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Clinical Management of Hospitalized Patients With High-Consequence Infectious Diseases in England
Alejandra Alonso1, Jonathan Cohen1, Joby Cole1
1Alejandra Alonso, MPH, is a Consultant in Paediatric Infectious Diseases, Department of Infection, Evelina London Children's Hospital; Jonathan Cohen, PhD, is a Consultant in Paediatric Immunology and Infectious Diseases, Department of Paediatric Immunology and Infectious Diseases, Evelina London Children's Hospital; Chris Meadows, FRCP, is a Consultant in Intensive Care Medicine and ECMO, Department of Critical Care, St Thomas' Hospital; and Geraldine O'Hara, PhD, is a Consultant in Infectious Diseases, Department of Infectious Diseases, St Thomas' Hospital; all with Guy's and St Thomas' NHS Foundation Trust, London. Jonathan Cohen is also a Consultant, Department of Women and Children's Health, and Chris Meadows is also an Honorary Senior Lecturer, Faculty of Life Sciences and Medicine; both at St Thomas Hospital, Kings College London, London. Joby Cole, PhD, is a Consultant in Infectious Diseases and Acute Medicine, and Anne J. Tunbridge, FRCP, is a Consultant in Infectious Diseases; both in the Department of Infection and Tropical Medicine, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield. Marieke Emonts, PhD, and Stephen Owens, PhD, are Consultants in Paediatric Infectious Diseases, Department of Paediatric Immunology and Infectious Diseases, Great North Children's Hospital; Brendan A. I. Payne, PhD, is a Consultant in Infectious Diseases and Virology, and Matthias L. Schmid, MD, is a Consultant in Infectious Diseases, Department of Infection and Tropical Medicine, Royal Victoria Infirmary; all with the Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne. Marieke Emonts is also an Honorary Professor, Paediatric Infectious Diseases, and Brendan A. I. Payne is also an Honorary Clinical Senior Lecturer; both at the Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne. Natasha Karunaharan, MRCPath, is a Consultant in Infectious Diseases and Microbiology, and Jake Dunning, PhD, is a Consultant in Infectious Diseases; both in the Department of Infectious Diseases, Royal Free Hospital, Royal Free London NHS Foundation Trust, London. Jake Dunning is also a Senior Research Fellow, Pandemic Sciences Institute, University of Oxford, Oxford. David Porter, PhD, and Andrew Riordan, FRCPCH, are Consultants in Paediatric Infectious Diseases and Immunology, Department of Paediatric Infectious Diseases and Immunology, Alder Hey Children's Hospital, Alder Hey Children's NHS Foundation Trust, Liverpool. Libuse Ratcliffe, FRCP, is a Consultant in Infectious Diseases, and Mike Beadsworth, MD, is a Consultant in Infectious Diseases and Tropical Medicine; both in the Tropical and Infectious Diseases Unit, Royal Liverpool Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool. Ruchi Sinha, MRCPCH, is a Consultant Paediatric Intensivist, Children's Intensive Care, and Elizabeth Whittaker, PhD, is a Consultant in Paediatric Infectious Disease and Immunology, Children's Infectious Diseases; both at St Mary's Hospital, Imperial College Healthcare NHS Trust, London. Elizabeth Whittaker is also an Honorary Senior Clinical Lecturer, Section of Paediatric Infectious Diseases, Imperial College, London.
Abstract:
Infectious disease physicians in England have been diagnosing and managing occasional cases of viral hemorrhagic fever since 1971, including the United Kingdom's first case of Ebola virus disease in 1976. Specialist isolation facilities to provide safe and effective care have been present since that time. Following the emergence of Middle East respiratory syndrome (MERS) in 2012, and the avian influenza A (H7N9) outbreak in 2013, and the 2014-2016 Ebola virus disease outbreak in West Africa, clinical and public health preparedness and response pathways in England have been strengthened for these types of diseases, now called high-consequence infectious diseases (HCIDs). The HCID program, led by NHS England and Public Health England between 2016 and 2018, helped to deliver these enhancements, which have since been used on multiple occasions for new UK cases and outbreaks of MERS, mpox, avian influenza, and Lassa fever. Additionally, HCID pathways were activated for COVID-19 during the first 3 months of 2020, before the pandemic had been declared and little was known about COVID-19 but HCID status had been assigned temporarily to COVID-19 as a precaution. The HCID program also led to the commissioning of a network of new airborne HCID treatment centers in England, to supplement the existing network of contact HCID treatment centers, which includes the United Kingdom's only 2 high-level isolation units. In this case study, the authors describe the airborne and contact HCID treatment center networks in England, including their formation and structures, their approach to safe and effective clinical management of patients with HCIDs in the United Kingdom, and challenges they may face going forward.
Insights
England has enhanced its high-consequence infectious disease (HCID) response system since 1971, establishing specialized treatment centers for viral hemorrhagic fevers and other dangerous pathogens. This system has been crucial for managing outbreaks like Ebola and COVID-19.
Area of Science:
- Infectious Diseases
- Public Health
- Epidemiology
Background:
- England has managed viral hemorrhagic fevers since 1971, with specialist isolation facilities available.
- Recent outbreaks (MERS, H7N9, Ebola) prompted strengthening of preparedness for high-consequence infectious diseases (HCIDs).
- The HCID program (2016-2018) enhanced clinical and public health response pathways in England.
Purpose of the Study:
- To describe the formation and structure of England's airborne and contact HCID treatment center networks.
- To outline the approach to safe and effective clinical management of HCID patients in the UK.
- To identify future challenges for HCID management in England.
Main Methods:
- Case study analysis of HCID preparedness and response in England.
- Review of the HCID program's implementation and outcomes.
- Description of the structure and function of airborne and contact HCID treatment centers.
Main Results:
- England has established robust HCID management pathways and treatment centers, including specialized airborne and contact facilities.
- These pathways were activated for MERS, mpox, avian influenza, Lassa fever, and early COVID-19 cases.
- The network includes high-level isolation units and newly commissioned airborne HCID treatment centers.
Conclusions:
- England possesses a well-developed system for managing high-consequence infectious diseases.
- The HCID treatment center networks provide safe and effective patient care.
- Ongoing evaluation and adaptation are necessary to address future challenges in HCID management.
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