All women should be routinely tested for the presence of rubella antibodies early in every pregnancy. If this result is available and the woman is known to be immune, she may be reassured that her foetus is at little risk.
Pregnant women, in whom immunity to rubella has not been confirmed for the current pregnancy, and who may have been exposed to rubella, must be investigated serologically—irrespective of a history of vaccination, clinical rubella or previous positive rubella antibody.
Serological testing:
• The pregnant woman should be tested for rubella antibodies as soon as possible after exposure.
• If the woman is rubella antibody-negative and remains asymptomatic, a second blood specimen should be obtained 21 days after the exposure date. However, a
It is essential that all requests to laboratories state:
• Duration of pregnancy and last menstrual period (LMP).
• Date of exposure to possible rubella.
• Date of blood specimen.
Ideally, a virologist should be consulted when the diagnosis is first considered. The clinical picture and all test results should be discussed by the virologist and the clinician to enable accurate interpretation of serological results prior to advising the woman about her individual risk.
Control of Case
Contact should be avoided, as far as possible, with pregnant women.
The case should be excluded from school for at least five days after onset of the rash.
Adults should be excluded from work for the same time.
If the case is pregnant, the diagnosis should be con-firmed serologically, then the patient referred to her obstetrician for specialist advice.
Control of Contacts
School contacts should not be excluded from school regardless of immunisation status.
Post-exposure immunisation will not necessarily be in time to prevent infection or illness.
Immunoglobulin may be given after exposure in early pregnancy. It may not prevent infection or viraemia, but may modify abnormalities in the baby.
Preventive Measures
MMR vaccine is recommended for all infants at 12 months, and at 10–16 years (Year 6 in Victoria).
Women attending for antenatal care should be tested for rubella antibodies and, if negative, the vaccine should be recommended immediately post partum.
Women of childbearing age should be tested prior to pregnancy, if possible. All seronegative women, if not pregnant, should be offered rubella vaccine.
Women receiving rubella vaccine should be instructed not to become pregnant for at least three full menstrual cycles.
Inadvertent rubella vaccination during pregnancy has not been associated with any CRS-like defects; hence, it is not necessary to recommend termination.
All health workers should receive rubella vaccine if not immune.
Epidemic Measures
All suspected outbreaks should be reported promptly to Human Services.
An outbreak of rubella in a school may justify mass immunisation, regardless of immune status.
Salmonellosis
Victorian Statutory Re q u i re m e n t s
Group B notification.
Infectious Agent
There are numerous serovars of Salmonella. Salmonella Typhimurium and Salmonella Enteritidis are the two most commonly reported worldwide. In 1993 in Victoria, the most common infections were with Salmonella Typhimurium, Salmonella Infantis and Salmonella Bovismorbificans.
Clinical Features
It is a bacterial disease that commonly presents as an acute gastroenterocolitis with fever, vomiting, nausea, abdominal pain and diarrhoea.
Dehydration may occur, especially among infants and the elderly.
Salmonellosis may be complicated by septicaemia or focal infection.
Public Health Significance and O c c u r re n c e
Occurrence is worldwide.
The prevalence of infection is highest in infants and young children.
Outbreaks occur in hospitals, institutions for children and nursing homes.
There is high morbidity, but death is uncommon except in infants and the elderly.
Method of Diagnosis
Isolation of Salmonella from faeces in cases of entero-colitis.
Isolation of Salmonella from blood and faeces in cases of septicaemia.
Re s e r voi r
Domestic and wild animals, including poultry.
Patients, convalescent carriers and mild and unrecog-nised cases.
Pets such as dogs and cats, tortoises, turtles and reptiles.
Chronic carriers are rare among humans but common among birds and animals.
Mode of Transmission
It can be transmitted by:
• Ingestion of the organisms in food derived from in-fected food animals or contaminated by human or animal faeces:
– Raw and undercooked eggs and egg products.
– Raw milk and raw milk products.
– Poultry and poultry products.
– Raw red meats.
• Faecal-oral transmission from person to person, especially when diarrhoea is present.
• Contaminated utensils or tables used for food process-ing and preparation.
• Pet turtles and chickens.
Incubation Period
Usually six to 72 hours; generally about 12–36 hours.
Period of Communicability
It is communicable through the course of infection—
usually several days to several weeks.
One per cent of infected adults and 5 per cent of chil-dren under five years excrete the organism for more than one year.
Antibiotics, given in the acute illness, can prolong the carrier state.
Susceptibility and Resistance
Susceptibility may be increased by some medical conditions, immunosuppresive therapy and malnutrition.
Severity of the disease varies with:
• The serotype.
• The numbers of organisms ingested.
• The vehicle of transmission.
• Host factors.
Control of Case
• Use Standard Precautions when handling faeces, contaminated clothing and bed linen from hospitalised patients.
• Exclude symptomatic cases from food handling and direct care of children, the elderly and
immunosuppressed patients.
• Instruct asymptomatic individuals in strict personal hygiene. Stress proper hand washing.
• Consider the use of quinolones in long-term carriers who are food handlers.
Tre a t m e n t
No antibiotic treatment is indicated in uncomplicated
Patients at high risk (for example, infants under two months of age, the elderly and the immunosuppressed), may need antibiotic therapy.
The recommended antibiotics for adults include co-trimoxazole, amoxycillin, ciprofloxacin and cefotaxime/
ceftriaxone.
Specialist advice should be sought for treating infants under two months of age.
Control of Contacts
Investigation of contacts and source of infection is not routinely performed in sporadic cases.
Preventive Measures
• Thoroughly cook all food derived from animals sources, particularly poultry, pork, egg products and meat dishes.
• Avoid recontamination from raw food within the kitchen after cooking is completed.
• Emphasise the importance of refrigerating food and maintaining a sanitary kitchen.
• Avoid consuming raw or incompletely cooked eggs, or using dirty or cracked eggs.
• Pasteurise all milk and egg products.
• Educate food handlers on the importance of hand washing and separation of raw and cooked foods.
• Exclude all individuals with diarrhoea from food han-dling and care of hospitalised patients, the elderly and children.
• Inspect and supervise abattoirs, butcher shops, food-processing plants and egg-grading stations.
Epidemic Measures
Attention should be paid to environmental cleaning, particularly in institutions, child care centres and food premises.
In cases of salmonella outbreaks in which eggs are implicated, look for the egg source and contact the Egg Industry Co-operative Ltd, telephone: (03) 9789 7077.
S c a b i e s
Victorian Statutory Re q u i re m e n t
Statutory notification not required.
School exclusion.
Infectious Agent
Sarcoptes scabiei (mite).
Clinical Features
It is a highly contagious parasitic skin infestation, charac-terised by thin, slightly elevated wavy greyish-white burrows that contain the mites and eggs. Multiple papules and vesicles soon appear.
The most common sites for burrows are between the fingers and toes, anterior surfaces of the wrists and elbows, axillae, lower abdomen, beneath female breasts and genitalia. The face, head, palms and soles are seldom involved in adults, but in infants any area of skin may be infected.
Immunosuppressed patients, those with Down syndrome and geriatric patients may also show a pattern of infesta-tion similar to that in infants.
Itching varies from person to person but may be severe.
It tends to be more marked at night or after a hot bath.
Scratching frequently leads to secondary infection.
A particularly virulent infection, known as crusted or Norwegian scabies can occur in debilitated or immunosuppressed patients including those with HIV infection. These cases are highly infective.
Public Health Significance and O c c u r re n c e
Occurrence is worldwide, regardless of age, sex, race or standards of personal hygiene.
Cyclical epidemics occur at intervals of 10 to 15 years.
Outbreaks may occur in child care centres and kinder-gartens, and not infrequently are reported in nursing homes and institutions.
Method of Diagnosis
See Clinical Features.
Diagnosis is confirmed by scraping the burrows with a needle or scalpel blade and identifying the mites or eggs under the microscope.
Re s e r voi r
Human. Other species of mite can also live on humans but do not reproduce in the skin.
Mode of Transmission
It is transmitted by:
• Skin contact with an infected person.
• Contact with infected towels, bedclothes and under-garments only if these have been contaminated by infested persons within the last four to five days.
Incubation Period
Usually two to six weeks before itching occurs in a person not previously infected.
If a person is re-exposed, the incubation period is one to four days.
Period of Communicability
It is communicable until mites and eggs are destroyed .
Control of Case
Infested patients should be excluded from school or workplace until the day following the first application of appropriate treatment.
For hospitalised patients, contact isolation should be used until appropriate treatment has commenced.
Infested personal garments, towels and bedclothes should be laundered or dry cleaned.
For details of treatment, see scabies information sheet.
Control of Contacts
• Investigate contacts and source of infestation.
• Treat all household contacts prophylactically and simultaneously.
Preventive Measures
• Educate the public about the mode of spread, early diagnosis and treatment.
• Promote good personal hygiene.
• Isolate the case until appropriate treatment has com-menced.
• Treat patients and their contacts simultaneously.
Epidemic Measures
In an institution, ensure that investigations, screening, treatment and education are undertaken on a coordi-nated basis.