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Control Guideline

MENINGOCOCCAL DISEASE

Public health priority Urgent. PHU response time Respond to any report of meningococcal disease on day of notification. Enter probable and confirmed cases on NDD within 1 working day and enter serogrouping results within 1 working day. Case management See Guidelines for the early clinical and public health management of meningococcal disease in Australia - Revised Edition 2007. Contact management See Guidelines for the early clinical and public health management of meningococcal disease in Australia - Revised Edition 2007.

NSW Public Health Units should follow the CDNA Guidelines for the early clinical and public health management of meningococcal disease in Australia - Revised edition 2007, in the investigation, management and follow up of cases and contacts of meningococcal disease. Additional requirements for meningococcal disease cases and contact management in NSW are detailed below.

Last updated: 18 September 2008

1. Reason for surveillance

See Guidelines for the early clinical and public health management of meningococcal disease in Australia - Revised Edition 2007.

2. Case definition

See Guidelines for the early clinical and public health management of meningococcal disease in Australia - Revised Edition 2007.

Confirmed case
A confirmed case requires either:
Laboratory definitive evidence, OR
Laboratory suggestive evidence AND clinical evidence.

Laboratory definitive evidence

  • Isolation of Neisseria meningitidis from a normally sterile site OR
  • Detection of specific meningococcal DNA sequences in a specimen from a normally sterile site by nucleic acid amplification testing.

Laboratory suggestive evidence
  • Detection of Gram negative diplococci in Gram stain of specimen from a normally sterile site or from a suspicious skin lesion, OR
  • High titre IgM or significant rise in IgM or IgG titres to outer membrane protein antigens of N. meningitidis,

Clinical evidence
  • A disease, which is compatible with invasive meningococcal disease in the opinion of the treating clinician.

Probable case
A probable case requires clinical evidence only.

Clinical evidence

A probable case requires:
  • The absence of evidence for other causes of clinical symptoms AND EITHER
  • Clinically compatible disease including haemorrhagic rash OR
  • Clinically compatible disease AND close contact with a confirmed case within the previous 60 days.

3. Notification criteria and procedure

Meningococcal disease is to be notified by:

  • Hospital CEOs on clinical diagnosis (ideal reporting by telephone within 1 hour of diagnosis)
  • Laboratories on diagnosis (ideal reporting by telephone within 1 hour of diagnosis).

Only probable and confirmed cases should be entered onto NDD.

4. The disease

See Guidelines for the early clinical and public health management of meningococcal disease in Australia - Revised Edition 2007.

5. Managing single notifications

Response time
Investigation
On the same day of notification of a case, begin follow-up investigation in accordance with Guidelines for the early clinical and public health management of meningococcal disease in Australia- Revised edition 2007.

Data entry
Within 1 working day of notification, enter probable and confirmed cases on NDD. Suspected cases should not be entered. Within 1 working day of notification of the serogroup of the organism, update the entry on NDD. Within 1 working day, remove from NDD cases for whom an alternative diagnosis has been made.

Within 1 working day email the Communicable Diseases Branch with information on the case's:

  • age
  • sex
  • suburb or town of residence
  • meningococcal C vaccination status
  • date of onset
  • method of diagnosis and serogroup (if known)
  • hospital
  • clinical status
  • name of childcare or school if relevant
  • estimated number of contacts.

Response procedure
The PHU response to a notification must follow Guidelines for the early clinical and public health management of meningococcal disease in Australia - Revised Edition 2007, and will normally be carried out in collaboration with the case's health carers. PHU staff should ensure that action has been taken to:

  • Confirm the onset date and symptoms of the illness
  • Confirm results of relevant pathology tests, or recommend the tests to be done
  • Encourage PCR and acute and convalescent serology to be done on suspected and probable cases
  • Find out if the case or relevant caregiver has been told of the diagnosis before beginning the interview
  • Seek the doctor's permission to contact the case or relevant caregiver
  • Ensure that contacts are identified and managed according to the Guidelines

When first notified of a case of meningococcal disease, the public health unit should contact the relevant laboratory to ensure that specimens are referred to a reference laboratory for grouping and typing and to allow retrospective analysis.

Where N. meningitidis is isolated by culture

  • Ensure that the laboratory refers the isolate to the Prince of Wales Microbiology Department for serogrouping. When urgent serotyping (as well as serogrouping) is required, e.g. in a suspected outbreak or cluster, isolates should also be sent directly to the South Western Area Pathology Service, Liverpool Hospital, Meningococcal Typing Laboratory.

Where a diagnosis of invasive disease is made by the detection of N. meningitidis DNA by PCR

  • Ensure that the laboratory refers both the original extract of the DNA and the original sample from which this DNA was extracted (i.e. blood, CSF, aspirated fluid) to the South Western Area Pathology Service, Liverpool Hospital, Meningococcal Typing Laboratory.

Case management
see Guidelines for the early clinical and public health management of meningococcal disease in Australia - revised Edition 2007.

For those cases of meningococcal disease where other laboratory testing has not confirmed the diagnosis, IgM serology should be routinely requested prior to discharge.

Contact management
See Guidelines for the early clinical and public health management of meningococcal disease in Australia - Revised Edition 2007. Several proforma letters are available.

Close contacts should receive:

  • Information for close contacts regarding clearance antibiotics and vaccination

Depending on the antibiotic prescribed for clearance close contacts should receive:
  • Ciprofloxacin: An antibiotic for contacts of person with a meningococcal infection; or
  • Rifampicin: An antibiotic for contacts of a person with a meningococcal infection ; or
  • Ceftriaxone: An antibiotic for contacts of a person with a meningococcal infection.

Where the case's serogroup is C,Y, W-135 or A, household contacts and household like contacts should receive:
  • Information for people who have had close contact with a person with meningococcal disease caused by a vaccine-preventable serogroup (amended as required).

Periodically public health units will give information to individuals who are in the broader social network of the case but who do not require clearance antibiotics. To reinforce the key public health messages to these people, public health units may elect to use:
  • Information for low level contacts (no antibiotics).

6. Managing special situations

Cases among children in school or child care settings
The PHU must inform the director or principal that a case has occurred, and provide a letter for the director or principal to distribute to the parents of all children attending the centre or school.

The letter should not reveal identifying information about the case, but should provide information that a child who attends the school has been diagnosed with the disease, and the level of risk to the other children. The NSW Health Fact Sheet providing information on meningococcal disease including signs and symptoms and treatment should accompany this letter.

If a case is reported during school holiday periods or on weekends it may not be possible to contact parents of children attending the school until school returns. However, every effort should be made to contact the school principal to arrange distribution of information to the parents if the child attended school during the incubation period. This may involve the school mailing letters to the parents. PHUs should contact the regional office of the Student Service and Equity Unit at the Department of Education and Training for assistance.

Appendix

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