Communicable diseases

Communicable diseases are illnesses caused by micro-organisms (e.g. bacteria, viruses and fungi) that can be spread from one person to another. These organisms are everywhere but most do not cause infection and can even be beneficial. However, some can cause infections which can result in symptoms such as fever and sickness. The organisms are spread during an infectious period and many are vaccine preventable.

A notifiable disease is one which has to be reported by law to the UK Health Security Agency (UKHSA). After a report, UKHSA will work to identify the source and put in control measures to prevent further spread or recurrence of the infection.

Health care professionals have a statutory duty to report any cases of notifiable diseases. Other settings like care homes, nurseries or schools, can contact the East Midlands UKHSA Health Protection Team for advice if there are cases of notifiable diseases in their setting (telephone 0344 2254 524 or email emhpt@ukhsa.gov.uk. Email for personal identifiable information (PII) is phe.emhpt@nhs.net)

Below is information on some of the most common communicable diseases and advice and guidance for different settings. Also case studies and training resources.

Measles is a viral infection that affects the respiratory system, spreads very easily and usually starts with cold-like symptoms followed by a rash. It can cause serious health complications like pneumonia and meningitis and lead to long-term health problems, such as persistent bronchitis, hearing/sight loss and seizures. Anyone at any age can be infected by the measles virus if they have not been vaccinated or had measles before. Those most at risk are the very young and people with weakened immune systems.

The UK Health Security Agency (UKHSA) declared a national incident in response to outbreaks of measles in February 2024.

The key to preventing measles is to have the measles, mumps and rubella (MMR) vaccine. Childhood MMR vaccination rates have declined slightly in recent years, but there are also adults who may have missed out on one or both doses of the MMR vaccination. The MMR vaccine is safe, effective and can give lifelong protection. It is usually given to children at one year old and a second dose at three years and four months, but it can be given at any age. A porcine-free version of the vaccine is also available.

The MMR vaccination is available through GP surgeries. They will also be able to check the records of individuals who are not sure if they have received both MMR doses.

It is important for adults to check their MMR status if they are:

working with the very young or with people who have weakened immune systems
about to start college or university
going to travel abroad
planning a pregnancy.

Anyone working with families is urged to encourage them to get children vaccinated.

We have developed some materials with information about measles and MMR to share. They are also available in Arabic, Kurdish, Polish, Punjabi, Romanian, Spanish and Urdu. Please email ph.response@nottscc.gov.uk to request copies of translated materials.

Resources for measles

Whooping cough (pertussis) is a bacterial infection of the lungs and breathing tubes. It spreads very easily and can sometimes cause serious problems. The number of cases of whooping cough has risen sharply in recent years and babies who are too young to start their vaccinations are at greatest risk.

Young babies with whooping cough are often very unwell and most will be admitted to hospital. When whooping cough is particularly severe, it can be fatal. Pregnant women can help protect their babies by getting vaccinated. After birth, babies can be protected by the infant vaccine programme.

People who have whooping cough are contagious from about six days after the start of cold-like symptoms to three weeks after the coughing starts. Starting antibiotics within three weeks of the onset of the cough, will reduce the time someone is contagious.

The UK Health Security Agency (UKHSA) East Midlands Health Protection Team identified an increase in cases of whooping cough in school children in Nottingham and Nottinghamshire in March 2024. They issued a letter to all parents and guardians [Word] to raise awareness of vaccination and symptoms.

Resources for whooping cough

Visit the NHS website for more information on whooping cough
Visit the NHS website for more information on the whooping cough vaccination in pregnancy
NHS Whooping Cough FAQs [Word]
Read our briefing document for more information on whooping cough [Word]

Scabies is an itchy rash caused by mites. It is spread through close skin contact and anyone can get it. It is not serious but should be treated quickly to stop it spreading. Everyone in a household with someone who has the infection will need to be treated, even if they do not have symptoms. Treatment will need to be coordinated to prevent reinfection and the full treatment course completed.

The symptoms of scabies are:

intense itching, especially at night
a raised rash or spots.

The spots may look red. They are more difficult to see on brown or black skin but will be felt.

A pharmacist will be able to recommend a cream or lotion treatment but children under two years old will need to see a GP.

Clothes and bedding also need to be washed at 50 degrees as soon as treatment starts.

Affected individuals can attend a setting but must avoid close physical contact with others until 24 hours after the first dose of chosen treatment.

Young children that cannot avoid close contact due to their age (e.g. those under five years old or with additional needs) should be excluded from a setting until 24 hours after the first dose of chosen treatment. The risks and benefits of this should be reviewed on a case-by-case basis and take into account the holistic needs of the individual and the impact on their wellbeing, as well as the risk of transmission of scabies to the wider school population. Other members of the affected individual's household do not need to be excluded from a setting.

Contact your UK Health Security Agency (UKHSA) Health Protection Team if there are two or more cases of scabies within your setting.

Resources for scabies

Visit the NHS website for more information on scabies
Visit the GOV.UK website for UKHSA guidance on the management of scabies cases and outbreaks in long-term care facilities and other closed settings

Respiratory infections (e.g. Covid-19 and flu) spread easily and may cause serious illness in some people. You may be infected with a respiratory virus and not have any symptoms but still pass an infection onto others.

The risk of catching or passing on respiratory infections is greatest when someone who is infected is physically close to or sharing an enclosed and/or poorly ventilated space with other people. When someone with a respiratory infection breathes, speaks, coughs or sneezes, they release small particles that contain the virus which causes the infection. These particles can be breathed in or come into contact with the eyes, nose, or mouth. The particles can also land on surfaces and be passed from person to person via touch.

There are things that will help reduce the risk of catching or spreading respiratory infections:

get vaccinated if you are eligible or invited
let fresh air in if you are meeting indoors
cover nose and mouth with a tissue when coughing and sneezing or cough or sneeze into the inner elbow if there are no tissues available
practise good hand hygiene and wash your hands regularly, especially if you have a cough or cold
keeping settings clean will help reduce the risk of transmission. Cleaning with water and detergent is normally all that is needed.

Resources for respiratory infections

Visit the GOV.UK website for guidance on living safely with respiratory infections including COVID-19
Visit the Royal College of Obstetricians & Gynaecologists website for information on Covid-19 and pregnancy

Norovirus (also called the winter vomiting bug) is a stomach bug that causes vomiting and diarrhoea. It can be very unpleasant but usually goes away in about two days.

To stop norovirus spreading:

wash hands thoroughly using soap and warm water after using the toilet or contact with a sick individual and before preparing and eating food
stay off school or work until 48 hours after symptoms clear
do not rely on alcohol gels instead of washing hands, as they do not kill the virus
wash any contaminated clothing or bedding using detergent at 60°C using disposable gloves to handle any items
use bleach-based cleaners to disinfect surfaces.

Resources for norovirus

We have developed a norovirus factsheet [Word] and norovirus poster [PDF] to download and share.
Visit the NHS website for more information on norovirus
Visit the GOV.UK website for guidance on managing norovirus outbreaks in acute and community health social care settings
Visit the GOV.UK website for guidance on how to stop norovirus spreading

Chickenpox is a highly contagious viral illness. It is most common in children under 10 but can affect people of any age. There are three stages of the infection:

stage 1: small spots appear which can be harder to see on brown or black skin
stage 2: the spots become blisters which are itchy and may burst
stage 3: the blisters become scabs.

The rash can be accompanied by a high temperature, aches and pains, generally feeling unwell and a loss of appetite. The spots are very itchy and it can cause children to feel miserable even if they don’t have many spots.

Chickenpox is highly contagious so anyone affected will need to stay away from school, work or nursery until all of the spots have formed a scab, which is usually five days after the spots appear.

For most children, chickenpox is a mild illness that gets better on its own. Chickenpox in adults can be more serious. Pregnant women and people with a weakened immune system should speak to their midwife or clinician if they are infected.

Complications can include bacterial skin infections resulting from scratching so care should be taken if bacterial infections like scarlet fever are circulating in a setting at the same time as chickenpox.

A vaccination is available on the NHS to people who are in regular or close contact with someone with a weakened immune system, who has a higher risk of getting seriously ill from chickenpox. For example, a child with leukaemia or an adult having chemotherapy.

Shingles is a common condition that causes a painful rash. It can sometimes lead to serious problems such as long-lasting pain, hearing loss or blindness. Symptoms of shingles include:

a tingling or painful feeling in an area of skin
a headache or feeling generally unwell
a blotchy rash will usually appear a few days later, usually on the chest and stomach on one side of the body.

Shingles can be transmitted by direct contact with the rash. People with shingles can mix with others if their rash is covered but should avoid contact with anyone who has not had chickenpox (which is caused by the same virus).

Shingles is more common and likely to cause serious problems in older people or those with a severely weakened immune system. There is a shingles vaccine for people:

turning 65
aged 70 to 79
with a severely weakened immune system.

It is possible to get shingles more than once so vaccination is advised for everyone who is eligible.

Staff in care homes who develop shingles should stay off work until lesions from the rash are dry.

Resources for shingles

Visit the NHS website for more information on shingles
Visit the NHS website for more information on the shingles vaccine
Visit the GOV.UK website for guidance on infection prevention and control in adult social care settings

Head lice (pediculosis) and nits are very common in young children and their families. They do not have anything to do with dirty hair and are picked up by head-to-head contact.

Resources for head lice

Visit the GOV.UK website for guidance on the characteristics, transmission and management of head lice
Visit the NHS website for more information on head lice and nits
NHS Head lice and nits [PDF]
Visit the National Institute for Healthcare and Excellence (NICE) website for management of head lice information

Attending face-to-face education or childcare is hugely important for children and young people’s health and their future. Infection control guidance is available to help staff working with children and young people manage a range of infections and minimise disruption.

Infections are common and for most people the risk of severe disease is low. They can be acquired at home or in the community and brought into settings, or acquired and spread within the setting.

Below are some resources to help identify when individuals should not attend a setting to reduce the risk of transmission.

Visit the NHS website to find information on: Is my child too ill for school?
Visit the NHS Nottingham and Nottinghamshire website to find information on: Should my child go to school/nursery today?
UKHSA/NHS Should I keep my child off school checklist [PDF]
UKHSA Health protection in education and childcare settings guidance: exclusion table [PDF]

Below are resources with general advice.

Visit the GOV.UK website for guidance on health protection in children and young people's settings, including education
Visit the UKHSA e-Bug website for information on micro-organisms and how to teach about them

Below are some resources for people working in adult social care to help prevent and reduce the transmission of infectious illnesses.

Visit the GOV.UK website for infection prevention and control: resource for adult social care guidance
Visit the GOV.UK website for infection prevention and control in adult social care: acute respiratory infection guidance
Visit the GOV.UK website for PPE guide for non-aerosol generating procedures
Visit the GOV.UK website for supporting safer visiting in care homes during infectious illness outbreaks guidance

Should I notify UKHSA of the high absence rate in school?

A Headteacher called because of the high number of children absent from school and wanted to check if they should report it to the UKHSA.

By talking it through the situation it was established that:

The number of children absent due to illness was higher than normal for that time of year (Autumn term).
The reasons for absence varied and there were no confirmed diagnoses of a notifiable disease in any children.
Symptoms varied and no one child had all of the illnesses/symptoms that were being reported.

It was agreed that:

The head would contact the UKHSA if there were any confirmed or probable cases of a notifiable disease.
The headteacher would keep in touch with parents if there was a probable or confirmed case of a notifiable disease.
The school would remind parents of the guidance about staying off school for children who are unwell, for example staying off school for 48 hours after vomiting or until a high temperature had returned to normal.
The school would remind parents and children about handwashing, using tissues or elbows to sneeze or cough into.
There were a number of children with coughs, colds and other respiratory illnesses which could include COVID-19. Current guidance for confirmed COVID infections would be to stay at home and avoid contact with other people, where possible and go back to school, and resume normal activities when they no longer have a high temperature and are well enough to attend.
The headteacher would consider staff or children within the setting who were clinically vulnerable and pregnant women to talk to them and risk assess them.

In this case the headteacher had done everything possible to manage the situation and no further action was required.

The school also tailored their messages to children and parents to suit their local community e.g. in different languages, easy read or in printed letters as well as via text messages or emails.

Below is a useful training resource if you would like to learn more about communicable diseases.

Preventing and Managing Infections in Childcare and Pre-school - Understand how infectious diseases spread and how to protect children from infections.