Public Health follow up of Meningococcal Disease Charlotte McDonnell Public Health nurse

Our Team 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