2020 Meningococcal Season Reminder

While COVID-19 dominates headlines, doctors need to remain alert for other significant infections.

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, and urgent transfer to hospital can be life-saving. All GPs should have benzylpenicillin in their surgeries and emergency bags.

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. Two cases of IMD (1B and 1Y) have been notified in SA residents since January 2020, with 27 cases notified in 2019 (19B, 4W & 4Y).

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 and 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 in the early stages, and does not occur with meningitis if septicaemia is not also present. Children may have clinical features not normally expected in an acute self-limiting illness, for example, poor eye contact, altered mental state, or pallor despite a high temperature. In children <16 years, early signs of peripheral vascular shutdown (leg pain, abnormal skin colour and cold hands and feet) should heighten suspicion of IMD. Serogroup W cases can present in less typical ways (e.g. septic arthritis, pneumonia and epiglottitis) and are associated with delayed diagnosis and a higher case fatality rate.

If a patient with a non-specific febrile illness does not require hospital referral, the carer should be told to watch the patient and 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 and treatment of IMD can be life-saving.
• Take blood for culture and PCR, if possible before giving antibiotics, and send with the patient to hospital.
• 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 and provision of clearance antibiotics to close contacts as soon as possible after diagnosis.

Vaccination

• Free meningococcal B vaccine is available in South Australia for children aged 6 weeks to ≤ 12 months and school students in Year 10.
• Free meningococcal ACWY vaccine is given at 12 months of age, through schools in Year 10 and through GPs for adolescents 15-19 years.

Further information

Invasive meningococcal disease — SA health
TG: Antibiotic — eTG complete
Meningococcal vaccines — SA Health

IMD can have serious health consequences or be fatal. Doctors are urged to provide or refer people for qualified counselling.

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