Policy and procedures around notification of reportable diseases

Summary

The applicant requested Manx Care's policies and procedures regarding the notification of reportable diseases, including time limits and lists of diseases. The authority responded by stating the information is publicly available online and provided attached documents, specifically a policy on Meningococcal infections.

Key Facts

• The request was received on 28 August 2025 and the outcome was issued on 3 September 2025.
• Manx Care cited Section 20 of the Freedom of Information Act 2015, stating the information is accessible by other means in the public domain.
• A link was provided to the Isle of Man government website for the list of notifiable organisms.
• An attached policy document titled 'Management of Meningococcal Infections in adults' was provided.
• The attached policy was authored by the Consultant Microbiologist and Lead Nurse, Infection Prevention & Control.

Data Disclosed

• 28 August 2025
• 3 September 2025
• 14 February 2024
• 14 February 2027
• 20/11/23
• 4899805
• Section 20
• Freedom of Information Act 2015

Exemptions Cited

• Section 20 - Information accessible to the applicant by other means (absolute)

Original Request

Hi, Please can you provide me with Manx cares policies and procedures relating to the reporting of notifiable/reportable diseases. Please include information in relation to:- 1- the policy/procedure for the notification of such diseases to public health 2 - the prescribed time limits from identification of such disease to reporting (i.e. reportable to public health within 5 days) 3 - list of reportable diseases 4 - any details of requirements to notify organisations such as schools or companies of employment of identified reportable diseases to mitigate spread Thanks

Data Tables (5)

Full Response Text

Manx Care Noble’s Hospital, Strang Braddan, Isle of Man IM4 4R (01624) 650 000

Our ref: 4899805 3 September 2025

Dear

We write further to your request, received 28 August 2025, which states:

"Hi,

Please can you provide me with Manx cares policies and procedures relating to the reporting of notifiable/reportable diseases.

Please include information in relation to:-

1- the policy/procedure for the notification of such diseases to public health

2 - the prescribed time limits from identification of such disease to reporting (i.e. reportable to public health within 5 days)

3 - list of reportable diseases

4 - any details of requirements to notify organisations such as schools or companies of employment of identified reportable diseases to mitigate spread

Thanks"

Response While our aim is to provide information whenever possible, Section 20 - Information accessible to the applicant by other means (absolute). All this is freely available in public domain. The list of notifiable organisms currently applicable in IOM is found here.
https://www.gov.im/about-the-government/departments/cabinet-office/public- health/health-protection/notifications-to-public-health/
Manx Care seeks to follows the attached legislation. Also attached are copies of Policies that are utilised within Manx Care.

Please quote the reference number 4899805 in any future communications.

Your right to request a review

If you are unhappy with this response to your freedom of information request, you may ask us to carry out an internal review of the response, by completing a complaint form and submitting it electronically or by delivery/post.

An electronic version of our complaint form can be found by going to our website at https://services.gov.im/freedom-of-information/Review . If you would like a paper version of our complaint form to be sent to you by post, please contact me and I will be happy to arrange for this. Your review request should explain why you are dissatisfied with this response, and should be made as soon as practicable. We will respond as soon as the review has been concluded.

If you are not satisfied with the result of the review, you then have the right to appeal to the Information Commissioner for a decision on; 1. Whether we have responded to your request for information in accordance with Part 2 of the Freedom of Information Act 2015; or 2. Whether we are justified in refusing to give you the information requested.
In response to an application for review, the Information Commissioner may, at any time, attempt to resolve a matter by negotiation, conciliation, mediation or another form of alternative dispute resolution and will have regard to any outcome of this in making any subsequent decision. More detailed information on your right to a review can be found on the Information Commissioner’s website at www.inforights.im. Should you have any queries concerning this letter, please do not hesitate to contact me. Further information about freedom of information requests can be found at www.gov.im/foi.

I will now close your request as of this date.

Yours sincerely

1

Management of Meningococcal Infections in adults
Document Control

Policy Name
Management of meningococcal infection in adults
Date
14 February 2024
Review Date
14 February 2027
Author
Consultant Microbiologist / Lead Nurse, Infection Prevention & Control /Clinical Director - Medicine
Approved by

Published Location
Manx Care Intranet - Infection Prevention & Control

Version History

Date
Version Number
Revision Notes
Author
20/11/23
1

Consultant
Microbiologist / Lead Nurse, Infection
Prevention & Control
/Clinical Director - Medicine

1.0
Purpose
The aim of this policy is to provide guidance to staff employed by Manx Care with regards to caring for patients who are known or suspected of having Meningitis. The policy will describe the different types of Meningitis and the relevant care and precautions required with regards to infection prevention and control.

2.0
Roles and Responsibility

2

• Infection prevention and control is everyone’s business. Each member of staff is responsible to seek out guidance and help in implementing this policy where they have difficulty.

• The Chief Executive has overall responsibility for reducing the risk of
  Health Care Associated Infection (HCAI) by ensuring that there are
  arrangements in place within the organisation to comply with the policy.

• The Manx Care Infection Prevention & Control Committee (IPCC) is responsible for signing off the approval and dissemination of this policy.

• The Director of Nursing, Medical Director and Board of Directors are responsible for ensuring that staff are aware of their responsibilities and that Infection Prevention and Control (IPC) is embedded at all levels of the organisation.

• The Director of Infection Prevention & Control (DIPC) will oversee the development of this policy and is responsible for producing an annual report on the state of HCAI in the organisation.

• The Infection Prevention & Control Team (IPCT) will develop, disseminate, and review this policy.

• Service / Area Managers will implement and audit compliance of this policy with the support of IPCT.

• Care group triumvirates will ensure that all staff for whom they have line - management responsibility are aware of, and comply with this policy.

• Link IPC Practitioners will actively promote compliance with this policy.

Meningitis / Meningococcal speticaemia

Meningitis is defined as inflammation of meninges. Meningococci (Neisseria meningitidis) are spread from person to person by respiratory droplets, and prolonged close contact facilitates spread. The bacteria are then carried in the nasopharynx, usually harmlessly, but with the potential to multiply and invade the bloodstream, causing septicaemia and meningitis

Signs and symptoms

Any of the following may occur: -

Sudden onset of fever, confusion, drowsiness

Petechial rash; non-blanching, may be widespread or localised. - Maculopapular rash also occurs
- Headache, vomiting, photophobia, irritability and neck stiffness

3

Management of Suspected (or confirmed) Meningitis

Patients in the community with newly diagnosed known or suspected Meningitis should be referred immediately to the acute emergency services by dialling 999. It is essential that all cases of Meningitis are notified immediately to the Directorate of Public Health

Out of hours: Ring Noble’s Hospital switchboard on 650000 and ask for on-call Public Health who will decide which contacts should be offered antibiotic chemoprophylaxis or vaccination.

It is strongly recommended that general practitioners give IV /IM benzylpenicillin 1.2g to cases of suspected meningococcal disease (i.e. meningitis with typical non-blanching rash or meningococcal septicaemia) before transfer to hospital.

Rapid transfer to hospital is of paramount importance, as even minutes can make a difference to the outcome - but urgent transfer should not be delayed in order to give the antibiotics.

Investigations

If the patient has had benzylpenicillin before admission, it may be difficult to grow the organism, but it is important to attempt it for

a) Confirmation of the diagnosis,
b) Typing of the strain and decisions on vaccination,
c) Local and national epidemiology.

The following should be routine: -

1. Blood culture. Before further antibiotics (but do NOT delay giving antibiotics).
2. EDTA blood sample (purple bottle) for meningococcal PCR (polymerase chain reaction).
3. Throat swab. As soon after admission as possible. This may be the only specimen which is positive if prior antibiotics given. However, this is only suggestive and not diagnostic of the disease.
4. CSF. For microscopy and culture if clinically indicated and if patient condition suitable. This may be tested by PCR (Film Array) if appropriate, as determined by the Microbiologist.
5. Paired sera for meningococcal antibody if cultures negative. First within a week of onset, second around two weeks later

Cranial computed tomography in suspected bacterial meningitis

Use clinical assessment and not cranial computed tomography (CT), to decide whether it is safe to perform a lumbar puncture. CT is unreliable for identifying raised intracranial pressure.
- If a CT scan has been performed, do not perform a lumbar puncture if the CT scan shows radiological evidence of raised intracranial pressure.

Antimicrobial Therapy

4

Do not wait to initiate antimicrobial therapy until a microbiological diagnosis has been made

Treatment needs to be commenced immediately if meningitis/meningococcal septicemia is suspected, with Ceftriaxone 2G BD IV. If penicillin anaphylactic / allergic contact Consultant Microbiologist.

Treatment may be adjusted once sensitivities are available on discussion with Microbiologist.
For meningitis of unknown cause, see Hospital Antibiotic Guidelines. Cases should be discussed with the Consultant Microbiologist.

Viral etiology

• Acyclovir 10mg/kg 8 hourly IV x 14 days, if immunocompromised 21 days
• Repeat LP at the end of treatment to confirm HSV PCR is negative before stopping the treatment , if positive continue with weekly LP
• Good hydration , U&E monitoring

Infection Prevention & Control

Transmission based precautions should be commenced immediately if meningitis is suspected and the type is unknown

• Isolate the patient in a single room for at least 24 hours of effective antibiotic treatment.
• Use transmission based precautions for droplets i.e. IIR mask, gloves and apron
• Health Care Workers HCW are not at any greater risk of contracting the illness than any other person unless they have been directly exposed to the patient’s oral secretions e.g. endotracheal intubation, tube management or mouth to mouth resuscitation.
• If viral meningitis is suspected then enteric precautions are to be implemented for 7 days after the onset of illness unless a non-enteroviral diagnosis can be made. This is due to the possibility of the virus being shed in the faeces.

Prophylaxis for close contacts

The decision to administer prophylaxis to close contacts is taken in consultation with the
Consultant Microbiologist and Public Health

A close contact is defined as prolonged close contact with the case in a household type setting during the seven days before onset of illness. Examples of such contacts would be those living and/or sleeping in the same household, pupils in the same dormitory,boy/girlfriends, or university students sharing a kitchen in a hall of residence.

5

Close contacts who always need prophylaxis (Give irrespective of vaccination status)
1.
People living in the same house as the patient or who have had prolonged close contact with the case in a household type setting for 8 hours or more 2. Family members and friends who have spent time with the patient, especially “kissing contacts”. Partners should be included.
3. Any childminder who has been looking after the patient in a domestic situation

1. Members of staff. Chemoprophylaxis is recommended only for those whose mouth or nose is directly exposed to large particle droplets/secretions from the respiratory tract of a probable or confirmed case of meningococcal disease during acute illness until they have completed 24 hours of systemic antibiotics. This type of exposure will only occur among staff who are working close to the face of the case without wearing a mask or other mechanical protection. In practice, this
   implies a clear perception of facial contact with droplets/secretions and is unlikely to occur unless using suction during airway management, inserting an airway, intubating, or if the patient coughs in your face.

General medical or nursing care of cases is not an indication for prophylaxis

Contacts who do not usually need prophylaxis

1. Children and teachers at the patient’s school (including nursery/ pre-school) or college.
2. Work colleagues.
3. Residents of nursing/residential homes.
4. Ambulance staff, nursing and medical staff, who have not been directly exposed to the patients saliva or nasopharyngeal secretions.
5. Food or drink sharing or similar low levels of salivary contact.
6. Attending the same social function, travelling in next seat on same plane, train, bus or car

Chemoprophylaxis

• Ciprofloxacin 500mg PO as a single dose
• Rifampicin 600mg BD x 2 days is an alternative
• Ciprofloxacin, Ceftriaxone or Azithromycin can be used as chemoprophylaxis in pregnancy
• When serotype is known there may be an option of vaccine for close contacts

Notification

Meningitis (all causes) and meningococcal septicaemia are notifiable diseases, i.e. it is a statutory requirement that the Directorate of Public Health (DPH) is informed of each case. DPH manages the community aspect of the case, e.g. prophylaxis and vaccination if there are a large number of contacts, information to schools, enquiries from the media etc. The 6

clinician is required to notify DPH about all suspected cases as soon as possible. Notification should be on suspicion - it is not necessary to wait for confirmation of a result. Notification is the responsibility of the doctor treating the patient, but the Consultant Microbiologist or Infection Control Nurses can give advice on this.

9.0
Cross Reference Policies

National Infection Prevention & Control Manual
https://iomgov.sharepoint.com/sites/ManxCareIntranet/Shared%20Documents/Care%20G roups/Infection%20Prevention%20%26%20Control/National%20Infection%20Prevention% 20and%20Control%20Manual.pdf?web=1

10.0
Ratification
Policy Name: Management of Meningococcal Infection in adults RATIFIED BY:
Signed: ……………………………………………….. Date: ………………………………………………………..

11.0
Implementation/Review

Active From: 14/02/24 Review Date: 14/02/2027

12.0
Monitoring & Compliance

Monitoring Requirement
Isolation
PPE
Fit testing
Prophylaxis
Monitoring Method
Bimonthly IPC audits
Hand hygiene & PPE audits

Monitoring Report to: Infection Prevention & Control Committee (Quarterly).

Operational Clinical & Quality Group

13.0
References

7

UKHSA (2022) Meningococcal disease: guidance, data and analysis. Accessed on 07/11/22 at https://www.gov.uk/government/collections/meningococcal-disease-guidance-data-and-

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