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Meningococcal Disease – Prevention &
Control
Classification: Policy
Lead Author: Dr Adam Jeans
Additional author(s): N/A
Authors Division: Clinical support & tertiary medicine
Unique ID: TC26(08)
Issue number: 3.1
Date approved: May 2016
Contents
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5
5.1
5.2
5.3
5.4
5.5
6
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Section
Page
Who should read this document
Key points
Background/ Scope
What is new in this version
Policy
Management of a suspected or confirmed case of meningococcal
disease during period of infectivity
Notification and Contact Tracing
Antibiotic prophylaxis
Prophylaxis for Health Care Workers involved in the care of the
patient
Immunisation
Explanation of terms/ Definitions
References and Supporting Documents
Roles and Responsibilities
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3
3
3
Document control information (Published as separate document)
Document Control
Policy Implementation Plan
Monitoring and Review
Endorsement
Equality analysis
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1. Who should read this document?
All clinical staff
Health & Wellbeing staff
2. Key Messages

Suspected or confirmed cases of meningococcal disease should be
nursed in a single room for the first 24 hours of antibiotic treatment.

Gloves and plastic aprons should be worn during patient contact. Fluid
resistant face masks and goggles/visors should also be worn when there is
a risk of contact with a patient’s respiratory secretions.

Public Health England (PHE) Greater Manchester Health Protection Team
(GM HPT) should be notified urgently by telephone of any probable or
confirmed cases of meningococcal disease. They will determine the need
for antibiotic prophylaxis for contacts and arrange this by liaising with
hospital staff and General Practitioners.
3. Background & Scope
Meningococcal disease occurs as a result of a systemic bacterial infection by
the meningococcus, Neisseria meningitidis. Six meningococcal capsular
groups (A, B, C, W, X and Y) distinguished by their polysaccharide capsule
cause almost all invasive infections in humans.
Infection most commonly presents as either meningitis or septicaemia, or a
combination of both. The incubation period is usually from three to five days
and the onset of disease varies from fulminant with acute and overwhelming
features, to insidious with mild prodromal symptoms.
Meningococci colonise the nasopharynx of humans and are frequently
harmless commensals. Between 5 and 11% of adults and up to 25% of
adolescents carry the bacteria without any signs or symptoms of the disease.
In infants and young children, the carriage rate is low. Conversely, carriage of
Neisseria lactamica, a non-pathogenic organism believed to confer protection
against meningococcal disease,
is highest in young children.
Transmission
Transmission is by aerosol, droplets or direct contact with upper respiratory
tract secretions of someone carrying the organism. Transmission usually
requires either frequent or prolonged close contact. The organism dies quickly
outside the host.
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Fewer than 2% of invasive meningococcal disease cases are considered to
result from close contact with a primary case. Most cases are likely to have
acquired the invasive strain from a close contact who is an asymptomatic
carrier.
Close contacts in a household setting have the highest risk of secondary
infection following an index case, where the absolute risk of developing
invasive infection within 30 days is 1 in 300 if antibiotic prophylaxis is not
administered. The risk is highest in the first seven days after a case and falls
rapidly during the following weeks. Administration of antibiotic prophylaxis to
eliminate meningococcal carriage and subsequent transmission among close
contacts has been shown to reduce the risk of secondary cases in close
contacts by up to 89%.
Period of Infectivity
The patient is considered to be infectious from the onset of the acute illness
until completion of 24 hours treatment with appropriate systemic
antibiotics.
4. What is new in this version?
References updated
Prophylaxis, immunisation, notification and background sections expanded
5. Policy
5.1 Infection control management of a suspected or confirmed case of
meningococcal disease during period of infectivity

The patient should be nursed in a single room until completion of 24
hours treatment with appropriate systemic antibiotics.

Contact and airborne precautions should be taken (see Protective and
Source Isolation Policy). Gloves and plastic aprons should be worn during
patient contact and handwashing performed before and afterwards.

Healthcare workers (HCWs) will avoid exposure to infectious respiratory
droplets by wearing fluid resistant face masks and goggles/visors in the
following situations:



Airway management during resuscitation
Endotracheal intubation
Whenever there is a risk of secretions splashing into the face or
eyes
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
During nasopharyngeal/tracheal suction ("closed" suction should be
used whenever practicable)
5.2 Notification and Contact Tracing

Public Health England (PHE) Greater Manchester Health Protection Team
(GM HPT) should be notified urgently by telephone of any probable or
confirmed cases of meningococcal disease. A probable case is defined as
a clinical diagnosis of meningitis, septicaemia or other invasive disease
where meningococcal infection is considered the most likely diagnosis,
usually because of the presence of a meningococcal rash.

GM HPT is responsible for identifying contacts and arranging appropriate
prophylaxis and immunisation by liaison with hospital clinicians and
General Practitioners.

Contact GM HPT on 0344 225 0562 option 3 then option 1. Out of hours
contact Health Protection on-call via Tameside General switchboard on
0161 331 6000.

The responsible clinician should also complete a written notification form
and send to GM HPT (see Notification of Infectious Diseases &
Contamination Policy).
5.3 Antibiotic prophylaxis

Antibiotic prophylaxis to eliminate carriage may be indicated for those who
have had prolonged close contact with the case in a household type
setting during the seven days before onset of illness. GM HPT will advise
on who should receive this.

Antibiotic prophylaxis should be given as soon as possible (ideally within
24 hours) after the diagnosis of the index case, but if delayed is still
indicated for up to four weeks.

Ciprofloxacin 500 mg as a single dose is recommended for prophylaxis in
adults.1 Rifampicin 600 mg orally twice daily for 2 days is an alternative
regimen. Refer to the British National Formulary (BNF) for
contraindications/cautions and dosing in children or patients with renal or
hepatic dysfunction.

In pregnancy, either ceftriaxone 2g IM single dose, azithromycin 500mg
single oral dose or ciprofloxacin 500mg single oral dose can be used as
chemoprophylaxis.1

Cases of meningococcal disease are normally treated with ceftriaxone and
consequently do not require additional treatment to clear throat carriage.
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However, cases that are treated with alternative antibiotic agents, including
cefotaxime, should receive prophylaxis in addition.1
5.4 Antibiotic prophylaxis for Healthcare Workers involved in the care of
the patient

General medical or nursing care of cases is not an indication for
prophylaxis. Antibiotic prophylaxis is recommended only for those whose
mouth or nose is directly exposed to large particle droplets/secretions from
the respiratory tract of a probable or confirmed case of meningococcal
disease before 24 hours of systemic antibiotic treatment has been
completed.

The risk of significant exposure is minimised by the use of surgical face
masks when carrying out airway management procedures. Antibiotic
prophylaxis should therefore rarely be necessary for healthcare workers,
but is indicated for:

Those who have carried out mouth to mouth resuscitation on the
patient

Those whose mouth or nose has been directly exposed to
respiratory droplets/secretions when not wearing a face mask. In
practice this implies a clear perception of facial contact with
droplets/secretions.

Exposure of the eyes to respiratory droplets is not considered an indication
for prophylaxis, but may carry a low risk of meningococcal conjunctivitis
and subsequent invasive disease. Staff should be counselled about this
risk and advised to seek early treatment if conjunctivitis should develop
within 10 days of exposure.

Advice on the case management of exposed HCWs will be given by the
Infection Control Team, GM HPT and Health & Wellbeing (Occupational
Health) after risk assessment.

In the event that the index case is a healthcare worker a risk assessment
will be performed by the Infection Control Team in conjunction with GM
HPT and Health & Wellbeing. Antibiotic prophylaxis is not usually indicated
for patient or staff contacts of such cases, but the threshold for giving
prophylaxis will be lower for immunocompromised contacts who may be at
increased risk of invasive disease.
5.5 Immunisation

All Microbiology laboratory staff will be offered meningococcal vaccination
in accordance with the policy for Immunisation of Laboratory Staff.
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
Routine vaccination of other staff is not recommended.
Immunisation may be indicated as part of the management of index cases and
their close contacts, once the serogroup of the organism is known:

Group B meningococcal vaccination (Bexsero®) is not routinely given as
post exposure prophylaxis to household contacts or to staff contacts. It
may be offered to close contacts when a cluster of cases of serogroup B
infection has occurred. MenC conjugate or the quadrivalent MenACWY
conjugate vaccine may be offered to close prolonged contacts when
infection with a capsular group other than B has been confirmed. GM HPT
will advise on the vaccination of contacts.

Healthy individuals should develop natural immunity after invasive group B
meningococcal disease and second episodes in the same individual are
rare. Additional vaccination is, therefore, unlikely to afford any added
protection after infection. Index cases should only be immunised with
Bexsero® if they have a medical condition for which immunisation is
indicated (i.e. asplenia, splenic dysfunction or a complement disorder) and
they were previously unimmunised or only partially immunised with
Bexsero® (see Prevention of infection in patients with an absent or
dysfunctional spleen policy for vaccination schedule).

Any unimmunised index case under the age of 25 years (whatever the
capsular serogroup) should be offered vaccination according to the
national schedule. Cases of confirmed serogroup C disease who have
previously been immunised with MenC conjugate (or polysaccharide)
vaccines should be offered a booster dose of MenC conjugate vaccine or
the quadrivalent MenACWY conjugate vaccine around the time of
discharge from hospital.

Index cases of serogroup C disease who are in the known risk-groups for
meningococcal disease (asplenia, splenic dysfunction, complement
disorders) and have not been immunised with the quadrivalent MenACWY
conjugate vaccine should complete the recommended immunisation
course, whilst those who received the quadrivalent MenACWY conjugate
vaccine more than 12 months previously should receive an extra dose of
the quadrivalent MenACWY conjugate vaccine.
6. Explanation of terms & Definitions
Terms explained in document.
7. References and Supporting Documents
1. Health Protection Agency. Guidance for public health management of
meningococcal disease in the UK. February 2011, updated March 2012.
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www.gov.uk/government/publications/meningococcal-disease-guidanceon-public-health-management
2. Public Health England. Preventing secondary cases of invasive
meningococcal capsular group B (MenB) disease. Version 1.1, April 2014.
www.gov.uk/government/publications/invasive-meningococcus-capsulargroup-b-menb-preventing-secondary-cases
3. Department of Health. Immunisation against infectious disease.
Meningococcal chapter update September 2015.
www.gov.uk/government/publications/meningococcal-the-green-bookchapter-22
4. Department of Health. Immunisation against infectious disease. UK
immunisation schedule.
www.gov.uk/government/publications/immunisation-schedule-the-greenbook-chapter-11
8. Roles and responsibilities
The Executive Director of Nursing & Director of Infection Prevention and
Control (DIPC) on behalf of the Chief Executive will ensure that the Clinical
Directors, Senior Nurses and Matrons take clinical ownership of the policy.
The Clinical Directors, Senior Nurses and Matrons on behalf of the Executive
Director of nursing will ensure that all health care workers comply with this
policy.
The Infection Control Team will:
 Act as a resource for information and support
 Monitor the implementation of this policy within clinical areas
 Regularly review and update the policy
 Partake in contact tracing with Public Health England Greater Manchester
(PHE GM)
The Health & Wellbeing (Occupational Health) Team will:
 Act as a resource for information and support of staff
 Assist in the treatment of staff contacts as identified by PHE GM and the
Infection Control Team
The responsible Clinician will:
 Follow the Trust Antibiotic Policy for the treatment of meningitis and liaise
with the Microbiologist about treatment
 Inform PHE GM immediately by telephone
 Complete a written notification form and send to PHE GM
 In liaison with PHE GM, provide antibiotics for household contacts of a
case
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The Nurse in Charge of the patient will:
 Inform the duty Infection Control Nurse of a patient suspected of having
meningococcal meningitis/septicaemia
 Initiate the specific infection control precautions required as stated in the
policy
 Ensure that all relevant staff are informed of the need to follow these
specific infection control precautions during the period of infectivity
All Trust staff including all clinicians will:
 Comply with the Meningococcal Disease – Prevention and Control policy
 Inform the Infection Control Team of any issues or concerns relating to the
policy
 Inform the Infection Control Team of any identified or suspected case of
meningococcal meningitis/septicaemia
The GM HPT Staff will:
 Identify close contacts and where appropriate arrange appropriate
prophylaxis and/or immunisation, by liaison with hospital clinicians and
General Practitioners.
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