NICE NG253 sepsis guidelines updated with tailored fluid resuscitation protocols and enhanced communication support for diverse patient populations. Expanded notifiable diseases list from April 2025.
Travel Health & Infectious Disease for GPs: Your Survival Guide
Because "It's probably viral" isn't always the right answer when they've just returned from the jungles of Papua New Guinea
Date Updated: March 6, 2026
Executive Summary: What You'll Master Today
Because you have 47 other things to do before lunch, and that's just the morning list
What You'll Learn
- • 8-step diagnostic algorithm for infectious disease
- • The 12 infections GPs must never miss
- • Complete notifiable diseases list (urgent vs routine)
- • Travel health consultation framework
- • Antimicrobial stewardship essentials
- • When to panic, when to treat, when to refer
Quick Facts
- • 2-5% of GP consultations involve infectious disease
- • Malaria kills 6 UK residents annually (all preventable)
- • 40+ diseases require urgent notification (within 24h)
- • Travel consultations should be 6-8 weeks pre-departure
- • qSOFA ≥2 = sepsis until proven otherwise
Latest Clinical Updates 2026
NICE NG253 sepsis guidelines updated (December 2026) - tailored fluid resuscitation protocols
Enhanced communication support for diverse patient populations in sepsis care
Expanded notifiable diseases list (April 2025) - additional organisms reportable
Updated antimicrobial stewardship quality standards (2026)
Revised travel health guidance incorporating dengue vaccination recommendations
Downloads
Golden Rules
- • Travel + fever = malaria until proven otherwise
- • Petechial rash + fever = meningococcal disease - give IM benzylpenicillin
- • qSOFA ≥2 = sepsis - start Sepsis Six immediately
- • Don't wait for lab confirmation to notify urgent diseases
- • When in doubt, phone the HPT - they're there to help
GP Infectious Disease Master Table
Quick-reference framework summarising the major infectious presentations seen in general practice. Helps trainees orientate diagnostic reasoning and navigate the page.
| Presentation | Typical Causes | Important Risk Factors | Red Flags |
|---|---|---|---|
| Fever | Viral illness, pneumonia, UTI, skin infection | Immunosuppression, recent exposure | Sepsis |
| Fever after travel | Malaria, dengue, typhoid | Travel to endemic areas | Malaria |
| Rash (±) fever | Viral exanthems, bacterial infection | Travel, insect exposure | Meningococcal disease |
| Diarrhoea | Viral gastroenteritis, food poisoning | Contaminated food/water | Severe dehydration |
| Respiratory infection | Viral URTI, influenza, pneumonia | Elderly, chronic disease | Severe pneumonia |
| Chronic/systemic illness | TB, HIV, parasitic infection | Travel, migration | Disseminated infection |
GP Infectious Disease Diagnostic Algorithm
Stepwise reasoning framework mirroring how GPs assess infectious disease presentations. Follow this systematic approach for every infectious disease consultation.
Is the Patient Acutely Unwell?
Identify early signs of serious infection or sepsis. Use qSOFA criteria (≥2 = high risk). Check vital signs, conscious level, and perfusion. If unstable, initiate Sepsis Six protocol immediately.
Key Points:
- qSOFA ≥2 = sepsis protocol
- Don't wait for investigations
- ABC approach first
Identify the Dominant Symptom Pattern
Categorise the presentation (fever, rash, diarrhoea, respiratory symptoms, systemic illness). This guides the next stage of diagnostic thinking.
Key Points:
- Fever patterns
- Rash characteristics
- GI vs respiratory focus
Assess Exposure Risks
Identify epidemiological clues that change the differential diagnosis.
Key Points:
- Travel exposure: destination, timing, activities
- Environmental: animals, insects, water/food
- Occupational: healthcare, needlestick, animals
Consider Patient Risk Factors
Host factors affecting susceptibility and severity.
Key Points:
- Immunocompromised patients
- Pregnant patients
- Elderly patients
- Migrants and refugees
Focus the Differential Diagnosis
Combine symptom pattern, exposure risks and host factors.
Key Points:
- Fever after travel
- Rash with fever
- Acute diarrhoeal illness
- Respiratory infection patterns
Decide on Investigations
Choose investigations appropriate to suspected infection.
Key Points:
- Microbiology testing
- Blood tests (FBC, CRP, cultures)
- Stool or urine tests
- Imaging if indicated
Decide on Management Strategy
Determine whether infection is self-limiting, treatable in primary care, or requiring specialist referral.
Key Points:
- Supportive care
- Empirical antibiotics
- Urgent referral criteria
Consider Public Health Responsibilities
Recognise infections with wider public health implications.
Key Points:
- Notifiable diseases
- Infection control advice
- Antimicrobial stewardship
Red Flags & Emergency Recognition
Critical Recognition Points
- qSOFA ≥2 → Sepsis Six protocol immediately
- Travel history + fever → Consider malaria until proven otherwise
- Petechial rash + fever → Meningococcal disease
- Rigors + fever → Bacteraemia likely
- Altered consciousness + fever → Meningitis/encephalitis
- Bleeding + travel → Viral haemorrhagic fever
MALARIA - The Great Imitator
MALARIA
Malaise and muscle aches
Non-specific flu-like symptoms
Anemia (severe, rapid onset)
Haemolysis causes rapid drop in Hb
Low platelets (thrombocytopenia)
Often first abnormal blood result
Altered consciousness (cerebral malaria)
Medical emergency - immediate referral
Rigors and cyclical fever
Classic tertian/quartan patterns
Icterus (jaundice in severe cases)
Indicates severe malaria
Acute kidney injury
Blackwater fever - dark urine
Sepsis Recognition - qSOFA Criteria
IMMEDIATE ACTION- • Respiratory rate ≥22 breaths/min (1 point)
- • Altered mental state - GCS <15 (1 point)
- • Systolic BP ≤100 mmHg (1 point)
- • Score ≥2: Initiate Sepsis Six protocol immediately
Viral Haemorrhagic Fevers
IMMEDIATE ACTION- • High-risk travel areas + fever + bleeding
- • Ebola: West/Central Africa
- • Lassa fever: West Africa
- • Marburg: East/Central Africa
- • Crimean-Congo HF: Balkans, Middle East
- • Action: Immediate isolation + call UKHSA (0344 225 4524)
The 12 Infectious Diseases GPs Must Never Miss
Sepsis
qSOFA ≥2 → Sepsis Six
MinutesMeningitis
IM benzylpenicillin
MinutesMalaria
Urgent blood film
HoursTuberculosis
Isolate + notify
HoursNecrotising fasciitis
Emergency surgery
HoursInfective endocarditis
Blood cultures + echo
HoursViral haemorrhagic fever
Isolate + call UKHSA
ImmediateSevere pneumonia
CURB-65 + antibiotics
HoursAcute epiglottitis
Secure airway
MinutesSevere dengue
Platelet monitoring
HoursCholera
Fluid replacement + notify
HoursRabies exposure
Post-exposure prophylaxis
HoursDifferential Diagnosis Frameworks
Approach to Fever with Localising Signs
Respiratory Focus
- • Community-acquired pneumonia - Most common
- • Atypical pneumonia - Mycoplasma, Legionella
- • Pulmonary TB - Especially if travel/immunocompromised
- • Influenza - With secondary bacterial infection
Bacterial vs Viral Clues
- • Bacterial: Rigors, high fever >38.5°C
- • Purulent sputum, focal signs
- • Neutrophilia, left shift
- • CRP usually >50 mg/L
- • Response to antibiotics
Fever Without Focus - When to Worry
HIGH RISK GROUPS
- → Age <3 months: Always investigate
- → Immunocompromised: Low threshold for admission
- → Fever >39°C for >48h: Consider bacterial cause
- → Rigors: Suggests bacteraemia
- → Petechial rash: Meningococcal disease
Fever in the Returning Traveller
Early Onset (<2 weeks)
- • Malaria - Any endemic area
- • Dengue - Asia, Americas, Africa
- • Chikungunya - Joint pain prominent
- • Rickettsial disease - Tick/mite exposure
- • Bacterial gastroenteritis
Medium Onset (2-6 weeks)
- • Malaria - Still possible
- • Typhoid - Rose spots, hepatosplenomegaly
- • Hepatitis A/E - Jaundice, elevated ALT
- • Acute schistosomiasis - Katayama fever
- • Brucellosis - Animal contact
Late Onset (>6 weeks)
- • Malaria - P. vivax, P. ovale
- • Tuberculosis - Pulmonary/extrapulmonary
- • Visceral leishmaniasis - Kala-azar
- • Chronic schistosomiasis
- • Amoebic liver abscess
MALARIA - Always Consider First
MALARIA
Malaise, myalgia
Non-specific flu-like symptoms
Anemia
Rapid onset, severe
Low platelets
Thrombocytopenia common
Altered consciousness
Cerebral malaria - emergency
Rigors
Cyclical fever pattern
Icterus
Jaundice in severe cases
Acute kidney injury
Blackwater fever
Approach to Rash with Fever
Viral Exanthems
- • Measles - Koplik spots, cough, conjunctivitis
- • Rubella - Mild illness, lymphadenopathy
- • Chickenpox - Vesicular rash, crops
- • EBV/CMV - Mononucleosis syndrome
- • Parvovirus B19 - Slapped cheek syndrome
Bacterial Infections
- • Meningococcal disease - Petechial rash
- • Scarlet fever - Sandpaper rash, strawberry tongue
- • Staphylococcal scalded skin - Nikolsky sign
- • Cellulitis - Localised, spreading
- • Necrotising fasciitis - Severe pain, rapid spread
Travel-Related Rashes
Dengue
Maculopapular rash, thrombocytopenia, tourniquet test positive
Typhus
Rose spots on trunk, flea/louse-borne
Rickettsial
Eschar at bite site, tick exposure
Approach to Diarrhoea
Viral Gastroenteritis
- • Norovirus - Vomiting prominent
- • Rotavirus - Children mainly
- • Adenovirus - Prolonged symptoms
- • Usually self-limiting 3-5 days
Food Poisoning
- • Salmonella - Fever + diarrhoea
- • Campylobacter - Bloody diarrhoea
- • Shigella - Dysentery syndrome
- • C. perfringens - Rapid onset
Traveller's Diarrhoea
- • ETEC - Most common cause
- • Giardia - Chronic, fatty stools
- • Cryptosporidium - Watery
- • Amoeba - Bloody diarrhoea
When to Send Stool Sample
INDICATIONS
- → Blood or mucus in stool
- → Fever + diarrhoea >3 days
- → Recent travel to high-risk area
- → Immunocompromised patient
- → Food poisoning outbreak
- → Healthcare worker with diarrhoea
When to Prescribe Antibiotics for Diarrhoea
INDICATIONS
- → Severe symptoms with fever >38.5°C
- → Blood in stool + systemic symptoms
- → Immunocompromised patients
- → Suspected traveller's diarrhoea with severe symptoms
- → Positive stool culture for bacterial pathogen
FIRST-LINE CHOICES
- → Azithromycin 500mg daily x 3 days (traveller's diarrhoea)
- → Ciprofloxacin 500mg BD x 5 days (if severe)
- → Avoid antibiotics in suspected STEC/VTEC
Approach to Respiratory Infection
Upper Respiratory Tract
- • Viral URTI - Most common, self-limiting
- • Influenza - Systemic symptoms, myalgia
- • Bacterial sinusitis - Purulent discharge
- • Strep throat - Centor criteria
Lower Respiratory Tract
- • Community-acquired pneumonia - CURB-65
- • Atypical pneumonia - Mycoplasma, Legionella
- • Acute bronchitis - Usually viral
- • COPD exacerbation - Purulent sputum
CURB-65 Pneumonia Severity Score
Score 1 point for each:
- • Confusion (AMT ≤8)
- • Urea >7 mmol/L
- • Respiratory rate ≥30/min
- • Blood pressure (SBP <90 or DBP ≤60)
- • Age ≥65 years
Score 0-1: Home treatment
Score 2: Consider admission
Score ≥3: Urgent admission
Travel Health & Pre-Travel Consultation
Pre-Travel Risk Assessment Framework
Assess destination risks, vaccination requirements, malaria prophylaxis needs, and provide tailored advice on food/water safety and insect bite prevention. Ideally 6-8 weeks before travel to allow time for vaccine courses.
ABCD of Malaria Prevention
ABCD
Awareness of risk
Know the destinations and seasons
Bite prevention
DEET, long sleeves, nets
Chemoprophylaxis
Appropriate antimalarial
Diagnosis
Seek help if fever develops
Risk Assessment Factors
- Disease risk: Malaria, yellow fever, Japanese encephalitis
- Altitude: >2500m requires acclimatisation
- Climate: Heat illness, UV exposure
- Healthcare facilities: Quality and accessibility
- Political stability: Security risks
- Activities: Adventure sports, water sports
- Accommodation: Rural vs urban, standards
Timing Considerations
- 6-8 weeks before: Ideal consultation time
- Yellow fever: 10 days before travel
- Hepatitis A: 2 weeks for immunity
- Japanese encephalitis: 28 days for full course
- Malaria prophylaxis: Start 1-3 weeks before
- Last minute: Still worth consulting
Malaria Prophylaxis Guidelines 2026
| Drug | Dose | Start Before | Continue After | Indications | Notes |
|---|---|---|---|---|---|
| Atovaquone/Proguanil (Malarone) | 250/100mg daily | 1-2 days | 7 days | Most areas, short trips | Expensive but well tolerated |
| Doxycycline | 100mg daily | 2 days | 4 weeks | Cost-effective, long trips | Photosensitivity, GI upset |
| Mefloquine (Lariam) | 250mg weekly | 2-3 weeks | 4 weeks | Pregnancy, long-term | Neuropsychiatric side effects |
| Proguanil + Chloroquine | 200mg + 300mg daily | 1 week | 4 weeks | Low-risk areas only | Limited use due to resistance |
Vaccination Priorities
Routine (UK Schedule)
MMR, DTP, seasonal influenza
Travel-Specific
Hepatitis A, typhoid, yellow fever
High-Risk Activities
Rabies, Japanese encephalitis, meningitis
Special Populations
Pregnancy
Avoid live vaccines, careful drug selection
Immunocompromised
Specialist advice, avoid live vaccines
Children
Weight-based dosing, age restrictions
Prevention Advice
Food & Water
Boil it, cook it, peel it, or forget it
Insect Bites
DEET, permethrin, bed nets
Sun & Heat
SPF 30+, hydration, acclimatisation
Travel Health Consultation Checklist
HISTORY
- →Destinations, dates, purpose of travel
- →Accommodation type and activities planned
- →Medical history and current medications
- →Previous vaccinations and travel experience
- →Pregnancy status and contraception
RISK ASSESSMENT
- →Disease endemicity at destination
- →Seasonal variations and current outbreaks
- →Individual risk factors
- →Duration and style of travel
INTERVENTIONS
- →Vaccinations required and recommended
- →Malaria prophylaxis if indicated
- →General health advice and precautions
- →Travel insurance and medical kit
- →Follow-up arrangements
Notifiable Diseases & Public Health
Expanded Notifiable Diseases List (April 2025)
Additional organisms now reportable to UKHSA including carbapenem-resistant Enterobacteriaceae and Candida auris. Urgent cases must be reported by phone within 24 hours.
URGENT Notification (24 hours by phone)
Acute flaccid paralysis (AFP) or Acute flaccid myelitis (AFM)
Acute infectious hepatitis (A/B/C)
Acute meningitis
Anthrax
Botulism
Cholera
Diphtheria
Enteric fever (typhoid or paratyphoid fever)
Haemolytic uraemic syndrome (HUS)
Infectious bloody diarrhoea
Legionnaires' disease
Measles
Meningococcal septicaemia
Mpox (previously known as monkeypox)
Plague
Rabies
Severe Acute Respiratory Syndrome (SARS)
Smallpox
Viral haemorrhagic fever (VHF)
Whooping cough (if diagnosed in acute phase)
ROUTINE Notification (3 days online)
Acute encephalitis
Brucellosis
Urgent if acquired in UK
Chickenpox (varicella)
Congenital syphilis
COVID-19
Creutzfeldt-Jakob disease (CJD)
Disseminated gonococcal infection (DGI)
Food poisoning
Urgent if part of cluster/outbreak
Leprosy
Malaria
Urgent if acquired in UK
Mumps
Neonatal herpes
Rubella
Scarlet fever
Tetanus
Urgent if associated with injecting drug use
Tuberculosis
Urgent if healthcare worker, cluster or MDR
Typhus
Yellow fever
Urgent if acquired in UK
How to Report Notifiable Diseases
URGENT Cases (24 hours)
- • Phone: 0344 225 4524 (office hours)
- • Out of hours: 0151 434 4819
- • Discuss immediate public health actions
- • Don't wait for laboratory confirmation
ALL Cases (3 days)
- • Online: NOIDs system (24/7 available)
- • Email: Local HPT team
- • Report suspected cases - don't wait for confirmation
- • Include patient demographics and clinical details
Public Health Responsibilities Checklist
RECOGNITION
- →Know the notifiable diseases list
- →Understand urgent vs routine classification
- →Don't wait for laboratory confirmation
REPORTING
- →Phone urgent cases within 24 hours
- →Online reporting within 3 days for all cases
- →Include relevant clinical and epidemiological details
INFECTION CONTROL
- →Isolate patients when appropriate
- →Contact tracing if required
- →Advise on prevention measures
FOLLOW-UP
- →Cooperate with public health investigations
- →Provide additional information if requested
- →Implement recommended control measures
Antimicrobial Stewardship
NICE Quality Standards 2026
Updated antimicrobial stewardship quality standards emphasize personalized treatment approaches and enhanced monitoring protocols. Focus on responsible prescribing and tackling antimicrobial resistance.
The 5 Key Questions
- 1. Do they need an antibiotic? Viral vs bacterial
- 2. Can I wait and see? Safety netting advice
- 3. What would I treat? Likely organism
- 4. Local guidelines? Check formulary
- 5. Patient factors? Allergies, interactions
Resistance Patterns 2026
TARGET Antibiotic Checklist
T - TREAT: Do they need an antibiotic?
A - APPROPRIATE: Right drug, dose, duration
R - REVIEW: 48-72 hour review planned
G - GUIDELINES: Local formulary consulted
E - EDUCATE: Patient counselled on use
T - TRACK: Safety netting advice given
Common Infections - First Line Treatment
Amoxicillin
Dose: 500mg TDS
Duration: 5 days
Clinical Notes
- First-line for mild-moderate CAP
- CURB-65 score guides severity
Contraindications
- Penicillin allergy
Monitoring
- ✓Clinical response at 48-72h
Nitrofurantoin
Dose: 100mg BD
Duration: 3 days
Clinical Notes
- First-line choice for uncomplicated cystitis
- Avoid in eGFR <45
Contraindications
- Renal impairment
- G6PD deficiency
Flucloxacillin
Dose: 500mg QDS
Duration: 5-7 days
Clinical Notes
- First-line for cellulitis
- Covers Staph aureus
Contraindications
- Penicillin allergy
YOU'VE GOT THIS
Remember: You don't need to be an infectious disease specialist to provide excellent infectious disease care. You just need to know when to worry, when to treat, and when to refer.
Trust your clinical instincts, use the algorithms, and don't be afraid to ask for help. The HPT team would rather get 10 unnecessary calls than miss one important case.