Meningococcal disease: Contact management protocol for urgent care and GPs

Purpose

• This document outlines actions for clinicians managing eligible contacts of a confirmed case of invasive meningococcal disease as advised by the local PHU.
• Access NSW Health meningococcal disease for health professionals for more information.

Disease

• Meningococcal disease is caused by infection with Neisseria meningitidis of which there are several serogroups, including A, B, C, W and Y, which are the vaccine preventable serogroups.
• Five to ten per cent of patients with invasive meningococcal disease die, even despite rapid treatment.
• Up to 1 in 4 people are asymptomatic carriers of Neisseria meningitidis bacteria.
• The bacteria do not easily transmit between people and do not survive well outside the body. Transmission is primarily via droplets and by close and prolonged contact with asymptomatic carriers of more virulent strains of the organism.

Clearance antibiotics

• Individuals who are assessed as a “close contact" by the PHU will be referred to the primary care provider to receive clearance antibiotics.
• The rationale for providing clearance antibiotics only to a select group of individuals assessed as “close contacts" is because they are the people most likely to be carrying a virulent strain of the bacteria.

• These antibiotics aim to eliminate carriage of bacteria among close contacts and help prevent it being transmitted to others.

• Clearance antibiotics are different to definitive treatment with antibiotics and people who receive clearance antibiotics are still at some risk of developing the disease.

• All contacts should therefore be made aware of the symptoms of meningococcal disease and should be advised to seek medical care urgently if these occur.

• Contacts are not infectious and do not need to isolate unless advised by the local PHU.

Suitable antibiotic agents for close contacts

The Australian Therapeutic Guidelines recommend the following regimes for Neisseria meningitidis clearance:

Further information on the characteristics of each antibiotic choice can be found in Table 2 in the NSW Health Meningococcal disease control guidelines for public health units.

PEP vaccination

• If the serogroup of the index case is A, C, W or Y, vaccination of close contacts with a meningococcal ACWY vaccine may be requested by the PHU.
• The meningococcal B vaccine is not recommended for contact management, as it typically requires a multi-dose schedule due to its reduced immunogenicity. A single dose administered after exposure is unlikely to provide sufficient protection against disease.
• Clinicians must record administration of the meningococcal ACWY vaccine in the Australian Immunisation Register under legislative requirements.

Feedback to PHU

• A record of clearance antibiotics administration or script issued must be forwarded to the referring PHU. This can be done using the meningococcal disease contact form.
• Any adverse events following immunisation are to be managed in accordance with the NSW Health adverse event following immunisation control guideline.
• Patient refusal to accept clearance antibiotics or meningococcal ACWY vaccine or an administration failure must be conveyed to the referring PHU.

More information

• For further information please call your local Public Health Unit on 1300 066 055
• Meningococcal disease control guidelines for public health units
• Meningococcal disease including patient fact sheet
• Clinical Excellence Commission - Sepsis