Disclosing information about serious communicable diseases

Confidentiality is important to all patients and all patients are entitled to good standards of care, regardless of what disease they might  have, or how they acquired it. Those who have, or may have, a serious communicable disease² might be particularly concerned about their privacy. This guidance, which forms part of the professional standards, sets out how the general principles in our guidance Confidentiality apply when doctors are accessing, using or disclosing information about the infection status of patients who have serious communicable diseases.

The professional standards describe good practice, and not every departure from them will   be considered serious. You must use your professional judgement to apply the standards to your day-to-day practice. If you do this, act in good faith and in the interests of patients, you will be able to explain and justify your decisions and actions. We say more about professional judgement, and how the professional standards relate to our fitness to practise processes, appraisal and revalidation , at the beginning of Good medical practice.

You should make sure that information you hold or control about a patient’s infection status is at all times effectively protected against improper disclosure. If you disclose information about a patient’s infection status, you must keep disclosures to the minimum necessary for the purpose.

You must pass information about notifiable diseases to the relevant authorities for communicable disease control and surveillance. Different diseases are notifiable in different UK countries and the reporting arrangements differ. You should follow the arrangements where you work.³ You should disclose anonymised information if practicable and as long as it will serve the purpose.

Good medical practice⁴ says:

You should follow our guidance Raising and acting on concerns about patient safety if you are concerned that a colleague who has a serious communicable disease is practising, or has practised, in a way that puts patients at risk of infection⁵. You should inform your colleague before passing the information on, as long as it is practicable and safe to do so.

Most patients understand and expect that relevant information must be shared within the direct care team to provide their care. If a patient objects to disclosure of personal information that you are convinced is essential to provide them with safe care, you should follow the guidance at paragraphs 30 - 31 of Confidentiality. If the patient does not have capacity to make the decision, you can disclose information if it is in their overall benefit, in line with the guidance at paragraphs 48 - 49 of Confidentiality.

If a patient who has been diagnosed with a serious communicable disease refuses to allow you to tell others providing their care about their infection status, and you believe that failing to disclose the information will put healthcare workers or other patients at risk of infection, you should explain to the patient the potential consequences of their decision and consider with the patient whether any compromise can be reached.

Like everyone else, healthcare workers are entitled to protection from risks of serious harm. But disclosure of information about a patient’s infection status without consent is unlikely to be justified if it would make no difference to the risk of transmission  – for example, if the risk is likely to be managed through  the use of universal precautions that are already in place.⁶ If the patient continues to refuse to allow you to tell other members of the healthcare team about their infection status, you must abide by their wishes unless you consider that disclosing the information is necessary to protect healthcare workers or other patients from a risk of death or serious harm.

If a colleague, police officer or anyone else suffers a needlestick or similar injury involving a patient  who has, or may have, a serious communicable disease, you should make sure that a risk assessment is made urgently by an appropriately qualified colleague. Post-exposure prophylaxis should be offered in accordance with that risk assessment, depending on the type of body fluid or substance involved and the route and severity of the exposure.⁷ 

You should ask for the patient’s consent to disclose their infection status after other people have been exposed to a serious communicable disease. If the patient cannot be persuaded to consent to disclosure, or if it is not safe or practicable to ask for their consent, you may disclose information if it is justified in the public interest. This could be, for example, if the information is needed for decisions about the continued appropriateness of post-exposure prophylaxis. You should follow the guidance on disclosing information in the public interest at paragraphs 63 - 70 of Confidentiality.

You should explain to patients who have serious communicable diseases how they can protect others from infection, including from sexually transmitted diseases. This includes the practical measures they can take to avoid transmission, and the importance of informing people with whom they have sexual contact about the risk of sexual transmission of serious communicable diseases.

You may disclose information to a person who has close contact with a patient who has a serious communicable  disease if you have reason to think that:

1. the person is at risk of infection that is likely to result in serious harm
2. the patient has not informed them and cannot be persuaded to do so.

If you believe that an adult who is at risk of infection lacks capacity to understand this information, and is at risk of serious harm, you must give relevant information promptly to an appropriate responsible person or authority, unless it is not of overall benefit to the patient to do so (see paragraphs 55 - 56 of Confidentiality).

You should tell the patient before you disclose the information if it is practicable and safe to do so. When you are tracing and notifying people, you should not disclose the identity  of the patient, if practicable. You must be prepared to justify a decision to disclose personal information without consent.⁸ 

Most patients with a serious communicable disease who are parents of, or care for, children will do all they can to protect the children from the risk of infection or the effects of the disease. You should make sure the patient understands the information and advice you give them, which you should tailor to their needs. You should do all you reasonably can to support them in caring for themselves and in protecting their children.

You should explain to a patient with a serious communicable disease the importance of testing any children who may already be infected, including children without symptoms and young people who might have been vertically infected with a blood-borne virus.

If you are concerned that a child is at risk of serious harm because their parents cannot be persuaded to protect them from the risk of infection, or because they refuse to allow the child to be tested, you should treat it as a safeguarding concern and follow the advice in our guidance Protecting children and young people: the responsibilities of all doctors.⁹ 

If a serious communicable disease has contributed to the cause of death, you must record this on the patient’s death certificate.