2020 Meningococcal Season Reminder

09 June 2020 - 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).

COMMUNICABLE DISEASE 
CONTROL BRANCH
- Attention all doctors - 
Date: 09/06/2020   Contact telephone number: 1300 232 272  (24 hours/7 days)

 

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.

Public - 12-A2

Read the official Health Alert here


 

1 June 2020 - Congenital syphilis - a sentinel public health event

01 June 2020 - Congenital syphilis - a sentinel public health event

There is currently a multi-jurisdictional outbreak of infectious syphilis affecting rural and remote Aboriginal communities.
This outbreak extended into the Far North and Western regions of South Australia (SA) in November 2016 and then to
metropolitan Adelaide in 2018. A total of 111 outbreak cases have been notified in SA.

In April 2020 an Aboriginal woman presenting for her first antenatal visit at 22 weeks was diagnosed with infectious syphilis
and despite treatment delivered a child with congenital syphilis one week later. Congenital syphilis is a sentinel public health
event, indicating that quality of preventive and/or therapeutic medical care may require improvement.

COMMUNICABLE DISEASE 
CONTROL BRANCH
- Attention all doctors - 
Date: 01/06/2020   Contact telephone number: 1300 232 272  (24 hours/7 days)

 

Congenital syphilis - a sentinel public health event

01 June 2020 - Congenital syphilis - a sentinel public health event

There is currently a multi-jurisdictional outbreak of infectious syphilis affecting rural and remote Aboriginal communities. 
This outbreak extended into the Far North and Western regions of South Australia (SA) in November 2016 and then to 
metropolitan Adelaide in 2018. A total of 111 outbreak cases have been notified in SA.

In April 2020 an Aboriginal woman presenting for her first antenatal visit at 22 weeks was diagnosed with infectious syphilis 
and despite treatment delivered a child with congenital syphilis one week later. Congenital syphilis is a sentinel public health 
event, indicating that quality of preventive and/or therapeutic medical care may require improvement.

Syphilis in pregnancy can result in perinatal death, premature delivery, and congenital abnormalities. In SA, since
November 2016, seven cases of infectious syphilis have been detected in pregnant Aboriginal women, and two children have
been born with congenital syphilis.

Medical practitioners in the South Australia are advised to:

  • Ensure systems are in place to support the identification of Aboriginal and Torres Strait Islander patients in any part of
    South Australia (metropolitan, regional and remote).
  • Consider additional ways your clinic can provide culturally safe care and be aware of alternate local antenatal care
    providers where relevant.
  • Offer syphilis testing to Aboriginal and Torres Strait Islander people and their partners anywhere in South Australia:
    • If there is clinical suspicion of syphilis
    • As part of antenatal testing – in addition to testing at the first visit (10-12 weeks), repeat testing at 28 weeks,
      36 weeks, at delivery, and at the 6 week post-natal check
    • As screening in:
      • All sexually active patients
      • All women of reproductive age  
      • Gay, bisexual men and men who have sex with men
      • Highly mobile individuals
      • Anyone who is diagnosed with another sexually transmissible infection such as chlamydia, gonorrhoea
        ​or trichomonas (offer HIV testing as well)
      • Anyone aged 15-50 years who is having a blood test for another reason – e.g. during an adult health check,
        or emergency department presentation.
  • Ensure the patient’s contact details are current and correct for follow up of results, treatment and liaising with local
    Aboriginal Health services where possible.

After a diagnosis of syphilis in Aboriginal and Torres Strait Islander people

  • Seek assistance, if required, with interpretation of syphilis serology results. Contact the pathology laboratory undertaking
    the test, or the Adelaide Sexual Health Centre on 7117 2800, or the CDCB syphilis register on 1300 232 272.
  • Undertake treatment appropriate to the stage of syphilis. See guidelines available at https://bit.ly/3eaRvfS
  • Test and treat for syphilis on the same day of presentation for all people with genital ulcers – do not wait for a positive result.
  • Notify cases of syphilis to CDCB on 1300 232 272.
  • Facilitate treatment of sexual partners of patients with infectious syphilis. Controlling the outbreak requires sexual contacts
    of infectious cases to be located as soon as possible and then tested and treated on the same day, without waiting for positive
    results. CDCB syphilis register staff can assist with partner notification.

 

Dr Louise Flood – Director, Communicable Disease Control Branch
 

 

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