2011 Meningococcal Season Reminder

6 May 2011

• Invasive meningococcal disease (IMD) should be considered in the differential diagnosis of any systemic febrile illness in any age group.
• A rash is not always present, especially in the early stages of the disease.
• Early recognition, immediate presumptive treatment with parenteral benzylpenicillin and urgent transfer to hospital can be life-saving.
• Urgent notification to the CDCB on suspicion of IMD enables a timely public health response.

Epidemiology

Notifications of invasive meningococcal disease (IMD) usually increase in winter and spring. The age distribution of IMD cases shows peaks in children less than five years and young adults aged 15 to 24 years. In South Australia, serogroup B is the predominant strain causing IMD. Since January 2011, six cases of IMD have been notified, compared to 9 cases at the same time in 2010. In 2010 a total of 28 cases were notified.

Notification of Cases

The Communicable Disease Control Branch (CDCB) must be notified urgently by phoning 1300 232 272 (24 hrs/7 days) when IMD is suspected. Do not wait for laboratory confirmation. This enables contact tracing, clearance antibiotics and vaccination, if needed, as soon as possible after diagnosis.

Clinical Features

Symptoms of IMD may be non-specific and include fever, rigors, headache, vomiting, photophobia, joint pains, drowsiness and irritability. Meningococcal septicaemia is more common than meningitis and has a greater mortality. A petechial or purpuric rash may be present, but in the early stages of IMD the rash may be atypical or absent, and may not occur with meningitis. Children may have clinical features not normally expected in an acute self-limiting illness, for example, poor eye contact, altered mental state, or pallor despite a high temperature. In children under 16 years, early signs of peripheral vascular shutdown (leg pain, abnormal skin colour and cold hands and feet) should heighten suspicion of meningococcal disease.

If a patient with a non-specific febrile illness does not require hospital referral, the carer should be told to watch the patient and seek urgent and immediate help if the patient deteriorates in any way, especially if a rash develops. A medical review may be urgently required at any time, even within hours of the initial consultation, as IMD can be associated with rapid clinical deterioration.

Early management

Early recognition and treatment of IMD can be life saving. Patients suspected of having IMD should be treated immediately with parenteral benzylpenicillin (preferably intravenously, otherwise intramuscularly) followed by urgent ambulance transfer to hospital. All general practitioners should have benzylpenicillin in their surgeries and emergency bags ready for immediate use. The doses are:

• Children aged up to one year: 300 mg
• Children aged one to nine years: 600 mg
• Adults or children aged 10 years or over: 1200 mg

Support services

In some cases meningococcal infection will have serious health consequences or can be fatal. Doctors are urged to provide appropriate counselling or refer people to suitably qualified counsellors. Other useful resources include community networks such as Meningococcal Australia Inc and the Paige Weatherspoon Foundation.

Further Information

Guidelines for the early clinical and public health management of meningococcal disease in Australia are available on the Department of Health and Aging website. A GP desktop card and an Emergency Department poster can be downloaded from the Public and Environmental Health website.