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HCID: Super-Spreading The Word

We'll discuss what constitutes a high consequence infectious disease (HCID) and why transferring such patients might be specialist.
© Dr Joe Brandreth, North Central London Adult Critical Care Transfer Service (NCL-ACTS)

What Is An HCID?

The UK Health Security Agency defines HCIDs as having some or all of the following characteristics:

  • acute infectious disease
  • typically has a high case-fatality rate
  • may not have effective prophylaxis or treatment
  • often difficult to recognise and detect rapidly
  • ability to spread in the community and within healthcare settings
  • requires an enhanced individual, population and system response to ensure it is managed effectively, efficiently and safely

HCIDs can be classified by mode of transmission…

  1. Contact HCIDs: predominantly spread by contact with the patient or infected bodily fluids or tissues, or with contaminated materials or fomites.
  2. Airborne HCIDs: spread by respiratory droplets and aerosols as well as by contact transmission.
  • The following list of HCIDs was compiled by the UK Health Security Agency and NHS England HCID programme:
Contact HCID Airborne HCID
Argentine haemorrhagic fever (Junin virus) Andes virus infection (hantavirus)
Bolivian haemorrhagic fever (Machupo virus) Avian influenza A H7N9 and H5N1
Crimean Congo haemorrhagic fever (CCHF) Avian influenza A H5N6 and H7N7
Ebola virus disease (EVD) Middle East respiratory syndrome (MERS)
Lassa fever Monkeypox
Lujo virus disease Nipah virus infection
Marburg virus disease (MVD) Pneumonic plague (Yersinia pestis)
Severe fever with thrombocytopaenia syndrome (SFTS) Severe acute respiratory syndrome (SARS)
  • You will notice that there are many serious infectious diseases that are not defined as HCIDs.
  • Of note, COVID-19, which was originally listed as an HCID, had its status changed in March 2020.

Implications For Transfers

  • In the UK it’s rare to encounter patients with HCIDs. However, it is occasionally necessary to retrieve a patient from the setting of an outbreak (e.g. evacuation of Ebola patients from West Africa between 2013 and 2016) or transfer internally to a HCID centre.
HCID patients should not be transported without careful consideration. The response to cases of HCIDs should be coordinated at a regional or national level and discussion between senior clinicians is paramount


© Dr Joe Brandreth, North Central London Adult Critical Care Transfer Service (NCL-ACTS)
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