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)
ii. Communication with health care professionals
The health care professionals (GPs, emergency medicine consultant, other hospital clinicians) in the area should
be updated on the situation and asked to refer and report any suspect cases immediately. Communications
should highlight the importance of early diagnosis, empirical treatment and prompt notification of suspect cases.
Emergency department physicians and other clinicians seeing patients should be advised to collect blood cultures
and throat swabs before administration of the first dose of antibiotics if possible. Treatment and referral should never
be delayed if specimen collection cannot be rapidly taken. Hospital clinicians are encouraged to take throat swabs
as well as blood cultures from persons suspected of having meningococcal disease as prior antibiotic therapy may
render blood and CSF cultures sterile.
Advice relating to pre-admission antibiotics is discussed in the section on clinical management.
iii. The community at large
Disseminating information to the community may require use of mass media, websites, community meetings and
help lines.
iv. The media
The outbreak control team should agree on a single spokesperson who is experienced in dealing with the media. A
senior experienced spokesperson is usually best suited to this role.
8.6 Response related to specific settings
8.6.1 Setting based outbreaks
Populations at risk in closed settings such as schools and crèches/preschool facilities are usually relatively easily
defined. However, identification of populations at risk in other larger settings (e.g. universities) with less defined
networks and close contacts may be more difficult.
When two or more cases are reported from an educational setting, public health should undertake a careful and
rapid assessment of the apparent cluster. The review should include the following;
• The clinical features of the cases
• Microbiological data (serogroup and subtype)
• Dates of illness onset and dates of last attendance at the site
• Epidemiological links between cases (age, class or school year, home address, social activities, friends)
• Numbers of students in the school and in each school year
• The public health management options include
o Giving information out to students/staff/parents only
o Giving out information and offering wider prophylaxis in the school or education setting.
If following investigation it is considered that the cases do not meet the case definition for meningococcal disease,
further action may not be indicated.
8.6.2 Public health action
Chemoprophylaxis
In responding to setting specific outbreaks, chemoprophylaxis is considered for a wider group than solely close
contacts even though the evidence to support the use of chemoprophylaxis to prevent further cases is not strong. The
target group should be a discrete group that contains the cases and makes sense to staff/parents/students. Once a
specific group is identified prompt action is recommended.
Close contacts should be provided with chemoprophylaxis as for sporadic cases (see Section 7.2 on
chemoprophylaxis following exposure).
Co-primary or secondary cases who are identified as being close contacts of the index case are assumed (unless
microbiological evidence is to the contrary) to have acquired their disease as a result of this close householdlike
contact. Such cases are not counted when deciding whether to offer setting based chemoprophylaxis (other
than in childcare settings). For example, two probable cases in university students in the same class who share
accommodation are assumed to been exposed in a household-like setting of the shared accommodation rather than
in class. 3
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