Infectious Diseases

Introduction

This chapter addresses infectious agents and infections likely to be encountered by law enforcement officers (LEOs), but it should not be viewed as a complete list of all infections. This chapter is intended to assist the police physician in determining LEO selection and fitness for duty. In a departure from other LEO guidance, the scope of this chapter extends beyond the evaluation of the individual LEO or candidate to address the public health issues that arise when the LEO has contracted one of these infections of concern. The objective is to prevent the spread of the infection among the LEO’s co-workers, the general public, and those detained in jails or incarcerated in correctional institutions.

No infectious disease in and of itself will create a blanket work restriction or exclusion for the LEO. An individualized assessment should be performed for each case. In general, it is the severity and symptoms of the infection, the treatment being received, or the transmissibility of the disease that will decide the LEO’s work status. One example is hepatitis C where the basis of the work restriction can be the symptoms of liver disease (such as acute or chronic inflammation of the liver or the scarring of cirrhosis) or the treatment for the disease (such as interferon therapy).

Rarely will an LEO need permanent restrictions as the result of an infectious disease. However, some acute, self-limited infectious diseases will require temporary exclusion from the workplace in order to limit the transmission of disease to co-workers or to the public. Transmission of disease must also be considered in infected but asymptomatic individuals (e.g., during incubation period, carrier state). For the few diseases that produce a chronic disease state, restrictions should be re-evaluated, as the severity of the disease may change over time.

The guidance provided in this section should be considered in the context of the health of the community being served (for example, what diseases commonly are known to occur), and the law enforcement agency’s specific mission. The LEO’s job responsibilities may vary and include patrol, routine contact with local jails and correctional institutions as well as health care facilities (e.g., hospital emergency departments); therefore, responsibilities should be considered in any decision making. An audit of departmental protective policies may beneficial to “ensure provision of appropriate post-exposure-assessment and treatment…improve understanding of infection risk, enhancing the ability to offer targeted education and services to officers.” 1

In order to limit the risk of vaccine-preventable infections among LEOs and to reduce transmission in institutions, recommendations for adult immunization from the U.S. Centers for Disease Control and Prevention’s (CDC’s) Advisory Committee on Immunization Practices (ACIP) should be followed. It is the consensus of this Task Group that the immunization status of all LEOs should be reviewed prior to attending academy training and on a periodic basis thereafter. In order to prevent a high burden of respiratory morbidity in the academy setting, academy administrators may consider consulting with an occupational medicine or infectious disease specialist to determine whether there would be a benefit in administering adenovirus vaccine to incoming recruits.2

This guidance is based upon reviews of standard medical texts,3,4 and Internet resources, and a structured search of the medical literature using three databases: 1) PubMed (Medline); 2) the National Criminal Justice Reference Service (NCJRS); and 3) Google/Google Scholar.a

aSearch terms were used in varying combinations to discover appropriate citations: For police concept: police; police officers; law enforcement; law enforcement officers; officers; public safety workers; first responders [excluding firefighters, emergency medical technicians, and paramedics]. For occupational exposure concept: occupational exposure; occupational accidents; occupational medicine; occupational diseases; occupational safety; occupational health; employment; job; police communicable disease training; police AIDS training. For diseases concept: communicable diseases; infectious diseases; bloodborne pathogens; needlestick injuries; pink eye; adenovirus; adenoviridae; hepatitis; hepatitis B; hepatitis C; chickenpox; shingles varicella zoster; herpesvirus 3, human; cold sores; herpes simplex 1; herpes labialis; German measles; rubella; rubella virus; measles; rubeola; mumps; mumps virus; human immunodeficiency virus; HIV; acquired immunodeficiency syndrome; AIDS; mononucleosis; infectious mononucleosis; influenza; influenza, human; Tuberculosis; Mycobacterium tuberculosis; bacterial infections of the skin; staph; Streptococcus pyogenes; Staphylococcus aureus; methicillin-resistant Staphylococcus aureus; MRSA; strep throat; bacterial pharyngitis; streptococcal infections; lice; lice infestations; fungal infections; mycoses; skin diseases, infectious; whooping cough; pertussis; meningococcal disease; Neisseria meningitides; meningitis, meningococcal.