Transcript Meningitis Presentation

MENINGOCOCCAL
DISEASE & PREVENTION
Dr Deb Wilson
Consultant in Communicable Disease Control
2001
Neisseria meningitidis
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gram negative diplococci
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throat carriage - varies with age
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Neisseria lactamica carriage thought to be protective
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systemic immunity or invasive disease usually develop within
a week of acquisition
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the length of carriage after acquiring meningococci varies
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transmitted by prolonged person to person spread through
droplets or respiratory secretions
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serogroups - A, B, C, W135, Y
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no environmental or animal reservoir
Meningococcal Disease
•Meningitis
•Septicaemia
•Conjunctivitis
•Septic Arthritis
•10% mortality rate ?20% in septicaemia
• sequelae - amputations, deafness, brain
damage, fits
Signs and symptoms
Meningitis
Septicaemia
Headache
Fever
Tachycardia
Photophobia
Muscle &
joint pains
Tachypnoea
Altered
consciousness
Neck
stiffness
Nausea &
vomiting
Cold hands &
feet
Rash
Pre-admission penicillin
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On suspicion of meningococcal disease give preadmission benzyl penicillin - saves lives
preferably i.v. but i.m. if access is difficult
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adults and children over 10
children aged 1 - 9 years
infants
1.2 g
600 mg
300 mg
alternatives if history of penicillin allergy are
chloramphenicol or cefotaxime
pre-admission treatment pack
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drugs
information
Diagnosis
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Clinical
Microbiological
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blood cultures
CSF microscopy & culture
throat swab
PCR on blood or CSF
serology
skin scrapings - microscopy & culture
Epidemiology

approximately 2500 cases and 250 deaths each
year in England & Wales
seasonal variation
increase in disease 1995 onwards, especially C
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incidence in County Durham & Darlington is
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10 per 100,000 per year
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incidence highest in under 5s and teenagers
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can occur at any age
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serogroup B causes 70% deaths in under 5s
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serogroup C causes 80% deaths in teenagers
Incidence in contacts of cases
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Relative Risk in household contacts of cases 5001200 X population risk
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RR in school contacts ?30 X population - highest
RR in nursery schools, lowest RR in secondary
schools
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secondary cases mainly occur in 7 days following
the index case
Roles and responsibilities
Recognise
symptoms and
seek help
Make clinical
diagnosis
Deal with worries of:
contacts
CASE
public
schools, colleges &
nurseries
workplace
media
Monitor who is getting
disease, where, trends
etc.
Confirm
microbiological
diagnosis
Treat
the case
Prevent linked
cases
Confirmed, Probable or
Possible
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cannot wait for microbiology before contact tracing
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Confirmed case
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Probable case
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microbiological confirmation with clinical diagnosis
signs and symptoms of meningococcal disease and
this the most likely diagnosis
Possible cases
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some signs and symptoms of meningococcal disease
but another diagnosis is as likely or more likely
Contact Tracing
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Defined by CCDC (or PHN)
Only contact trace confirmed or probable cases
Close contacts in 7 days before index case unwell
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usual household members
stayed under same roof
boyfriend / girlfriend (intimate kissing)
Not
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close contacts
sharing crockery
social kissing
contacts of contacts
healthcare workers (unless mouth to mouth)
Close contacts need….
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Information about signs and symptoms to increase
vigilance
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Antibiotic prophylaxis
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Vaccine
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a.s.a.p.
rifampicin or ciprofloxacin (unlicensed)
only if case is confirmed serogroup C (or A, W135 or
Y)
Hospital & primary care roles re antibiotic
prophylaxis
Clusters in schools, colleges
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Single cases in school/college - offer information
only to school, no prophylaxis
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Two confirmed or probable cases that are due to the
same organism (or could be due to the same
organism)
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offer information
offer antibiotic prophylaxis +/- vaccine to whole
school - or relevant group
Laboratory Confirmed Cases of Serogroup C Meningococcal Disease
England & Wales - Cumulative Cases aged 15 to 17 years old
160
Cumulative Cases 1998/1999
140
Cumulative Cases 1999/2000
120
Cumulative Cases 2000/2001 (to week
2000/51)
Immunisation with serogroup C
conjugate vaccine in 15 - 17 yr olds
began on 1 November 1999
80
60
40
20
week no (totals from mid-year)
53
51
49
47
45
43
41
39
37
35
33
31
29
27
25
23
21
19
17
15
13
11
9
7
5
3
0
1
no of cases
100
CONJUGATE VACCINES
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conjugation - coupling of the polysaccharide antigen to a
conjugate (e.g. protein) can overcomes the problem of
lack of serological response to bacterial capsules
Hib vaccine was the first conjugate vaccine dramatic
reduction in invasive Hib disease in children
?pneumococcal conjugate vaccine next
Bacterial Capsules
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polysaccharide capsule
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helps avoid ingestion of the bacteria by phagocytes
prevents complement system being activated
young children, the elderly and the immunocompromised
are unable to mount a serological response to the capsule
of bacteria - including pneumococci, meningococci and
haemophilus influenzae
some capsule polysaccharides mimic host
polysaccharides, thus protecting themselves
 an issue with serogroup B meningococci
spleen is important with capsulate bacteria - intrasplenic
phagocytosis