Guidance

Algorithm for management of toxigenic C. ulcerans in companion animals: text version

Published 21 March 2023

Applies to England

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This publication is available at https://www.gov.uk/government/publications/public-health-management-of-toxigenic-c-ulcerans-in-companion-animals/algorithm-for-management-of-toxigenic-c-ulcerans-in-companion-animals-text-version

The algorithm contains 4 main steps and then divides into 2 parts, depending on whether the case is animal or human.

First 4 steps

  1. Animal sample positive for C. ulcerans at private veterinary laboratory. Confirm identification using MALDI-TOF or Vitek. Contact UK Health Security Agency (UKHSA) Colindale to confirm sample fulfils criteria for toxin testing.

  2. Sample submitted for testing at UKHSA Colindale.

  3. Toxigenic C. ulcerans confirmed at UKHSA Colindale.

  4. Health protection team (HPT) informed of result and Incident Management Team established (if necessary).

Management of index animal

Ensure animal is commenced on appropriate antibiotics as advised by APHA. Other animals in household or setting may also require antibiotic treatment at the same time.

Repeat swabs taken 5 to 7 days after completion of antibiotic course.

If animal remains positive for C. ulcerans on repeat swabs, the Animal and Plant Health Agency (APHA) will advise on further management.

Management of human contacts

Local health protection team to identify close contacts. This will include household members and veterinary staff.

Public health actions:

  • check for symptoms of diphtheria in human contacts. If symptomatic, arrange clinical assessment
  • provide warn and inform information to all contacts
  • monitoring of symptoms for 10 days
  • arrange for nose or throat swab and any new skin lesions if present for all close contacts to be sent to local laboratory for culture
  • check vaccination status and offer diphtheria-containing booster vaccination to all contacts who have not received a vaccine in the past 12 months

Only if exposure is considered high risk or if concerns about clinical vulnerability of a contact, then consider antibiotic chemoprophylaxis following discussion with Emerging Infection and Zoonoses team.

If human close contact has toxigenic C. ulcerans detected on swab, manage as confirmed diphtheria case.

End of algorithm

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