Updates to the Communicable Disease Control Manual

Updates to the Mpox chapter in the following sections:

• Contact management 
• Laboratory testing guidelines

Updates to the Measles chapter in the following sections:

• Contact Management
  • Post-exposure prophylaxis
• Laboratory testing guidelines
• Case definition

Updates to the COVID-19 chapter in the following section:

• Laboratory testing guidelines

Updates to the Pertussis chapter in the following section:

• Management of case 
  • Treatment
• Management of Contacts
  • Prophylaxis
• A new section: Laboratory Testing 

The Highly Parthenogenic Avian Influenza has been changed to Avian Influenza and the page has been fully updated across all sections.

A new chapter on invasive group A streptococcal infection (iGAS) was added to align with iGAS becoming notifiable from 1 October 2024.

Updates to the Mpox chapter in the following section:

• Management of case

Updates to the Measles chapter in the following sections:

• Contact management

Updates to the Salmonellosis chapter, in the following sections:

• Case definition 

Updates to the Measles chapter in the following sections:

• Management of contacts (Testing, Definitions. Prophylaxis, Restriction) 
• Management of case 
• Reporting

Updates to the Legionellosis chapter, in the following sections:

• Other control Measures
  • Disinfection

Updates to the Measles chapter in the following sections:

• Management of Cases
  • Link to case and contact management chart 
• Management of Contacts 
  • Link to case and contact management chart 

Updates to the COVID-19 Chapter in the following sections

• Testing

Updates to the Pertussis chapter in the following section:

• Management of case 
  • Restriction

Updates to the Diphtheria chapter in the following section:

• Managment of contacts 
  • Prophylaxis

Updates to Poliovirus infection in the following sections

• Major update of all sections. 

Updates to the Leptospirosis in the following sections.

•  Notification
  • Notification procedure
• Reporting 
  • Added WorkSafe information. 
  • National Reporting 

Updates to the Arboviral diseases in the following sections.

• Case classification to add Zika
• Mode of transmission to include modes for Zika
• Laboratory criteria
• Incubation periods for Chikungunya and Zika

Updates to the Legionellosis chapter, Diphtheria chapter and Measles chapter in the following sections.

The key updates in the Legionellosis chapter are as follows:

• Case definition 

The key updates in the Diphtheria chapter are as follows:

• Notification procedure

The key updates in the Measles chapter are as follows:

• Epidemiology
• Management of contacts (Definitions, Prophylaxis)

Updates were made to the Mpox chapter

The key updates in the Mpox chapter are as follows:

• Links
• Management of case
• Annex , Table 1: Summary of contact tracing definitions

Updates to the Pertussis chapter in the following sections.

• Notification procedure
• Management of case

Updates to immunisation information in the Pertussis chapter.

Updates to isolation requirements in the Monkeypox (MPOX) chapter.

Updates to the Measles chapter in the following sections.

• Epidemiology in New Zealand
• Case definition
• Laboratory test for diagnosis
• Case classification
• Mode of transmission
• Management of a case
• Management of contacts
• Other control measures
• Reporting

Updates to isolation requirements in the Monkeypox (MPOX) chapter.

Updates were made to the Measles chapter in the following sections.

• Laboratory test for diagnosis – detection of IgM antibody specific to the virus‘ was removed from the requirements for laboratory definitive evidence for a confirmed case that did not receive a vaccine.
• Case Classification – ‘Probable’ case classification updated.
• Spread of infection – ‘Period of communicability’ section updated.
• Management of case – ‘Isolation as a case’ section added.
• Management of contacts – ‘Acceptable presumptive evidence of immunity’ and ‘Quarantine as a contact’ sections updated.

Updates to the tuberculosis, rabies, and invasive meningococcal disease chapters of the Direct Lab Notifications section

Updates to definitions and guidance in Monkeypox chapter.

A new chapter on Monkeypox was added.

In the Syphilis chapter, the case definition for congenital syphilis has been updated.

Appendix 4: Direct laboratory notification of communicable diseases flowcharts was updated, with an updated cholera flowchart in Section A and several new flowcharts added in Section B.

Updates were made to the Hydatid disease chapter in the following sections.

• Epidemiology in New Zealand – information about alveolar echinococcosis added.
• A clarification was added to the investigation subsection that a serological diagnosis has been attempted where there is any doubt that infection may have occurred since 2002, if it has not previously been done.
• Reporting section – updated that on receiving a notification, medical officers of health should notify the Director of Public Health at the Ministry of Health if infection is suspected to be locally acquired in New Zealand 2002.

Updates were made to the Neisseria meningitidis invasive disease chapter in the following sections.

• Epidemiology in New Zealand.
• Period of communicability: the content was edited.
• Management of case:
  • recommended antibiotics for suspected cases were added
  • a sub-section on vaccines was added for those who have previously had meningococcal disease.
• Management of contacts: the sub-section on vaccines was changed with two vaccines funded for contacts.
• Cefotaxime was also added to the antibiotics able to eradicate N. meningitidis carriage.

General considerations for the control of communicable diseases in New Zealand was updated to reflect the new levels for lead notification.

Appendix 4 was updated with notes added to flowcharts in Section C.

Q fever and rickettsial diseases are now in separate chapters and have been updated.

The key changes to the Q fever chapter were:

• updating information on laboratory testing for diagnosis, including updated criteria for laboratory definitive evidence and new criteria for laboratory suggestive evidence
• updating information on management of contacts.

The key changes to the Rickettsial diseases chapter were:

• updating information on laboratory testing for diagnosis, including updated criteria for laboratory definitive evidence and new criteria for laboratory suggestive evidence
• updating the notification procedure.

Appendix 4 was also updated to include Section B laboratory notification of communicable diseases flowcharts and to add the meningoencephalitis – primary amoebic flowchart in Section A.

We updated the Measles, Mumps and Rubella chapters and Appendix 4.

The key changes to the Measles chapter were:

• adding throat swab as appropriate sample
• incorporating the changes to the Immunisation Schedule and the changes to presumptive evidence of immunity.
• updating algorithm for post-exposure MMR
• noting that culture is no longer performed in NZ but is included as acceptable diagnostic test if used to diagnose overseas.

The key changes to the Mumps chapter were incorporating the changes to the Immunisation Schedule and updating references.

The key changes to the Rubella chapter were:

• prophylaxis section – removing ‘post-exposure immunisation of non-pregnant women is recommended, especially if given within 3 days of exposure’
• editing the information about immunising pregnant contacts and definition of protection.

Appendix 4 was updated to include Section A, Section C and other direct laboratory notification of communicable diseases flowcharts.

We updated the Creutzfeldt-Jakob disease and other spongiform encephalopathies chapter.

The key changes include:

• revision of notification procedure 
• revision of clinical descriptions
• revision of guidance on investigations for diagnosis
• revised References and Further Information section.

We also updated the General considerations chapter to reflect the addition of novel coronavirus capable of causing severe respiratory illness (including COVID-19) to the list of notifiable diseases.

We updated the Tuberculosis chapter to refer to the new Guidelines for Tuberculosis Control in New Zealand 2019.

Updates were made to the VTEC/STEC chapter and Table 2.4 in Appendix 2.

Sections with more significant changes include:

• Epidemiology in New Zealand: more detailed description provided
• Clinical description turned into a clinical case definition 
• Health education: more information provided
• References and further information: more detailed references provided.

Sections with minor changes include:

• Mode of transmission
• Period of communicability
• Investigation
• Identification of source
• Reporting.

We added Appendix 4, which contains the direct laboratory notification diagram for HIV.

The HIV chapter and AIDS chapter were revised for clarity. This followed on from the update in October 2018 to incorporate the new HIV and AIDS notification system.

Updates were made to the Mumps chapter. Serology testing has been deleted from the laboratory evidence in the case definition.

Updates were made to the Neisseria meningitidis invasive disease chapter and case definitions for Syphilis and Gonorrhoea were added to the manual. The chapters for syphilis and gonorrohoea will be finalised alongside surveillance developments.

The key changes to the Neisseria meningitidis invasive disease chapter include include:

• updates to the antimicrobials (ciprofloxacin) and immunisation (conjugate vaccines) sections
• references and further information.

Updates were made to the Measles chapter.

Sections with changes include:

• Epidemiology in New Zealand
• Mode of transmission 
• Management of contacts
• Incubation period
• Infection control.

Updates were made to the mumps and Neisseria meningitidis invasive disease chapters.

The key changes to the Mumps chapter include:

• laboratory testing if no epidemiological link established
• clarification about low value of mumps IgM and IgG serology testing.
• clarification of the period of communicability used for contact tracing
• correction of duplication and footnote numbering
• references and further information.

For the Neisseria meningitidis invasive disease chapter, changes were made to the immunisation section to include information on how to access meningococcal B vaccine for a multi-occupancy residential meningococcal B outbreak.

A number of minor changes, to improve the clarity of the wording and the intent, were also made to the following chapters:

• Hepatitis A
• Typhoid and paratyphoid fever
• Verocytotoxin-producing or Shiga toxin-producing Escherichia coli (VTEC/STEC)
• Appendix 2: Enteric disease.

A number of changes were made to the enteric chapters, in particular to the case definitions, clinical description and laboratory test for diagnosis sections.

The key changes are:

• case definitions
• clinical description
• to reflect changes in diagnostic testing methods, changes have been made to the laboratory test for diagnosis section
• case classification
• appendix 1, 2 and 3 have amendments to legislation requirements and table 2.4: Exclusions and clearance criteria.

The Pertussis chapter was also updated. The key changes include:

• updated objectives of surveillance for pertussis in the epidemiology in New Zealand section
• clinical description changes to ‘A clinically compatible case characterised by a cough and one or more of paroxysms of cough; cough ending in vomiting, cyanosis or apnoea; inspiratory whoop’
• case classification for ‘Probable’ changed to: ‘A clinically compatible illness where the cough is lasting longer than 2 weeks’
• exclusion of cases can be shortened to 2 days if azithromycin is used
• susceptible contacts should be given prophylaxis and not excluded while taking prophylaxis as long as they don’t have symptoms.

An updated chapter on Poliomyelitis was published.

An updated Invasive pneumococcal disease chapter was published to include changes to the case definition and section on laboratory tests for diagnosis.

An updated Legionellosis chapter was published. The key changes in the new chapter are:

• updates to the section on the clinical description of infection with Legionella
• updates to the section on laboratory tests for diagnosis, including the addition of details about detection of Legionella species nucleic acid as a definitive laboratory evidence for a confirmed case.

An updated Rheumatic fever chapter was published. The key changes in the new chapter are:

• the removal of the requirement to notify Rheumatic Heart Disease under the age of 20
• alignment of the case definitions to be consistent with the New Zealand Heart Foundation Guidelines and the EpiSurv case report form
• the removal of the information relating to group A Streptococcus (GAS) to focus the chapter on Acute Rheumatic Fever (ARF)
• the contact tracing section has been updated
• information has been included on the notification of cases and the use of registers.