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

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Guidelines for the Early Clinical and Public Health Management of Bacterial Meningitis (including Meningococcal Disease) 7.6.4 Cases of confirmed serogroup A, W 135 or Y infections • Index cases who have not been immunised with the conjugate quadrivalent (ACW 135 Y) vaccine should complete an immunisation course with conjugate quadrivalent (ACW 135 Y) vaccine. Those who received the conjugate quadrivalent (ACW 135 Y) vaccine more than 12 months previously should be given a second dose. 7.6.5. Contacts of confirmed serogroup A, W 135 or Y infections • Vaccination with conjugate quadrivalent (ACW 135 Y) vaccine should be offered to all close contacts of any age (two doses, one month apart if aged between 2 – 12 months; one dose in older individuals). Recommendation • Depending on the serogroup of the index case, vaccination with MenC or MenACWY vaccine may be recommended for close contacts 7.7 Vaccine failures Vaccine failure implies an inadequate response to the vaccine and may reflect host factors or sub-optimal storage or administration of the vaccine. All vaccine failures should be reported to HPSC as part of the ongoing monitoring of the Men C programme. Additionally a sample of convalescent serum prior to re-immunisation should be taken and sent to the IMMRL who will forward the sample to the HPA Meningococcal Reference Unit for further analysis. The IMMRL contact the clinician directly to arrange the sample. -66-
Guidelines for the Early Clinical and Public Health Management of Bacterial Meningitis (including Meningococcal Disease) Chapter 8. Management of Clusters/ Outbreaks of Meningococcal Disease Key points • The objective of public health management of outbreaks is to interrupt the transmission of disease and prevent further cases occurring. • Clusters/outbreaks may be institution or organisation based or community based. 8.1 Definitions An institution or organisation based outbreak of meningococcal disease: Two or more definite cases of meningococcal disease within a four-week period in a group with epidemiological links, AND where the available microbiological characterisation of the organisms is the same. A community based outbreak: Consider intervention if the age specific attack rate is “high”. Although a precise threshold for intervention has not been set, age-specific attack rates should be calculated. A minimum of four cases of definite meningococcal disease within a three-month interval, or 40/100,000 in any age group in a three-month period, in a geographical area that makes epidemiological sense AND where available microbiological characterisation of the organisms is the same. 3 Decisions regarding chemoprophylaxis and vaccination (if appropriate) for a wider group than solely close contacts is dependent on local risk assessment. Easy to understand written information should be provided to all individuals regarding control measures taken (or not), early warning signs and contact details for follow-up advice. 8. 2 Introduction Outbreaks may occur in the general community or in other settings such as schools and universities. The public health actions for each of these settings may vary and will depend on the identification of epidemiological links between cases and identification that the same organism is associated with the outbreak cases. Outbreaks of invasive meningococcal disease need to be distinguished from increases of sporadic and epidemiologically unlinked cases. Such increases may occur in the general community or within settings such as schools and crèches. When clustering of cases occurs local public health should look for epidemiological links between cases, even if these are not immediately evident. Identification of such epi-links will inform and direct public health control activities. The objective of public health management of such outbreaks of invasive meningococcal disease is to interrupt transmission and prevent further cases. Once an outbreak is either suspected or recognised there is an immediate need to initiate a coordinated response. Elements of this response include: • Review available data to determine if there is an outbreak and its extent. • Identify population at risk and calculation of age-specific and region-specific attack rates. • Establish an outbreak control team (OCT) and consider a site visit. • Identify those requiring chemoprophylaxis and/or immunisation. • Provide information to all contacts and other persons involved. • Raise awareness and increase surveillance. • Provide adequate information to health care providers, affected communities, the media and the general public. • Monitor and evaluate control measures and prepare final report. -67-
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