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)
7.5 The public health response
The public health response should be implemented as soon as possible, and includes the following actions:
• Identification of close contacts.
(The designated medical officers of health (MOH) under Infectious Disease Regulations 34 have the authority
and obligation to “make such enquiries and take such steps as are necessary or desirable for investigating
the nature and source of such infection, for preventing the spread of such infection and for removing
conditions favourable to such infection”. Under these same regulations, “a person who refuses to comply
with a requirement or direction given or a request for information made in pursuance of any of the provisions
of these Regulations shall be guilty of a contravention of these Regulations”).
• Arranging appropriate chemoprophylaxis to those identified as requiring prophylaxis.
• Provision of appropriate information.
7.5.1 Dissemination of information
Following a case of meningococcal disease, it is important to give out information because early diagnosis and
treatment should improve outcome. There is a small but real risk of further linked cases. 46 Vigilance for signs and
symptoms among contacts is important especially in the immediate high risk period (one week) after onset of
symptoms in a case. Accurate and timely information should help limit the spread of false rumours and anxiety and
to some extent allay public concern.
Information should be sufficient to ensure awareness of the situation whiles preserving patient confidentiality.
The family of a case should be informed that information will be distributed as appropriate. Leaflets or other printed
material about meningococcal disease should be widely available and quickly distributed after reporting of a
confirmed or clinical case. Examples of information sheets can be found in the Appendix of these guidelines.
Information to those given chemoprophylaxis should include:
• Symptoms and signs of the disease and the need to seek urgent medical advice should they become unwell
• Chemoprophylaxis does not exclude the possibility, although small, of a person developing meningococcal
disease
• There is no need for an asymptomatic person who is taking chemoprophylaxis to be ‘quarantined’ in any way
Recipients should be given this information at the time of receiving chemoprophylaxis. This information is covered in
the example sheets at the back of the document (see Appendix for examples).
Consider the need to inform other HSE colleagues, GPs and GP out-of-hours services about the case and what public
health actions have been taken or are required.
When a case occurs in a childcare facility the manager should be informed. The information should be sufficient
to ensure that other parents are aware of the situation whilst preserving the confidentiality of the patient.
Arrangements should be made to provide information for all the parents and, if indicated, chemoprophylaxis for
those identified as close contacts.
When a case occurs in a school or college the principal/head should be informed. Arrangements should be made to
provide information for other parents/students. The information should be sufficient to ensure that parents/students
are aware of the situation whilst preserving the confidentiality of the patient.
If a suspected case occurs in a childcare or educational facility and public health action is not immediately indicated
(e.g. a case considered that diagnoses other than meningococcal disease are at least as likely) it may still be
advisable to discuss the situation with the manager/head at an early stage. The manager/head will then be in a
good position to respond immediately to parental concerns.
7.5.2 Vaccines
Meningococcal serogroup C conjugate vaccine (MenC)
Meningococcal serogroup C conjugate vaccine (MenC) was introduced into the Irish childhood immunisation
programme in October 2000 and a catch-up programme was provided to all children and young adults up to the
age of 23 years. The vaccine confers high levels of serum bactericidal antibody and induces immunological memory
in individuals from the age of two months. 60 Preliminary estimates of vaccine efficacy suggest that the vaccine is 88-
96% effective against invasive meningococcal disease due to serogroup C infection. Protection declines over time
especially when given under 1 year of age. 61
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