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56
Exclusion of Contacts.
Those who have been in contact with infectious patients may have
picked up organisms and may develop the disease. In some diseases
these contacts may be infectious before the onset of the clinical manifestations
of the illness so that they might, in their turn, spread the
infection. Even though they are not to develop the illness, some of
these contacts may be harbouring the organisms and they may be
spreaders. With a view to reducing the risk of spread of infection by
such contacts, it was at one time the practice to restrict the movements
of contacts for a period long enough to determine whether they were
likely to be developing the disease. This practice has been relaxed by
stages, and it is now only exceptionally that adult contacts are excluded
from their work. There are two main classes of workers who may be
required to abstain from their ordinary work. The one is of those persons
whose work brings them into close contact with those such as young
children who are especially susceptible to attack, or hospital nurses who
might cause infection in a ward. The other group is of those whose
work brings them into contact with such foods as milk which, if infected,
might result in widespread infection. Even in the case of persons so
employed, it is not always necessary that they should stay away from
work, but only from that work at which there is the risk of spread. Many
employers are able to put the contact employees temporarily on to some
alternative work where there is no greater risk of the spread of infection
than in the case of ordinary members of the public. If a person has to
remain away from work with a view to reducing the risk of spread of
infection, he is entitled to draw sickness benefit at the rate he would
receive were he ill. This payment can be made, however, only if the
Medical Officer of Health for the district can issue a certificate that the
exclusion of the contact is necessary with a view to reducing the risk of
spread of infection. The Ministry of Health Circular 115/48 reads:
"As Medical Officers of Health are aware, it is only exceptionally
that it is necessary to require a contact or carrier of infectious disease to
stay away from work, and then only as regards the more serious infections.
But a Medical Officer of Health, in his responsibility for preventive
action, may on occasion consider it necessary, where there is special risk,
that such a person should absent himself from his employment for a
time: and it is in such circumstances that the right to draw sickness
benefit will arise. Benefit will only be paid on the strength of a certificate
by a Medical Officer of Health that the person concerned is under medical
observation by reason of being a carrier of infectious disease, or of having
been in contact with a case of infectious disease, (as the case may be), in
circumstances which make it advisable to exclude him from work. The
Medical Officer of Health should accordingly be prepared to issue such
a certificate where he thinks it proper to do so in order that the person
concerned may send it to the local office of the Ministry of National
Insurance in support of his claim for sickness benefit. The certificate
should be given in writing, preferably on official notepaper."
The practice of excluding from school child contacts of infection
has been markedly relaxed in recent years. Not only is exclusion required