Breadcrumbs

2019 Meningococcal Season Reminder

22 May 2019

  • 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.
  • Early recognition, immediate empirical treatment with parenteral benzylpenicillin or ceftriaxone, & urgent transfer to hospital can be life-saving.

Epidemiology

  • Notifications of IMD usually increase in winter and spring. IMD can occur in any age group, with peaks in children <5 years & young adults aged 15-24 years. Seven cases of IMD (4B, 2W & 1Y) have been notified in SA residents since January 2019, with 34 cases notified in 2018 (27B, 4W & 3Y).

Clinical features

IMD usually causes meningitis, septicaemia, or a combination of both. Symptoms are often non-specific: fever, headache, vomiting, photophobia, joint pains, neck stiffness, drowsiness & irritability. Septicaemia is more common than meningitis, with a greater mortality. A petechial or purpuric rash may be present, but can be atypical or absent in the early stages, & does not occur with meningitis if septicaemia is not also present. 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 <16 years, early signs of peripheral vascular shutdown (leg pain, abnormal skin colour & cold hands & feet) should heighten suspicion of IMD. Serogroup W cases can present in less typical ways (e.g. septic arthritis, pneumonia & epiglottitis) & are associated with delayed diagnosis & a higher case fatality rate.

If a patient with a non-specific febrile illness does not require hospital referral, the carer should be told to watch the patient & seek urgent 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.

Management before hospitalisation

  • Early recognition & treatment of IMD can be life-saving.
  • Take blood for culture & PCR, if possible before giving antibiotics, & send with the patient to hospital.
  • Immediately treat patients with suspected IMD with
    • benzylpenicillin 2.4 g (child: 60 mg/kg up to 2.4 g) IV or IM or
    • ceftriaxone 2 g (child 1 month or older: 50mg/kg up to 2 g) IV or IM.
  • Transfer the patient urgently to hospital by ambulance.
  • All GPs should have benzylpenicillin in their surgeries & emergency bags.

Notification of cases

  • Notify suspected cases to the Communicable Disease Control Branch (CDCB) urgently by phoning 1300 232 272 (24 hrs/7 days). Do not wait for laboratory confirmation. This enables rapid contact tracing & provision of clearance antibiotics to close contacts as soon as possible after diagnosis.

Vaccination

  • Free meningococcal B vaccine is available in South Australia for children aged 6 weeks to <4 years & adolescents aged 15 to <21 years.
  • Free meningococcal ACWY vaccine is given at 12 months of age with a catch-up through schools in Year 10 (adolescents 14-16 years), & through GPs for adolescents 15-19 years.

Further information

For all enquires please contact the CDCB on 1300 232 272 (24 hours/7 days)

Dr Louise Flood – Director,
Communicable Disease Control Branch

^ Back to top