Consultants In Communicable Disease Control Research Articles

Thetford plastics fire, October 1991: the role of a preventive medical team in chemical incidents.

To review the role of a medical team in the emergency management of a major polyvinyl chloride (PVC) fire in an urban area. The district health authority's consultant in communicable disease control (CCDC) was requested to advise on the health impacts of a fire that consumed some 1000 tonnes of plastic, mainly PVC, over 72 hours and which emitted a large smoke plume that threatened the health of local residents and emergency workers alike, constituting one of the largest incidents the local emergency services had dealt with in recent years. A medical team was formed comprising the CCDC, a regional epidemiologist, an occupational physician, and a medical toxicologist. This paper is an account of this team's experience of advising on the medical management of the emergency without having any formally established role or previous training for the task. The main issues requiring the input of the medical team included: the possible products of combustion and their effects on health; the clinical management of those exposed; the alerting of local hospitals to the type of casualties to expect; the special health risks posed to emergency workers, especially the firemen; the need for evacuation of local residents; the risks of contamination of soil, water, and crops; the potential health impact of the plume; and the provision of expert and authoritative advice on the short and long term health implications to the public. Active surveillance systems, which included the local general practitioners and hospitals, were established and air monitoring instigated. The 46 casualties were restricted to emergency personnel who had inadvertently received exposure to the fire smoke: all recovered within 48 hours. Local residents were unharmed. The incident showed the need for preventive medical teams trained to fill a formal advisory and investigative role for chemical releases and fires, and which can play an integral part in emergency management.

Major chemical incidents – a response, the role of the Consultant in Communicable Disease Control and the case of need for a national surveillance–resource centre

The aim of this study is to discuss the adequacy of current arrangements for dealing with major chemical incidents through the offices of the Consultant in Communicable Disease Control (CCDC). This paper describes the public health response to an explosion at a chemical works which was followed by illnesses of unknown aetiology in emergency service workers and other people. An outline of the circumstances as they presented themselves and a description of the lessons learned from the management of this disaster are presented alongside an overview of the prevailing infrastructure of advice, support and training available to CsCDC. Key issues relevant to these areas are discussed. A total of 181 potential cases were notified to the investigating team, of whom 115 had an illness possibly associated with the explosion. Of these, 93 suffered a gastrointestinal illness and 68 had so-called 'toxic' symptoms (eye, skin and bronchopulmonary irritation). Forty-six people had both sets of symptoms at the same time. Current arrangements dictate that public health physicians have a role in incidents such as this, whether they seek such a position or not. The specialty would do well to consider developing formal disaster training schemes for those likely to have to manage major incidents (usually the CCDC), and would benefit from the setting up of a chemical-environmental incident surveillance-resource centre. Such a centre should have a remit for teaching and training, information support, incident recording, coordination of expert resources, and liaison between interested bodies both nationally and internationally.

Tuberculosis in London: a review, and an account of the work of the London consultants in communicable disease control group working party

Tuberculosis (TB) has been recorded in London for centuries but reports have declined over the last 100 years, with a 10-fold decrease between 1948 and 1987. However, from 1987–1993 notifications of TB in London rose by 34%, compared with 15% nationally. This rise, together with concerns about undernotification and the emergence of multi-drug resistance in New York, led to establishment of a London Consultants in Communicable Disease Control Working Party on TB to review current surveillance data. Notifications to the Office of Population Censuses and Surveys from the London Boroughs declined by approximately 6·5% per year from 1982–1987. If this had continued until 1993 there would have been 3579 fewer notifications than actually received. The proportion of cases in the 15–44 age group rose markedly in males. The proportion of notifications in those aged 65 and above was higher in the Thames Regions outside London, where the total TB notifications declined by 3·5% over the same period. Recommendations were made to improve TB surveillance in London; and a city-wide surveillance function was established in 1994 to collate and monitor data on TB.

Progress with establishing and implementing standards for infection control in the UK

The process of agreeing standards for infection control in England and Wales is described. To ensure ownership of these standards an extensive consultation exercise was undertaken. Further development has been left to Infection Control Teams (ICTs) and the relevant health care workers. Management and Consultants in Communicable Disease Control were also sent the standards to further encourage support for their implementation. The results of a questionnaire of ICT resources and activities is alluded to and these data will be a valuable point of reference to monitor changes in the status quo of a rapidly changing health service.

Communicable disease control in England; recommendations from an American

The problems associated with the Wakefield salmonella and the Stafford Legionnaires' disease outbreaks and the recommendations of the Acheson Committee formed in response led to the creation of the position of Consultant in Communicable Disease Control (CCDC) within the District Health Authorities. The reality of the position as implemented differs from that envisaged by the Acheson Committee and has resulted in ambiguities about the role of the CsCDC, the source of their support, and the range of their responsibilities. This paper, by an American invited to review the position, outlines the history of the position, the current status of CsCDC, and the barriers to effective performance of the position. It ends with a series of recommendations for improving disease control within England by solidifying the position, establishing its role in disease control within the National Health Service and recommending an educational/training pathway to attract and prepare physicians for the position.

Local notification of infectious diseases—a neglectedtool

A country-wide survey of consultants in communicable disease control (CCDCs) wasconducted to assess the use of Section 16 of the Public Health (Control of Disease) Act, 1984 for the local notification of infectious diseases. A response rate of 84% was achieved. The results indicate that, although the power is generally little used, 24 local authorities have locally notifiable diseases and at least eight CCDCs are actively considering the use of Section 16. The power may be particularly valuable as an additional tool in the surveillance of ‘clinically diagnosed’ and locally troublesome infections such as scabies.

The public health physician's role in chemical incidents.

Chemical incidents such as the methylisocyanate release at Bhopal and the aluminium sulphate incident in Lowermoor, Cornwall, are uncommon. However, five chemical incidents occurred in Somerset in 12 months between 1990 and 1991, and District Health Authorities are required to have plans to deal with such events. A survey of the plans held by the Consultants in Communicable Disease Control in South Western and Wessex Regional Health Authorities is discussed and the roles of public health physicians and emergency organizations are outlined.

The present and future role of the Consultant Physician with an interest in infection

The Council of the British Society for the Study of Infection (BSSI) has considered the present and future role of the Consultant Physician with an interest in infection. The BSSI is anxious to set standards and improve the quality of care delivered to patients with infection; to give advice on the prevention and management of infection and to provide such services economically to assist Health Managers in the purchase of infection-related medical services appropriate to the needs of the community they serve. New approaches to the care of infected patients are reviewed where the Clinical Specialist, Microbiologist and Consultant in Communicable Disease Control (CCDC)--in Scotland, Consultant in Public Health Medicine (CPHM)--work together in a team. As the U.K. moves closer to its European partners in 1992, it seems timely for each specialty to make a clear statement about its training programme and the requirements expected of a fully trained Consultant in each discipline. Comparisons between the ratio of Consultants with a special interest in infection and the population are made, where known, between U.K. and other European countries. A model job description for the U.K. clinical specialist is therefore being made available, the present inadequate numbers of consultants are stated and recommendations made to expand urgently the number of Consultant Physicians with an interest in infection.

Consultants in communicable disease control

Consultants in communicable disease control

Consultants in communicable disease control.

Consultants in communicable disease control.

Consultants in communicable disease control

Consultants in communicable disease control

Consultants in communicable disease control

Consultants in communicable disease control

Consultants in communicable disease control.

Consultants in communicable disease control.

Information access

The Council of the British Society for the Study of Infection (BSSI) has considered the present and future role of the Consultant Physician with an interest in infection. The BSSI is anxious to set standards and improve the quality of care delivered to patients with infection; to give advice on the prevention and management of infection and to provide such services economically to assist Health Managers in the purchase of infection-related medical services appropriate to the needs of the community they serve. New approaches to the care of infected patients are reviewed where the Clinical Specialist, Microbiologist and Consultant in Communicable Disease Control (CCDC)—in Scotland, Consultant in Public Health Medicine (CPHM)—work together in a team. As the U.K. moves closer to its European partners in 1992, it seems timely for each specialty to make a clear statement about its training programme and the requirements expected of a fully trained Consultant in each discipline. Comparisons between the ratio of Consultants with a special interest in infection and the population are made, where known, between U.K. and other European countries. A model job description for the U.K. clinical specialist is therefore being made available, the present inadequate numbers of consultants are stated and recommendations made to expand urgently the number of Consultant Physicians with an interest in infection.