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)
Chapter 12.
Public Health Management of Clusters of Serious
Pneumococcal Disease
Key points
• Invasive pneumococcal disease (IPD) is a notifiable disease. Enhanced surveillance of IPD paediatric
cases is routinely undertaken.
• Individual cases IPD occurring in closed setting do not require public health control measures.
Chemoprophylaxis is not recommended for close contacts of individual cases of IPD.
• Rarely S. pneumoniae can cause clusters of serious disease. Clusters have been described in settings
such as hospitals, long term care facilities, prisons, military settings, hostels, child day care centres.
• Clusters of invasive pneumococcal disease (two or more cases in a closed setting in 14 days) should
be reported to the local department of public health immediately for further investigation.
• Control measures that may be required include: infection control measures, antibiotic
chemoprophylaxis, vaccination of close contacts.
12.1 Introduction
There is a limited evidence base for the management of clusters of severe pneumococcal disease. The following
guidance data relating to clusters of severe pneumococcal disease has been based on the HPA document “Interim
UK guidelines for the public health management of clusters of serious pneumococcal disease in closed settings”
(July 2008). 4
12.2 Definitions
A suspect cluster is defined as the occurrence of two or more cases of serious pneumococcal infection occurring in a
closed setting within a 14 day period (based on clinical, microbiological, epidemiological findings).
A confirmed cluster is defined as two or more confirmed cases (meeting case definition) of the same (or not yet
determined) serotype in a closed setting with onsets within a two week period.
A closed setting is defined as a setting where the individuals are normally in close contact with each other and
include the following settings: household, residential home, hospital ward, military establishment, prison, homeless
shelter, children’s day care centre and other similar settings.
Close contact is defined as an individual who has had significant contact with a cluster case in the closed setting.
The period of significant contact is from 48 hours before onset of symptoms in the case until completion of 24 hours
of systemic antibiotic treatment.
Significant contact may be either prolonged or transient. Prolonged contact is defined as either overnight or
daytime stay in the same closed setting.
Transient close contact is defined as when the mouth or nose is directly in contact with the large droplets or
secretions from the respiratory tract of a cluster case during the acute illness.
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