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

2. 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

4. 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.

5. 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

6. 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

7. 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.

9. 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.

10. 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

11. 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

12. 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.

14. 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

15. 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

17. Useful websites: Regional Public Health www.rph.org.nz
Ministry of Health New Zealand