentation
Key Notifiable Diseases in UK Practice
Gastrointestinal:
- Food poisoning (most commonly notified)
- Cholera
- Typhoid/paratyphoid
- Hepatitis A, E
Respiratory:
- Tuberculosis
- Legionnaires' disease
- Whooping cough (pertussis)
- SARS, MERS
Vaccine-preventable:
- Measles, mumps, rubella
- Diphtheria
- Tetanus
- Poliomyelitis
Blood-borne/STI:
- Hepatitis B, C (acute)
- HIV (new diagnosis — some local arrangements)
Other:
- Meningococcal disease
- Malaria
- Rabies
- Plague
- Viral haemorrhagic fever
- Anthrax, botulism
When to Notify
- On clinical suspicion — do not wait for laboratory confirmation
- Even if unsure — err on the side of notification
- Even if the patient refuses testing or treatment
Differential Diagnosis
| Category | Examples | Urgency |
|---|---|---|
| Urgent (phone immediately) | Meningococcal disease, diphtheria, plague, VHF, polio, rabies, botulism, cholera, SARS | Immediate phone call |
| Routine (within 3 days) | Food poisoning, TB, measles, mumps, rubella, hepatitis A/B/C, malaria, whooping cough | Written notification |
| Laboratory-only | Some conditions reportable only via lab (not clinical notification) | Via SGSS |
Diagnosis / Investigation
Notification Requirements
- Patient name, date of birth, address, sex
- Suspected disease
- Date of onset of symptoms
- Date of notification
- Name and address of notifying doctor
- Relevant travel history, occupation, risk factors
Laboratory Surveillance
- Parallel system to clinical notification
- Laboratories report confirmed diagnoses to UKHSA via SGSS (Second Generation Surveillance System)
- Molecular typing (WGS) enables cluster detection
- Reference laboratories provide specialist identification and typing
Surveillance Outputs
- Weekly communicable disease reports
- Annual epidemiological reports
- Real-time surveillance dashboards
- International reporting to WHO/ECDC
Management
Public Health Response to Notification
- Risk assessment: CCDC assesses significance and required action
- Contact tracing: identify and advise contacts; offer prophylaxis/vaccination where appropriate
- Exclusion: advise on exclusion from work/school (e.g. 48-hour rule for GI infections)
- Post-exposure prophylaxis: e.g. rifampicin for meningococcal contacts, immunoglobulin for hepatitis A contacts
- Outbreak investigation: if cluster identified (activate OCT)
- Environmental investigation: food/water sampling, premises inspection
- Vaccination: catch-up campaigns for vaccine-preventable diseases
GP Responsibilities
- Be aware of current list of notifiable diseases
- Notify on clinical suspicion
- Provide relevant clinical and epidemiological information
- Cooperate with public health investigation
- Advise patients on exclusion, treatment, and follow-up
- Ensure practice staff aware of notification procedures
Prognosis
- Effective notification and surveillance have contributed to control of many infectious diseases in the UK
- Delays in notification can result in missed opportunities for outbreak control
- Under-notification is a recognised problem (estimated 50-80% of cases not notified for some diseases)
- Electronic notification systems and laboratory automation are improving timeliness
- Whole genome sequencing has revolutionised outbreak detection and cluster investigation
- International Health Regulations require notification of diseases of international concern to WHO
Other Relevant Information
Full List of Notifiable Diseases in England (2010 Regulations)
| Disease | Disease | Disease |
|---|---|---|
| Acute encephalitis | Acute infectious hepatitis | Acute meningitis |
| Acute poliomyelitis | Anthrax | Botulism |
| Brucellosis | Cholera | COVID-19 |
| Diphtheria | Enteric fever (typhoid/paratyphoid) | Food poisoning |
| Haemolytic uraemic syndrome | Infectious bloody diarrhoea | Invasive Group A strep |
| Legionnaires' disease | Leprosy | Malaria |
| Measles | Meningococcal septicaemia | Mumps |
| Plague | Rabies | Rubella |
| SARS | Scarlet fever | Smallpox |
| Tetanus | TB | Typhus |
| VHF | Whooping cough | Yellow fever |