Guidelines for the Early Clinical and Public Health Management of ...

Guidelines for the Early Clinical and Public Health Management of Bacterial Meningitis (including Meningococcal Disease)
Additional tests that may be useful include:
• Direct microscopy and demonstration of intracellular Gram negative diplococci (GNDC) in scrapings from a
petechial or purpuric lesion.
• Culture for N. meningitidis from non-sterile site (throat, eye) is recommended as an adjunct to other samples
as it may yield an isolate for epidemiological typing, however, this is not a diagnostic test.
• Serological tests for antibody to N. meningitidis have been utilised in the past but are now rarely used.
• In the case of isolates of N. meningitidis and H. influenzae, strain differentiation (phenotyping, molecular
typing, and gene sequencing) is performed at the Irish Meningococcal and Meningitis Reference Laboratory
(IMMRL). In addition, epidemiological typing and antimicrobial susceptibility testing of invasive isolates of
group B streptococcus is available at the IMMRL.
Epidemiological typing and detailed antimicrobial susceptibility testing of pneumococcal isolates is performed by
the Pneumococcal Pilot Typing Project (collaborative project between the RCSI Education and Research Centre,
Department of Clinical Microbiology in Beaumont Hospital and CUH Temple St, and HPSC).
Notification of any case of invasive disease causing meningitis should have regard to agreed case definitions under
the infectious disease regulations.
Isolation of the organism or a positive PCR test are the most commonly reported laboratory tests used to confirm
disease.
Public Health Management of Sporadic Cases of Invasive Meningococcal Disease
• Nasopharyngeal carriage of N. meningitidis is common; with some 10% of the population carrying
meningococci at any given time.
• There is a well established increased risk of further cases among the household contacts, and intimate
kissing and sexual contacts of a case of meningococcal disease.
• Settings where the increased risk is lower than that of household contacts include those in very close
contact with a case after the onset of symptoms, and in childcare facilities.
• When sporadic cases occur in schools and third level institutions, specific risk assessment is required to
determine which contacts, if any, are at increased risk.
• The public health response to meningococcal disease includes: identification of close contacts, arranging
appropriate chemoprophylaxis and provision of appropriate information.
• The main reason for giving chemoprophylaxis is to eliminate meningococci from any carrier who may be
in the network of contacts of each index case. This reduces the risk to other susceptible individuals in the
network, protecting them from acquiring the meningococcal strain from the carrier and possibly developing
invasive disease.
• Depending on the serogroup of the index case, vaccination with MenC or MenACWY vaccine may be
recommended for close contacts.
• Throat swabs have no role in the public health management of contacts of invasive meningococcal disease.
Public Health Management of Cases of Invasive Haemophilus Influenzae Type b (Hib) or Pneumococcal disease
• Chemoprophylaxis is recommended for contacts of a case of invasive Hib disease only when there is another
at risk individual in the contact network (see relevant section).
• Chemoprophylaxis is not normally recommended for contacts of cases of sporadic pneumococcal meningitis
(unless clusters of disease) (see relevant section).
Management of clusters of invasive meningococcal disease
• The objective of public health management of outbreaks is to interrupt the transmission of disease and
prevent further cases occurring.
• Clusters/outbreaks may be based in an institution or organisation or community.
-13-