What upper respiratory infections must be reported to public health?

Reportable Upper Respiratory Infections to Public Health

Severe Acute Respiratory Syndrome (SARS) and pertussis (whooping cough) must be reported to public health authorities, as they represent significant threats to public health due to their potential for outbreaks and severe complications. 1, 2

SARS Reporting Requirements

SARS is a mandatory reportable condition that requires immediate notification to public health authorities. The reporting process includes:

• Probable cases must be reported immediately to local Health Protection Units 1
• Confirmed cases must be discussed with the Health Protection Agency's Communicable Disease Surveillance Centre (CDSC) 1
• A standard SARS report form must be completed and faxed to the local Consultant in Communicable Disease Control (CCDC) 1

Case Definitions for SARS Reporting:

1. Probable SARS case (requires reporting):

   • Respiratory illness requiring hospitalization
   • Fever >38°C
   • Cough or breathing difficulty
   • Radiographic evidence consistent with pneumonia or respiratory distress syndrome
   • Epidemiological link within 10 days before onset (travel to affected area, laboratory exposure, or contact with a case) 1

2. Confirmed SARS case (requires reporting):

   • Clinical symptoms suggestive of SARS
   • Laboratory evidence of SARS-CoV infection 1

3. Person Under Investigation (PUI) (requires reporting to local Health Protection Units):

   • Fever >38°C OR cough OR breathing difficulty
   • Epidemiological link within 10 days before onset 1

Pertussis (Whooping Cough) Reporting Requirements

Pertussis is a notifiable disease that must be reported to public health authorities due to its high infectivity and potential for outbreaks. 2

• The CDC recommends prompt identification, treatment, and reporting of pertussis cases 2
• Pertussis remains highly infectious with a secondary attack rate exceeding 80% among susceptible persons 2
• Healthcare providers must report confirmed and suspected cases to facilitate contact tracing and prophylaxis 2

Clinical Presentation of Pertussis:

Pertussis progresses through three distinct stages:

1. Catarrhal stage: Mild respiratory symptoms indistinguishable from common colds
2. Paroxysmal stage: Severe coughing episodes with characteristic "whoop" and posttussive vomiting
3. Convalescent stage: Gradual recovery with decreasing frequency of coughing 2

Other Respiratory Infections

Most common upper respiratory infections do not require mandatory reporting to public health authorities:

• Common cold (rhinovirus and other viruses)
• Influenza (except during novel strain outbreaks)
• Acute bronchitis
• Most cases of community-acquired pneumonia
• Routine viral lower respiratory tract infections 1, 3

However, certain respiratory pathogens may require reporting during outbreaks or in specific circumstances:

• Novel influenza strains (pandemic potential)
• Epidemic lung infections 1
• Clusters of respiratory illness of unknown etiology

Key Considerations for Clinicians

1. When to report:

   • Report immediately when SARS or pertussis is suspected
   • Don't wait for laboratory confirmation to initiate reporting for SARS
   • For pertussis, report cases within the timeframe specified by local health departments

2. Information to include in reports:

   • Patient demographics
   • Clinical presentation and disease stage
   • Epidemiological links (travel history, exposures)
   • Laboratory results if available
   • Contact information for exposed individuals

3. Infection control measures:

   • SARS patients should be isolated with appropriate precautions 1
   • Pertussis patients should be isolated for 5 days after starting antibiotic therapy 2
   • Healthcare workers with pertussis should be restricted from work during the first 5 days of antimicrobial therapy 2

Common Pitfalls in Reporting

• Delayed reporting: Failing to report suspected cases promptly can lead to missed opportunities for contact tracing and outbreak control
• Incomplete information: Providing insufficient details about epidemiological links and contacts
• Misdiagnosis: Confusing pertussis with other causes of prolonged cough, particularly in adolescents and adults
• Over-reliance on laboratory confirmation: Waiting for positive test results before reporting suspected SARS cases

By promptly reporting these notifiable respiratory infections, clinicians play a crucial role in preventing outbreaks and protecting public health.