Cover
About the authors
Foreword
Section 1: Introduction
1. 1.1 How to use this book
2. 1.2 Basic concepts in the epidemiology of infectious disease
3. 1.3 Basic concepts in the prevention of infection
4. 1.4 Emergency risk communication
5. 1.5 Health protection on‐call
Section 2: Common topics
1. 2.1 Meningitis and meningism
2. 2.2 Gastrointestinal infection
3. 2.3 Community acquired pneumonia
4. 2.4 Rash in pregnancy
5. 2.5 Rash and fever in children
6. 2.6 Illness in returning travellers
7. 2.7 Jaundice
8. 2.8 Infection in the immunocompromised
Section 3: Diseases
1. 3.1 Amoebic dysentery
2. 3.2 Anthrax
3. 3.3 Bacillus cereus
4. 3.4 Botulism
5. 3.5 Brucellosis
6. 3.6 Campylobacter
7. 3.7 Chickenpox and shingles (varicella–zoster infections)
8. 3.8 Chikungunya
9. 3.9 Chlamydia pneumoniae
10. 3.10 Chlamydia trachomatis
11. 3.11 Cholera
12. 3.12 CJD and other human transmissible spongiform encephalopathies
13. 3.13 Clostridium difficile
14. 3.14 Clostridium perfringens
15. 3.15 Coronavirus (including MERS and SARS)
16. 3.16 Cryptosporidiosis
17. 3.17 Cyclosporiasis
18. 3.18 Cytomegalovirus
19. 3.19 Dengue fever
20. 3.20 Diphtheria
21. 3.21 Enterococci, including Glycopeptide‐Resistant Enterococci (GRE)
22. 3.22 Enterovirus infections (including hand, foot and mouth disease)
23. 3.23 Epstein–Barr Virus
24. 3.24 Giardiasis
25. 3.25 Gram‐negative bacteraemia (including carbapenem‐resistant enterobacteriaceae)
26. 3.26 Gonorrhoea, syphilis and other acute STIs
27. 3.27 Hantavirus infection
28. 3.28 Head lice
29. 3.29 Helicobacter pylori
30. 3.30 Hepatitis A
31. 3.31 Hepatitis B
32. 3.32 Hepatitis C
33. 3.33 Hepatitis, delta
34. 3.34 Hepatitis E
35. 3.35 Herpes simplex
36. 3.36 Haemophilus influenzae type b (Hib)
37. 3.37 HIV
38. 3.38 Influenza
39. 3.39 Japanese B encephalitis
40. 3.40 Legionellosis
41. 3.41 Leprosy
42. 3.42 Leptospirosis
43. 3.43 Listeriosis
44. 3.44 Lyme disease
45. 3.45 Malaria
46. 3.46 Measles
47. 3.47 Meningococcal infection
48. 3.48 MRSA (Meticillin‐Resistant Staphylococcus aureus)
49. 3.49 Mumps
50. 3.50 Mycoplasma pneumoniae infection
51. 3.51 Norovirus
52. 3.52 Paratyphoid fever
53. 3.53 Parvovirus B19 (fifth disease)
54. 3.54 Plague
55. 3.55 Pneumococcal infection
56. 3.56 Poliomyelitis
57. 3.57 Psittacosis
58. 3.58 Q fever
59. 3.59 Rabies
60. 3.60 Relapsing fever
61. 3.61 Respiratory Syncytial Virus (RSV)
62. 3.62 Ringworm
63. 3.63 Rotavirus
64. 3.64 Rubella
65. 3.65 Salmonellosis
66. 3.66 Scabies
67. 3.67 Schistosomiasis
68. 3.68 Shigellosis
69. 3.69 Shiga toxin‐producing Escherichia coli (STEC) and other diarrhoeagenic E. coli
70. 3.70 Smallpox
71. 3.71 Staphylococcal food poisoning
72. 3.72 Streptococcal infections
73. 3.73 Tetanus
74. 3.74 Threadworms
75. 3.75 Tick‐borne Encephalitis
76. 3.76 Toxocariasis
77. 3.77 Toxoplasmosis
78. 3.78 Tuberculosis (and non‐tuberculous mycobacteria)
79. 3.79 Tularaemia
80. 3.80 Typhoid fever
81. 3.81 Vibrio parahaemolyticus infection
82. 3.82 Viral haemorrhagic fevers, including Ebola
83. 3.83 Warts and verrucae (and molluscum contagiosum)
84. 3.84 West Nile virus
85. 3.85 Whooping cough
86. 3.86 Yellow fever
87. 3.87 Yersiniosis
88. 3.88 Zika virus infection
89. 3.89 Other organisms
4 Services and organisations
1. 4.1 Surveillance of communicable disease
2. 4.2 Managing infectious disease incidents and outbreaks
3. 4.3 Community infection control
4. 4.4 Hospital infection control
5. 4.5 Antimicrobial stewardship
6. 4.6 Risks to and from healthcare workers
7. 4.7 Co‐ordination of immunisation services
8. 4.8 Co‐ordination of sexual health services
9. 4.9 Prevention of blood‐borne viral infections
10. 4.10 Co‐ordination of services for tuberculosis control
11. 4.11 Travel health
12. 4.12 Migrant and refugee health
13. 4.13 Emergency preparedness planning and response
14. 4.14 Non‐infectious environmental hazards
15. 4.15 Managing acute chemical incidents
16. 4.16 Managing acute radiation incidents
17. 4.17 Deliberate release of biological, chemical or radiological hazards
18. 4.18 Clinical governance and audit
19. 4.19 Global health security
5 Communicable disease control in Europe
1. 5.1 WHO and International Health Regulations
2. 5.2 Collaboration within the European Union
3. 5.3 Detailed national example: organisational arrangements for health protection, England, 2017
4. 5.4 Austria
5. 5.5 Belgium
6. 5.6 Bulgaria
7. 5.7 Croatia
8. 5.8 Cyprus
9. 5.9 Czech Republic
10. 5.10 Denmark
11. 5.11 Estonia
12. 5.12 Finland
13. 5.13 France
14. 5.14 Germany
15. 5.15 Greece
16. 5.16 Hungary
17. 5.17 Iceland
18. 5.18 Ireland
19. 5.19 Italy
20. 5.20 Latvia
21. 5.21 Lithuania
22. 5.22 Luxembourg
23. 5.23 Malta
24. 5.24 The Netherlands
25. 5.25 Norway
26. 5.26 Poland
27. 5.27 Portugal
28. 5.28 Romania
29. 5.29 Slovakia
30. 5.30 Slovenia
31. 5.31 Spain
32. 5.32 Sweden
33. 5.33 Switzerland
34. 5.34 United Kingdom
Appendix 1
Index
End User License Agreement

List of Tables

Chapter 01
1. Table 1.2.1 Modes of transmission of infectious agents
Chapter 02
1. Table 2.1.1 Differential diagnosis of meningism
2. Table 2.1.2 Causes of viral meningitis
3. Table 2.1.3 Causes of bacterial meningitis
4. Table 2.2.1 Differential diagnosis of common gastrointestinal infection
5. Table 2.3.1 Differential diagnosis of community acquired pneumonia
6. Table 2.4.1 Infections that may present with a rash in pregnancy
7. Table 2.5.1 Causes of different types of rash in children
8. Table 2.6.1 Presentations of travel‐related infections
Chapter 03
1. Table 3.4.1 Differential diagnosis of botulism
2. Table 3.10.1 Epidemiology of acute Chlamydia and LGV in Europe and the UK
3. Table 3.22.1 Clinical syndromes caused by selected non‐polio enteroviruses
4. Table 3.25.1 Key features of infection with specific Gram negative organisms
5. Table 3.26.1 Epidemiology of acute STIs in Europe and the UK^a
6. Table 3.26.2 Clinical features of acute sexually transmitted infections (STIs)
7. Table 3.26.3 Laboratory diagnosis of acute STIs
8. Table 3.26.4 Some specific UK STI surveillance schemes
9. Table 3.26.5 Managing STI outbreaks at local level
10. Table 3.27.1 Main hantavirus serotypes
11. Table 3.28.1 Head lice: suggested responsibilities
12. Table 3.30.1 General patterns of HAV infection in European countries
13. Table 3.31.1 Risk groups for hepatitis B in Europe
14. Table 3.32.1 Target groups for particular HCV prevention measures
15. Table 3.46.1 Measles cases and notification rate in Europe December 2016–November 2017
16. Table 3.62.1 Epidemiological characteristics by body area
17. Table 3.62.2 Clinical features by body area
18. Table 3.62.3 Zoophilic dermatophytes and their source of infection
19. Table 3.65.1 Frequency and some possible sources of common Salmonella serovars
20. Table 3.66.1 Responsibilities in control of scabies
21. Table 3.69.1 E. coli causing diarrhoea (other than STEC)
22. Table 3.69.2 Causes of Haemolytic Uraemic Syndrome
23. Table 3.70.1 Distinguishing smallpox from chickenpox in a well, non‐immune person
24. Table 3.78.1 TB rate in European countries, 2015
25. Table 3.78.2 Typical action in response to tuberculin test results (UK example)
26. Table 3.82.1 Viral haemorrhagic fevers
27. Table 3.83.1 Wart morplhologies
28. Table 3.89.1 Main diseases caused by a selection of rare bacterial organisms
29. Table 3.89.2 Rickettsia, Ehrlichia and Anaplasma infections
30. Table 3.89.3 Rare potentially imported viral infections. The table does not cover infections with their own chapters or viral haemorrhagic fevers (Chapter 3.82)
31. Table 3.89.4a Leishmaniasis
32. Table 3.89.4b Trypanosomiasis
33. Table 3.89.4c Babesiosis
34. Table 3.89.4d Acanthamoebiasis
35. Table 3.89.4e Naegleriasis
36. Table 3.89.5a Intestinal roundworms
37. Table 3.89.5b Filariae
38. Table 3.89.5c Tapeworms (cestodes)
39. Table 3.89.5d Flukes (trematodes)
40. Table 3.89.6 Fungal infections
Chapter 04
1. Table 4.1.1 Diseases under mandatory EU surveillance
2. Table 4.1.2 Laboratory reporting of infectious diseases to the HPT: statutory list in England
3. Table 4.1.3 Data to be included in laboratory reports when available (to CCDC/HPTs in England)
4. Table 4.2.1 Cryptosporidiosis in England, December 1990. Odds ratios for exposure to selected factors
5. Table 4.4.1 Hospital surveillance of HCAI, AMR, and antimicrobial stewardship
6. Table 4.4.2 Standard infection control measures in hospitals
7. Table 4.4.3 Example of roles and responsibilities for infection prevention and control (England, 2017)
8. Table 4.6.1 Exposure categories for healthcare workers (HCWs)
9. Table 4.6.2 Specific disease risks
10. Table 4.6.3 Lookback exercises for HIV exposure from HCW
11. Table 4.6.4 Lookback exercises for hepatitis B virus (HBV) exposure from HCW
12. Table 4.6.5 Lookback exercises for hepatitis C virus (HCV) exposure from HCW
13. Table 4.7.1 Routine immunisation schedule: UK example^a
14. Table 4.8.1 Priorities for sexual health improvement
15. Table 4.12.1 Vaccinations to be offered in the absence of documented evidence of prior vaccination
16. Table 4.14.1 Environmental hazards and sources
17. Table 4.14.2 Key stages in the investigation of clusters of non‐infectious disease
18. Table 4.15.1 Responsibilities of agencies and groups involved in the planning for, and response to an acute chemical incident (UK example)
19. Table 4.15.2 Check‐list for local public health officer in acute chemical incidents. These questions and actions will assist the public health officer identify the source, pathway and receptor in order to guide actions needed to reduce the impact of the incident on public health
20. Table 4.16.1 Radiation incidents: responsibilities in the UK
21. Table 4.16.2 Effects of rapid whole body radiation exposure (Acute radiation syndrome)^a
22. Table 4.17.1 Potential chemical and biological toxin terrorism agents
23. Table 4.17.2 Potential bioterrorism organisms and toxins
Chapter 05
1. Table 5.3.1 Core activities of local health protection teams
2. Table 5.3.2 Other agencies with a role in communicable disease control
3. Table 5.3.3 Agencies and individuals involved in local health protection
4. Table 5.34.1 Notifiable diseases example: diseases notifiable in England under the Health Protection (Notification) Regulations 2010

List of Illustrations

Chapter 02
1. Fig 2.2.1 Seasonal distribution of gastrointestinal pathogens (Rotavirus, Campylobacter, Salmonella All) 1998–2017, England, Wales & Northern Ireland (3‐week moving average).
2. Fig 2.2.2 Seasonal distribution of gastrointestinal pathogens (E. Coli O157, Norovirus, Cryptosporidium) 1998–2017, England, Wales & Northern Ireland (3‐week moving average).
Chapter 04
1. Fig. 4.2.1 Outbreak of Campylobacter gastroenteritis associated with consumption of unpasteurised milk at a boarding school (point source).
2. Fig. 4.2.2 Outbreak of Campylobacter gastroenteritis associated with consumption of unpasteurised milk at a boarding school (continuing source).
3. Fig. 4.2.3 Outbreak of measles in a community (propagated outbreak).
4. Fig. 4.17.1 Organisation of on‐scene response.
5. Fig. 4.17.2 Response to suspicious package or material.

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Library of Congress Cataloging‐in‐Publication Data

Names: Hawker, Jeremy, author.
Title: Communicable disease control and health protection handbook / Jeremy Hawker, Norman Begg, Ralf Reintjes, Karl Ekdahl, Obaghe Edeghere, Jim van Steenbergen.
Description: 4th edition. | Hoboken, N.J. : Wiley‐Blackwell, 2019. | Preceded by Communicable disease control and health protection handbook / Jeremy Hawke … [et al]. 3rd ed. 2012. | Includes bibliographical references and index. |
Identifiers: LCCN 2018036091 (print) | LCCN 2018036485 (ebook) | ISBN 9781119328056 (Adobe PDF) | ISBN 9781119327790 (ePub) | ISBN 9781119328049 (paperback)
Subjects: | MESH: Communicable Disease Control | Public Health Surveillance | Handbooks
Classification: LCC RC112 (ebook) | LCC RC112 (print) | NLM WA 39 | DDC 616.9–dc23
LC record available at https://lccn.loc.gov/2018036091

Cover Design: Wiley
Cover Images: People: © filadendron/Getty Images;Map: Ralf Hiemisch/Getty Images

About the authors

Professor Jeremy Hawker has worked at local, regional, national and international levels in communicable disease control and health protection. He is currently Consultant Epidemiologist in the Field Service of Public Health England’s National Infection Service. He holds honorary chairs at the Universities of Liverpool (in association with the NIHR‐funded Health Protection Research Unit in Gastrointestinal Infections), Warwick (Evidence in Communicable Disease Epidemiology and Control) and Staffordshire (Public Health). He was Registrar of the UK Faculty of Public Health, the standard setting body for specialist public health practice in the UK from 2008 to 2013 and is a former Board member of the UK Public Health Register.

Dr. Norman Begg is an independent vaccine consultant who has worked in public health and the pharmaceutical industry. He trained in public health and worked for many years as a consultant at the UK Public Health Laboratory Service (now part of Public Health England) where he was Head of the Immunisation Division and Deputy Director of the Communicable Disease Surveillance Centre. He has acted as a regular advisor to the World Health Organization. He has published extensively in the field of paediatric vaccines and is a former co‐editor of ‘Immunisation Against Infectious Disease (the Green Book)’ At GlaxoSmithKline Vaccines global HQ in Belgium, he held senior roles in clinical development and medical affairs; he was their Chief Medical Officer from 2010 to 2015.

Professor Ralf Reintjes holds a full professorship for Epidemiology and Public Health Surveillance in Hamburg, Germany, and is adjunct professor for Infectious Disease Epidemiology in Tampere, Finland. He was a Fellow of the ‘European Programme for Intervention Epidemiology Training’ at the National Institute of Public Health and the Environment in the Netherlands, head of the Department of Hygiene, Infectious Disease Epidemiology, and Vaccinations at the Institute of Public Health of NRW, Germany, and head of the Emerging Risks Unit at the European Food Safety Authority in Parma, Italy. He has acted as consultant for the World Health Organization, the EU and other organisations in many European, African and Asian countries. He has published extensively in the field of Epidemiology, Surveillance, Health Systems, and Policy research.

Professor Karl Ekdahl is head of the Public Health Capacity and Communication Unit at the European Centre for Disease Prevention and Control (ECDC). He is a specialist in infectious diseases, and prior to joining ECDC he was Deputy State Epidemiologist for Sweden. In 2007, he was appointed Adjunct Professor in Infectious Disease Epidemiology at the Karolinska Institutet in Stockholm. He is also the former Editor‐in‐Chief of the scientific journal Eurosurveillance.

Dr. Obaghe Edeghere trained in public health medicine and has worked for several years in communicable disease and health protection with an interest in public health surveillance (particularly syndromic surveillance systems), antimicrobial resistance and healthcare‐associated infections. He is currently a Consultant Epidemiologist in the Field Service of the National Infection Service, Public Health England.

Dr. Jim van Steenbergen is an independent consultant in communicable disease control. After clinical work in The Netherlands and Zambia he trained in public health and worked as consultant in communicable disease control in a regional public health service before becoming national co‐ordinator CDC in 1995, since 2005 part of the Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM). From 2011 to 2016 he was associate professor at the Centre of Infectious Diseases, Leiden University Medical Centre (LUMC).

Foreword

Six years have passed since the third edition of the Communicable Disease Control and Health Protection Handbook was published. In many other areas of public health this may not seem a long time. However, when it comes to communicable disease control there is always an element of urgency, and each large international (or national) outbreak is an impetus for reflection on what went well and what could be done better next time. Therefore, our area of work is as much driven by the large events as it is by slow developments.

Since the last edition, the WHO has three times invoked formal declarations of public health emergencies of international concern (PHEIC) under the International Health Regulations (IHR 2005); in 2014 the polio declaration, the same year the Ebola declaration, and in 2016 the Zika virus declaration. Each of these emergencies has different characteristics and provides different lessons.

Two of the most tangible consequences of larger international outbreaks the last 10 years, are the new EU legislation on Cross‐border Threats to Health (Decision 1082/2013) and the establishment of the new WHO Health Emergencies Programme. Both highlight the importance of increasing the core capacities of the countries to prepare for and respond to health threats, and the need for efficient international co‐operation. These tasks cannot be performed by the health sector itself, but need an inter‐sectoral and one‐health approach. The new edition of the handbook, covers these areas.

However, the challenge does not only lie with the big outbreaks. We are also facing silent and slow, but no less threatening epidemics. Here I am of course referring to the growing problem of antimicrobial resistance, which can only be overcome by proper antibiotic stewardship and consequent infection prevention and control in hospitals. However, everyone needs to contribute, hence the one‐health approach, to buy us the time needed for the introduction of new technologies and principles of fighting infections that may in the future save us from a situation similar to the one in the pre‐antibiotic era.

The years since the previous edition of this book have also presented new challenges in the shape of increasing lack of trust in authorities, ‘alternative facts’, and social media filter bubbles, where rumours and myths are spreading. In the age of social media, vaccine sceptics are getting effective platforms for disseminating their messages. As public health professionals, we are, therefore, facing new tasks in debunking these myths. This is requiring new skill sets outside the traditional public health competencies, and as public health professionals, we will need to provide leadership, regardless of our specific position.

Public health professionals are facing numerous challenges. Many are working not only with communicable diseases, but in a broader public health setting, where some of the specific infectious diseases requiring public health actions are only rarely encountered. The practitioner in the field noting an infection case, or cluster of cases, therefore from time to time will need easy access to practical, authoritative and updated information to guide initial assessment and practical response.

In today's information age, we are not lacking sources of information – quite the contrary, but the format is not always relevant to the practical problem at hand. This is where the Communicable Disease Control and Health Protection Handbook has its niche. The format of the handbook is designed to provide the on‐call public health officer with necessary information at a glance in the acute situation. It provides clear and practical guidance on what needs to be done and when to engage others. It is thus a good compliment to other sources of information, for example relevant national guidelines. At the same time, the overview chapters are useful for setting the individual cases in a larger public health perspective.

As the Director of the European Centre for Disease Prevention and Control (ECDC), I especially appreciate the specific European dimensions of the book. The country chapters provide a useful overview of the public health systems in each of the EU countries and some more. This European dimension highlights that fighting communicable diseases is not only a national priority, but is a task requiring co‐operation across the borders.

July 2018

Andrea Ammon
Director
European Centre for Disease Prevention and Control

Abbreviations

ACDP: Advisory Committee on Dangerous Pathogens
AIDS: Acquired immunodeficiency syndrome
AIH: Autoimmune hepatitis
AMR: Antimicrobial resistance
BBV: Blood‐borne virus
BCG: Bacille Calmette–Guérin (vaccine against TB)
BSE: Bovine Spongiform Encephalopathy
CAP: Community acquired pneumonia
CCDC: Consultant in Communicable Disease Control (local public health doctor with executive responsibilities for CDC)
CCG: Clinical Commissioning Groups (health service purchaser)
CDC: Communicable disease control
CDI: Clostridium difficile infection
CFR: Case Fatality Rate
CHP: Consultant in Health Protection
CICN: Community infection control nurse
CJD: Creutzfeldt–Jakob Disease
CMV: Cytomegalovirus
CNS: Central nervous system
CRE: Carbapenem‐resistant enterobacteriaceae
CSF: Cerebrospinal fluid
D: Diarrhoea
DEET: N,N‐diethyl‐m‐toluamide
DNA: Deoxyribonucleic acid
DOT(S): Directly observed therapy (supervised)
DPH: Director of Public Health
DTP: Diphtheria, tetanus and pertussis (whole‐cell)
EBV: Epstein–Barr virus
ECDC: European Centre for Disease Prevention and Control
EEA: European Economic Area
EHO: Environmental health officer
EIA: Enzyme immunoassay
EIEC: Enteroinvasive Escherichia coli
ELISA: Enzyme‐linked immunosorbent assay
EM: Electron microscopy
EU: European Union
FSA: Food Standards Agency
FWE: Food, water and environment
GI: Gastrointestinal
GP: General Practitioner (Primary Care Physician)
GUM: Genitourinary medicine
HACCP: Hazard Analysis Critical Control Point
HAI: Hospital acquired infection
HAV: Hepatitis A virus
HBV: Hepatitis B virus
HCAI: Health‐care associated infection
HCV: Hepatitis C virus
HCW: Health Care Worker
HDV: Delta Hepatitis
HEPA: High‐Efficiency Particulate Air (Filters)
HEV: Hepatitis E virus
Hib: Haemophilus influenzae type b
HIV: Human Immunodeficiency Virus
HNIG: Human normal immunoglobulin
HP: Health Protection
HPT: Health Protection Team
HPV: Human papillomavirus
HSCT: Haemopoietic Stem Cell Transplantation
HSV: Herpes simplex virus
HUS: Haemolytic uraemic syndrome
ICD: Infection control doctor (hospital)
ICN: Infection control nurse
ICT: Infection control team (hospital)
IDU: Intravenous drug user
IFA(T): Indirect immunofluorescent antibody (test)
IgG: Immunoglobulin class G
IgM: Immunoglobulin class M
IHR: International Health Regulations
IID: Infectious intestinal disease
IPV: Inactivated poliovirus vaccine
IU: International unit
IV: Intravenous
LA: Local Authority
LBRF: Louse‐borne relapsing fever
LD: Legionnaires' disease
LGV: Lymphogranuloma venereum
MDR: Multi‐drug resistant (usually referring to TB)
MERS: Middle‐East respiratory syndrome
MLST: Multilocus sequence typing
MLVA: Multiple‐locus variable number tandem repeat analysis
MMR: Measles, mumps and rubella vaccine
MRSA: Met(h)icillin resistant Staphylococcus aureus
MSM: Men who have sex with men
NAAT: Nucleic acid amplification test
NCSP: National Chlamydia Screening Programme
NHS: National Health Service
NICE: National Institute for Health and Care Excellence
NPA: Nasopharyngeal aspirate
OPV: Oral poliovirus vaccine
Pa: Pertussis vaccine (acellular)
PBS: Primary biliary sclerosis
PCR: Polymerase Chain reaction
PEP: Post‐exposure prophylaxis
PFGE: Pulsed‐field gel electrophoresis
PHE: Public Health England
PPE: Personal protective equipment
PrEP: Pre‐exposure prophylaxis
PSC: Primary sclerosing cholangitis
PT: Phage type
RAPD: Random amplified polymorphic DNA typing
RCGP: Royal College of General Practitioners
RNA: Ribonucleic acid
RSV: Respiratory syncytial virus
RT‐PCR: Reverse transcription polymerase chain reaction
SARS: Severe acute respiratory syndrome
SCID: Severe Combined Immunodeficiency
SOP: Standard Operating Protocol/Procedure
Sp/spp: Species
STEC: Shiga‐toxin producing E. coli
STI: Sexually transmitted infection
TB: Tuberculosis.
TBE: Tick‐borne encephalitis
TBRF: Tick‐borne relapsing fever
TSE: Transmissible spongiform encephalopathy
TTP: Thrombotic thrombocytopaenia purpura
TWAR: Taiwan Acute Respiratory Agent
UK: United Kingdom of Great Britain and Northern Ireland
UTI: Urinary tract infection
vCJD: Variant Creutzfeldt–Jakob Disease
VHF: Viral haemorrhagic fever
VRE: Vancomycin resistant Enterococcus
VZIG: Varicella‐zoster immunoglobulin
WGS: Whole genome sequencing
WHO: World Health Organization (OMS)
WNV: West Nile Virus
XDR: Extensively drug resistant (usually referring to TB)

Vaccine abbreviations (used in Section 5)

BCG: Bacille Calmette–Guérin (vaccine against TB)
DTP: Diphtheria, tetanus and pertussis vaccine
HepA: Hepatitis A vaccine
HepB: Hepatitis B vaccine
HiB: Haemophilus influenzae type B vaccine
HPV: Human papilloma virus vaccine
IIV: Inactivated influenza vaccine
IPV: Inactivated polio vaccine
LAIV: Live attenuated influenza vaccine
MCV: Meningococcal conjugated vaccine (4‐valent)
MenB: Neisseria meningitidis group B vaccine
MenC: Neisseria meningitidis group C vaccine
MMR: Measles, mumps and rubella vaccine
PCV: Pneumococcal conjugated vaccine
Rota: Rotavirus vaccine
RotaC: Rotavirus species C vaccine
TBE: Tick‐borne encephalitis vaccine
VAR: Varicella zoster vaccine