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Procedure for Managing Cases of Meningitis

contact: Denise Long, Director of Student Support and Wellbeing

Procedure

Meningitis

Meningitis is an inflammation of the membranes that cover the brain.

It can be caused by infection with either viruses or bacteria.

  • Viral meningitis is the most common. It is normally a mild illness for which there is no specific treatment and recovery is usually complete.
  • Bacterial meningitis is most often caused by a pneumococcus or meningococccus organism. The pneumococcal disease affects mainly infants, the elderly and people with immunodeficiency or chronic disease. It does not usually spread from person to person. Meningococcal disease is spread from person to person by prolonged, intimate contact. The bacterium is carried in the nose and throat of about 10% of the population in general and 20% of young people. Only rarely does this carriage of the bacterium give rise to disease. It is not known why some people carry the organism without illness while a few acquire the disease. The bacterium does not survive for long outside the body which is why spread is by intimate contact between people. Cases of the disease occur sporadically but clusters occur in households, schools and colleges. The infection may affect the brain (meningitis) but may also enter the blood stream (meningococcal septicaemia). The disease is fatal in about 10% of cases.

Clinical diagnosis is based on the following symptoms and signs:

  • headache
  • photophobia [dislike of bright light]
  • neck stiffness
  • high temperature
  • vomiting
  • reduced consciousness
  • characteristic rash

Laboratory tests are required to confirm the diagnosis but public health action may be required as soon as there is a strong suspicion of meningococcal disease and may be taken before full test results are complete.

Laboratory tests will reveal the strain of the meningococcus causing the disease. Group B meningococci cause most disease [60-65% of cases] and no vaccine is yet available for this group. Group C causes 35-40% of cases and is more likely to be the cause of outbreaks in young people. There is a vaccine for group C which takes about 7 days to become effective and protects for three to five years.

An individual who contracts the disease will be admitted to hospital and treated with antibiotics.
To prevent spread, close contacts of the person with the disease are given antibiotics [ciprofloxacin or rifampicin] orally. As the disease does not easily spread from person to person, wide-scale preventative measures are not usually necessary. Antibiotics are the principle means of prevention. In outbreaks of group C disease vaccination may be offered on the advice of the local Consultant in Communicable Disease Control.

Procedures

The procedures for dealing with meningococcal disease at University College London have been approved by Academic Committee and the Health and Safety Management Team.

The outbreak control group comprises:

  • The local Consultant in Communicable Disease Control
  • One of the UCL Student Health Practice partners (‘the Student Health Physician’ hereafter)
  • The Director of Student Support and Wellbeing
  • The Education and Campaigns Officer of UCL Union
  • The UCL Press Officer

Notification, Reporting and Duties

The doctor attending a case of meningococcal disease or a suspected case has a duty to report immediately, by telephone, to the Consultant in Communicable Disease Control (CCDC) during office hours or to the on-call public health doctor out-of-hours.

In office hours, the CCDC will inform the Student Health Physician at UCL.

In office hours, the Student Health Physician will inform the Director of Student Support and Wellbeing.

Out-of-hours, the duty public health doctor will inform the Communications Centre of UCL via the main UCL telephone number. The Communications Centre will inform the Director of Student Support and Wellbeing or her/his deputy.

All reporting must take place without delay

Responsibilities of CCDC

  • Inform the UCL Student Health Physician and liaise with the Gower Place Practice.
  • Inform and liaise with the Director of Student Support and Wellbeing or her/his deputy out-of hours.
  • Obtain details of all close contacts and decide who needs to be issued with preventive antibiotics and offered vaccine.
  • Arrange for close contacts to be alerted and issued with preventive antibiotics and offered vaccine.
  • Inform and alert the general practitioners of all close contacts who are treated.
  • Provide information and advice to UCL.
  • Obtain further advice where two or more cases occur.
  • Convene, where appropriate, the outbreak control group in consultation with colleagues.
  • Consider activating UCL help-line, out-of-hours.

Student Health Physician

  • Inform and liaise with the Director of Student Support and Wellbeing or her/his deputy.
  • Inform and provide advice to the relevant head of department, warden or residence manager.
  • Inform UCL Switchboard during office hours.
  • Liaise with the CCDC or duty public health doctor.
  • Alert relevant general practitioners.
  • Provide information and advice to students attending the Gower Place Practice.
  • Participate as a member of the outbreak control group.
  • Consider the activation of out-of-hours help-line.

Director of Student Support and Welbeing

  • Inform and liaise with the Provost, the Education and Campaigns [E&C] Officer of UCL Union and the UCL Press Officer.
  • Liaise with the Student Health Physician.
  • Ensure that information is issued speedily to students as appropriate.
  • Inform UCL Switchboard during office hours.
  • Participate as a member of the outbreak control group.
  • Out-of-hours liaise with the duty public health doctor.
  • Inform and provide advice to the relevant head of department, warden or residence manager.
  • Provide preventative advice and information about meningococcal disease to students together with the E & C officer of UCL Union.
  • Consider the activation of the out-of-hours help-line.

UCL Press Officer

  • Liaise with the Provost's office, the Director of Student Support and Wellbeing, the Student Health Physician, the CCDC (or duty public health doctor) and the local health authority public relations officer.
  • Keep the relevant head of department, warden or residence manager and UCL Union fully informed.
  • Arrange for the issue of information bulletins to relevant departments and residences.
  • Participate as a member of the outbreak control group.

Procedures for different types of case

Dealing with a possible case of meningococcal disease

A possible case is based on a clinical diagnosis without microbiological confirmation, where the attending doctor and the CCDC or duty public health doctor consider that diagnoses other than meningococcal disease are at least as likely.

No public health measures will be taken.

Notice A / Notice Aa will be issued to direct contacts and students in the same residence and/or department.

No further action unless the diagnosis is confirmed as an actual case of meningococcal disease.

Dealing with a single case of confirmed or probable meningococcal disease

This procedure will be followed where the diagnosis is confirmed microbiologically or where the CCDC (or duty public health doctor) and the attending doctor consider that meningococcal disease is the most likely.

Notice B will be issued immediately to all direct contacts and students in the same residence or department. Information will be issued to all departments and residences as soon as possible.

Preventive antibiotics will be issued to all close contacts.

A reserve press statement will be drawn up.

Follow up action if the patient dies or a further suspected case is admitted to hospital, including activation of out-of-hours help-line.

Dealing with two or more unrelated cases of meningococcal disease

Two cases are considered unrelated if the bacteria causing them are of different serogroups or if the two cases or probable cases occur more than four weeks apart or if the two cases or probable cases have no links [no social contact, different residences, different courses]. Two possible cases will not be treated as linked.

Notice C will be issued immediately to students in the same residence or department. Information will be issued urgently to all departments and residences.

Preventive antibiotics will be issued to close contacts and wider measures will be given consideration.

The CCDC or duty public health doctor will seek advice on further action and consider whether to convene the outbreak control group.

Insofar as is possible, general practices serving UCL students will be alerted.

A press statement will be issued.

Follow-up action will be considered if a patient dies, if linking evidence comes to light or if further suspect cases are admitted to hospital.

Activation of out-of-hours help-line.

Dealing with two or more related cases of meningococcal disease

Cases are considered related if they are caused by bacteria of the same serogroup or if two confirmed or probable cases occur within four weeks.

Notice D will be issued immediately to students in the same residence or department. Information will be issued urgently to all residences and departments.

The public health measures to be taken urgently will be:

1. Convene the outbreak control group.
2. Alert students and staff.
3. Alert local hospitals and establish emergency ward arrangements.
4. Alert general practices in the health authority via the public health link.
5. Insofar as is possible alert all general practices serving UCL students.
6. Define the high risk group.
7. Check for potential cases in the high risk group.
8. Issue preventive antibiotics to the high risk group.
9. If the causative organism belongs to group C offer vaccination as soon as possible to the high risk group.
10. Consider taking throat swabs.
11. Inform all CCDC's via Epinet.

Convene a meeting with students and staff in the high risk group.

Consider setting up a help-line.

Convene a press conference.

Activation of out-of-hours help-line.

Out-of-hours help-line

When, in accordance with the Procedure, it is deemed necessary to provide advice during out-of-hours to those who call in with anxiety related to an outbreak, the UCL Switchboard will deliver a message referring callers to the underlisted:

Meningitis Now 0808 801 0388 - http://www.meningitisnow.org/
Meningitis Research Foundation 0808 800 3344 - http://www.meningitis.org/
UCL Student Health Service 020 7387 6306 - http://www.gowerplacepractice.nhs.uk/

To activate the message, see appendix on telephone contacts. During office hours, callers will be referred by UCL Switchboard to Student Health or the Director of Student Support and Wellbeing's office.

October 2014