2021 Meningococcal Season Reminder

02 June 2021

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. All GPs should have benzylpenicillin in their surgeries and emergency bags.

There have been 4 cases of IMD notified in SA year to date in 2021 (2 B, 2 W) with one death. In 2020 and 2019, there were five (3 B, 2 Y) and 27 (19 B, 4 W, 4 Y) notifications of IMD, respectively.

Notifications of IMD usually increase in winter and spring. IMD can occur in any age group, with peaks in children less than 5 years and young adults aged 15-24 years.

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. Children may have clinical features not normally expected in an acute self-limiting illness, e.g. irritability, drowsiness, 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 atypically (e.g. septic arthritis, pneumonia & epiglottitis).

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

  • Be alert for IMD. Early recognition & treatment of IMD can be life-saving.
  • Take blood for culture & PCR, if possible prior to antibiotics, & send with the case to hospital. Do not delay commencement of antibiotics.
  • 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.
  • Notify suspected cases to 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.
  • IMD can have serious health consequences or be fatal. Doctors are urged to provide or refer people for qualified counselling.

Vaccination

  • State funded meningococcal B vaccine is available in South Australia for children aged 6 weeks to ≤ 12 months, & school students in Year 10 (who are SA residents with a Medicare card).
  • National Immunisation Program (NIP) meningococcal ACWY vaccine is available for children aged 12 months of age, school students in Year 10, & through GPs for adolescents 15-19 years.
  • NIP meningococcal ACWY & B vaccine is also available for people with specific medical conditions: see the Australian Immunisation Handbook for more details.

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
Public – I4-A1