Notifiable Diseases are those whose occurrence is required by the law of the country to be reported to the appropriate authority – usually the medical officer of health.

This procedure of notification is one of the most important features of any health service. The reason for this is obvious: if a case of a serious disease, capable of starting an epidemic, is notified to the public health authorities immediately at the moment it is diagnosed (or even suspected) then there is a much greater chance of preventing the epidemic.

For some notifiable diseases, there is no real risk of an epidemic, but the very occurrence of one case of the disorder can be an indication of some breakdown in hygiene.

The specific diseases which are notifiable vary a little from one country to another, depending on the prevailing health conditions. However, some typical characteristics of a notifiable disease are:

• Potentially life-threatening
• Spreads rapidly
• Cannot easily be treated or cured, for example when no vaccine or antibiotics are available
• In some cases notifications are used to monitor the development of community outbreaks or the success of immunisation programmes

The notification system in England and Wales is the oldest national system for collecting statistics on communicable diseases. The Infectious Disease (Notification) Act 1889 was introduced to identify and prevent the spread of infectious diseases.

Under this system, general practitioners have a statutory obligation to notify a 'Proper Officer' of the local authority of suspected cases of certain infectious diseases. The 'Proper Officers' are required every week to inform the Communicable Disease Surveillance Centre (CDSC) at the Central Public Health Laboratory in Colindale, North London, details of each case of each disease that has been notified. CDSC has responsibility for collating these weekly returns and publishing analyses of local and national trends.

So, Who are 'Proper Officers'?

The term 'Proper Officer' is widely used in local government and is defined as 'an officer appointed for that purpose by that body'. In most cases this person is the Consultant in Communicable Disease Control (CCDC), but in some cases may be the most senior professional Environmental Health Officer.

Diseases which are notifiable (to Local Authority Proper Officers) under the Public Health (Control of Disease) Act 1984 or the Public Health (Infectious Diseases) Regulations 1988 (UK) may be taken as typical of the situation in other countries. Many of the diseases originally notifiable under the 1889 Act are now rare or have been eliminated in England and Wales, but other diseases have been added to the list which now covers 30 infections. These are:

• Acute Encephalitis
• Anthrax
• Cholera
• Diphtheria
• Dysentery
• Enteric fever
• Food poisoning
• Leprosy
• Leptospirosis¹
• Malaria
• Measles, mumps and rubella
• Meningitis (Meningococcal and pneumococcal)
• Haemophilus influenzae²
• Viral Meningococcal septicaemia (without meningitis)
• Ophthalmia neonator
• Paratyphoid fever
• Plague
• Poliomyelitis
• Relapsing fever
• Scarlet fever
• Smallpox
• Tetanus
• Typhus
• Tuberculosis
• Viral haemorrhagic fever
• Viral hepatitis, ie, hepatitis types A, B and C
• Whooping cough (pertussis)
• Yellow fever

The Issue of Patient Confidentiality

A major principle of infectious disease control is to ensure that the outbreak is contained, and thus its spread is limited. Therefore speed is of the essence and in order to facilitate this, 'attending' physicians (usually the patient's general practitioner or hospital physician) is obliged to provide full identifying information to the Proper Office of the Local Authority, on patients with a notifiable infectious disease. In this way the relevant Public Health Authority is then able to contact the patient directly so that appropriate action can be taken to control or prevent further infection.

As the law is currently interpreted, this obligation does not extend to microbiology laboratory staff, who would probably be involved in making or confirming the diagnosis in the first place.

The Proper Officers send fully anonymised data to the CDSC at Colindale.

What about Scotland?

The list of notifiable diseases in Scotland differs from that in the rest of the UK. The Scottish list does not include:

• Acute encephalitis
• Cerebrospinal fever
• Enteric Fever
• Leprosy
  
• Viral meningococcal septicaemia
• Ophthalmia neonator
• Yellow Fever

But it does include:

• Chickenpox
• Continued fever
• Erysipelas³
• Legionellosis⁴
• Lyme disease
• Puerperal fever
• Rabies
• Toxoplasmosis
• Typhoid fever

In Scotland, NHS Boards encourage local healthcare providers and other local agencies to report relevant information to them promptly. The NHS Boards are then required to report notifiable disease information centrally to the Common Services Agency, who then pass it to a sub-division, the Scottish Centre for Infection and Environmental Health (SCIEH). SCIEH is the body responsible for national surveillance in Scotland.

Notifiable Non-Infectious Industrial Diseases

There are a number of non-infectious industrial diseases (such as certain poisonings, asbestosis and pneumoconiosis) which are notifiable, but the nature of these vary greatly from country to country.

Further information on the notification of infectious diseases in England and Wales is available from the Health Protection Agency.