Transcript Not a case - Regional Public Health

Public Health follow up of
Meningococcal Disease
Charlotte McDonnell
Public Health nurse
Our Team
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7 x Public Health Nurses ( 1 based in Wairarapa)
1 x Clinical Nurse Specialist
1 x Team Leader
4 x Medical Officers of Health
1 x Medical Officer and 1 x Registrar
• 3 x Technical Officers
Transmission and Carriage
Transmission is by direct contact with the respiratory
droplets or saliva from the nose and throat of a person who
is carrying the bacteria.
Most people who come into contact with the bacteria do not
become ill. Babies, young children, teenagers and young
adults are more likely to be affected.
Approximately 5-15% of healthy people can be carriers of
meningococcal bacteria that live in the nose and throat
without entering the body and causing illness.
The incubation period is between 2-10 days but usually 3-4
days. The case is infectious until they have completed 24
hours of antibiotics.
Classification of a case
• Under Investigation: A case that has been
notified but information is not yet available to
classify it as probable or confirmed.
• Probable: A clinically compatible illness
• Confirmed: A clinically compatible illness that is
laboratory confirmed.
• Not a case: A case that has been investigated and
subsequently found to not meet the case
definition
• All cases are notifiable to Regional Public Health
upon suspicion
Laboratory confirmation requires at least
ONE of the following:
• Isolation of Neisseria Meningitidis bacteria or
detection of its nucleic acid from bloods, CSF or
other normally sterile site ( eg. Pericardial or
synovial fluid).
 Detection of gram negative intracellular
diplococci in blood , CSF or skin petechiae
Public Health management of a case
• Notification received via ED, GP, laboratory, self
notify
• MOH reviews case history.
• PHN assigned to case
• Contact management plan established by MOH in
liaison with PHN
• Case interview conducted by PHN
• High risk contacts established and
chemoprophylaxis given accordingly, in liaison
with MOH.
Public Health Focus
• Investigation of case and follow up of contacts
• Respiratory droplet isolation
• Eradication of carriage
• Counselling: potential short term and long term
consequences of infection.
Public health management of contacts
• Identify people at risk who have had contact with
the case 7 days preceding onset of illness until 24
hours after onset of antibiotics
Close Contacts versus Social contacts
• Close Contacts: anyone who has slept overnight
in the same household, dormitory as the case or
who has been in a seat adjacent to the case in a
plane, bus or train for more than 8 hours
• Health Care workers: unprotected contact with
URT secretions during intubation, resuscitation or
close examination of oropharynx
• Exchange of URT secretions eg intimate kissing
• NOT: kissing on cheek, mouth, sharing of food or
drink
Chemoprophylaxis
• Antibiotic prophylaxis is ideally to be given within
24 hours of diagnosis
• Purpose is to eradicate the carriage of bacteria
and prevent transmission to other people.
• It will not stop development of disease if already
exposed.
Chemoprophylaxis and Vaccination
• Rifampicin oral twice daily for 2 days
• Ciprofloxacin oral 500mg stat ( drug of choice for
women on oral contraceptive pill and for
prophylaxis of large groups of people).
• Ceftriaxone IM ( if pregnant or breastfeeding)
• Free vaccine for contacts of a case with vaccine
preventable strains: A,C, W135, Y
Protection against Meningococcal
Disease
• Education
 Get help ASAP. Go back to GP or ED if person
deteriorates
• Check frequently on unwell people
• Consider Vaccination for high risk groups
Useful websites:
• Regional Public Health
• www.rph.org.nz
• Ministry of Health New Zealand
• www.health.govt.nz