1. An Update on Meningococcal Disease Dr Suzanne Cotter
World Meningitis Day
April 24th 2018
Dr Suzanne Cotter
Health Protection Surveillance Centre

2. Topic for today Invasive Meningococcal Disease (IMD)
What is it and who gets it ?
How is it transmitted?
Clinical presentation and urgent actions
Overall IMD trends in Ireland
Focus serogroup B and C disease (MenC and MenB)
Impact of meningococcal vaccines on IMD incidence
Concerns
Re-emergence of IMD serogroup C
Missed vaccination (MenC and MenB vaccines)

3. Invasive Meningococcal Disease (IMD)
Caused by N. meningitidis (meningococcus)
Gram negative diplocci
A, B, C, W, X ,Y most common serogroups
All age groups affected
Most common in young children and adults
Suspicion of IMD is a medical emergency
Immediate referral to hospital required
Diagnosis and serogroup identification by
Local hospital and national reference laboratory
National vaccination programme
MenC implemented since 2000
MenB implemented since 2016

4. Transmission of meningococcus
Person- person transmission
droplet spread (respiratory or throat secretions from carriers)
close and prolonged contact normally required
Household, child care, sexual, child house parties > 4 hours
Average incubation period
4 days (range 2 and 10 days)
Carriage
Asymptomatic carriage common
~10% to 20% of population carry organism in throat
Carriage rate may be higher in epidemic situations ,

5. Clinical presentation Meningocccal septicaemia
Meningitis
Meningocccal septicaemia
Stiff neck
High fever
Photophobia
Confusion
Headache
Vomiting
As for meningitis +/-
Fatigue
Cold hands and feet, cold chills
Aches/pain in muscles, joints, chest or abdomen
Rapid breathing
Diarrhoea (more common with MenW)
Haemorrhagic rash
Adverse outcomes
Case fatality ~ 5-10%
Other sequelae (~10%-20%); brain damage, hearing loss, learning disability, amputation ,

6. Surveillance IMD is a notifiable disease
by laboratories and clinicians
Director of Public Health (DPH)/Medical Officer of Health (MoH)*
Objectives of surveillance
Identify, control and protect case contacts
chemoprophylaxis +/-vaccination
Detect and confirm outbreaks
Monitor
incidence trends, incl. serogroup distribution
antibiotic resistance
impact of meningitis control strategies, particularly vaccination programmes
*in local Departments of Public Health

7. Invasive Meningococcal Disease Serogroup distribution, 2018 –
B, C, Y,
Map Production: WHO Health Emergencies
Data Source: World Health Organization
SEROGROUP
boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may
of any opinion whatsoever on the part of the World Health Organization concerning the legal status of
not yet be full agreement.
The boundaries and names shown and the designations used on this map do not imply the expression
SEROGROUP
Most frequent
Programme W
B, C, W Y
B, C, W,
B, W,
C, W W
B, C, Y
B, C, W
A, C , A A
© WHO All rights reserved.
Less frequent
Invasive Meningococcal Disease
Serogroup distribution, 2018 – B,
C, W, X,
Map date: 16/02/2018
any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or

8. Rates of invasive meningococcal disease reported cases, EU/EEA, 2015
Source:

9. Bacterial meningitis notifications by organism, Ireland, 1999-2017*
Source: CIDR; *2017 data provisional

10. IMD by serogroup, year of vaccine introduction,*
Source: CIDR; *2017 data provisional

11. MenC as % all IMD, by age and year, 1999-2017*
Source: CIDR; *2017 data provisional

12. MenC cases by MenC vaccination status, age group, Ireland. 2016 & 2017
MenC cases by MenC vaccination status, age group, Ireland & 2017* (n=51)
Source: CIDR; *2017 data provisional

13. MenB notifications (number and CIR**) by age groups and year, 1999-2017*
Source: CIDR; *2017 data provisional
**CIR; Crude incidence rate (per 100,000 pop.)

14. Summary Overall significant decrease in all IMD since 2000
MenB and MenC most common IMD serogroups in Ireland
MenC disease
Rapid decline following introduction of MenC vaccine
Recent emergence of concern
Occurring among age groups targeted for vaccine
Indication of increased carriage in community
MenB disease
Introduction of MenB vaccine will prevent cases in children
Full impact to be monitored

15. Resources HSE HPSC Guidelines for the Early Clinical and Public
Approval Date
Document Purpose
Revised
Responsibility for Review and Audit
Document Developed by
Revision Number
Document Approved by
Target Audience
Contact Person
Title
Chapter 9. Chemoprophylaxis. Recommendations regarding chemoprophylaxis use of ciprofloxacin.
Note: The November 2016 revised edition includes updates to the following sections:
Chapter 4. Invasive pneumococcal Disease case definition-updated
Chapter 7. Public health management of sporadic cases of meningococcal disease. Updates to vaccines
available and recommended in Ireland, including Meningococcal B vaccine.
Health Management of Bacterial Meningitis
Guidelines for the Early Clinical and Public
(including Meningococcal Disease)
Web:
Health Protection Surveillance Centre
Dr Suzanne Cotter
Health Protection Surveillance Centre 3
Scientific Advisory Committee,
Committee, HPSC
January 2012
Hospitals, Departments of Public Health, HPSC
November 2016
Bacterial Meningitis Sub-Committee of the Scientific Advisory
Health care staff dealing with patients where a diagnosis of
(and meningococcal disease) in primary care and at hospital
level
To promote best practice management of bacterial meningitis
of bacterial meningitis (including meningococcal disease)
bacterial meningitis or septicaemia is suspected
To standardise practice
Guidelines for the early clinical and public health management
To ensure that GPs, hospital and public health clinicians are
To act as an educational tool
To act as a basis for audit and evaluation
clear on roles and responsibilities
Report of the Scientific Advisory Committee of HPSC
Resources
HSE HPSC
Guidelines for the Early Clinical and Public
Health Management of Bacterial Meningitis
(including Meningococcal Disease)
FAQs on bacterial meningitis and IMD
Quarterly reports on bacterial meningitis
European Centre for Disease Prevention and Control (ECDC)
Meningococcal disease
WHO – Meningococcal disease
Guidelines for the Early Clinical and Public Health Management of Bacterial Meningitis (including Meningococcal Disease)
Guidelines for the Early Clinical and Public Health Management of Bacterial Meningitis (including Meningococcal Disease)
Published: January 2012
Document c
ontrol
Revised: November 2016
-2-

16. Acknowledgements Clinicians, nurses and hospital laboratories
Irish Meningitis and Sepsis Reference Laboratory (IMSRL)
Departments of Public Health
Dr Piaras O’Lorcain, Surveillance Scientist, HPSC