Recommended courses of action to manage cases with infection and contacts
On 18 March, UKHSA published a CAS Alert to outline priority steps that primary care and hospital clinicians should consider taking to manage suspected cases, potential contacts of cases, and to reduce the risk of infection spreading. Note that this is a rapidly evolving situation and UKHSA will update advice as further information emerges.
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Context
The UK Health Security Agency (UKHSA) is continuing to investigate an outbreak of meningococcal disease (meningitis and septicaemia) in Kent. Investigations have confirmed that some of the cases are group B meningococcal disease.
UKHSA is coordinating a national response to the outbreak. This does not mean a national NHS incident has been declared. A national incident is a formal operational status used when the health service is under significant system-wide pressure, which is not the case with this outbreak. NHS services continue to operate as normal.
It’s important to know how to spot the symptoms of  ²¹²Ô»å  as early detection and treatment can save lives. Early symptoms can often be confused with other illnesses such as a cold, flu or hangover and students are particularly at risk of missing the early warning signs. If you or anyone you know develops any of these symptoms, seek medical help immediately by contacting a GP, calling NHS 111 or dialling 999 in an emergency. Knowing the signs and taking early treatment can be lifesaving.
Background and interpretation
The meningococcus bacteria, Neisseria meningitidis, can cause meningitis and/or septicaemia (overwhelming blood infection). It is spread by close prolonged or intimate contact. The bacteria may be carried harmlessly at the back of the nose and throat and only rarely goes on to cause invasive disease. However, when invasive meningococcal disease does arise, it is very serious, progresses rapidly, and requires urgent medical treatment.
Meningococcal bacteria are classified by their outer capsule into different serogroups, of which MenB currently accounts for most disease in England. MenC, W and Y cases do also occur but have been reduced to exceptionally low levels following the long-established MenC vaccination programme and the highly effective MenACWY teenage vaccination programme introduced in 2015.
Young people, in the age range of the cases in this current outbreak, would be too old to have been eligible for the national MenB vaccination programme that has been offered routinely to infants since September 2015. Licensed MenB vaccines offer direct protection against most, but not all, MenB strains causing disease in the UK. However, they do not prevent acquisition of carriage.
Spotting the signs
Meningococcal disease (meningitis and septicaemia) is an uncommon but serious disease caused by meningococcal bacteria. Very occasionally, the meningococcal bacteria can cause serious illness, (inflammation of the lining of the brain) and septicaemia (blood poisoning), which can rapidly lead to sepsis.
The onset of illness is often sudden and early diagnosis and treatment with antibiotics are vital. Early symptoms, which may not always be present, include:
- a rash that doesn’t fade when pressed with a glass
- sudden onset of high fever
- severe and worsening headache
- stiff neck
- vomiting and diarrhoea
- joint and muscle pain
- dislike of bright lights
- very cold hands and feet
- seizures
- confusion/delirium
- extreme sleepiness/difficulty waking
Young people going on to university or college for the first time are particularly at risk of meningitis because they newly mix with so many other students, some of whom are unknowingly carrying the bacteria at the back of their nose and throat.
Vaccination information
There are numerous strains of the meningococcal infection. The MenACWY vaccination gives good protection against MenA, MenC, MenW, and MenY and is routinely offered to teenagers in school Years 9 and 10. However, this vaccine does not protect against all forms of meningococcal infection. Other strains such as MenB can circulate in young adults. The MenB vaccine has been available on the NHS as part of routine childhood immunisations since 2015, and so those aged over 10 have not received it as part of the routine schedule.
Current incident management response
Antibiotics continue to be the most effective measure to limit the spread of invasive meningococcal disease, with more than 2,500 doses already provided to students, close contacts, and others, including individuals who attended Club Chemistry between 5 and 7 March. GPs nationwide are being advised to prescribe antibiotics to anyone who visited the club during those dates, as well as University of Kent students instructed to seek preventative treatment. This is so that anyone who has travelled home, or away from Kent, can easily access this important preventative treatment close to them.
In response to the seriousness of the outbreak, a targeted vaccination programme will also begin for residents of the Canterbury Campus Halls of Residence at the University of Kent, with up to 5,000 students expected to be contacted initially and offered the vaccine. UKHSA will continue to assess ongoing risk to other populations and the programme may be extended.
Specific advice for NHS clinicians
Infection Prevention and Control (IPC) and Personal Protective Equipment (PPE)
For patients presenting with suspected meningococcal disease, standard infection prevention and control precautions should be followed in line with the . Use appropriate PPE (including Level 2 PPE where clinically indicated) for assessment and management of suspected IMD.
- Clinical staff should apply standard respiratory hygiene and infection control measures in routine clinical settings
- Wear a fluid resistant surgical facemask for routine care of patients with suspected invasive meningococcal disease
- Wear an FFP3 mask or Hood for aerosol-generating procedures performed on patients with suspected invasive meningococcal disease
- Continue transmission-based precautions until the patient has been established on antibiotics for at least 24 hours
- No additional or enhanced IPC measures are required beyond those recommended in national guidance
Initial management of suspected IMD cases
In a community setting, rapid admission to hospital is the highest priority when IMD is suspected. Patients with IMD may present with septcaemia and/or meningitis. Clinicians should have a high index of suspicion where a young person aged 16-30 attends with consistent signs or symptoms.
Meningococcal sepsis should be considered in a rapidly deteriorating patient with sepsis even in the absence of a non-blanching rash, which is usually a late sign. In acute settings, patients with sepsis should be managed according to local sepsis guidelines and immediate clinical management should focus on stabilisation (including fluid resuscitation as appropriate) and early engagement with ITU colleagues where necessary.
Information on antibiotic treatment indicated for suspected meningococcal infections is included in the outbreak Urgent Public Health Message and .
Notifying cases to UKHSA
Inform your UKHSA local health protection team of all suspected cases as soon as possible and without waiting for laboratory confirmation, so they can swiftly provide advice to household and other close contacts in the community and manage indicated public health measures: ()
Diagnostics
The following samples should be taken where possible:
1) blood for culture (before 1st dose of antibiotics)
2) blood for PCR (ideally EDTA or, alternatively other unclotted blood specimen)
3) CSF where possible, and where there is no contraindication to lumbar puncture (within 4 days of commencing antibiotics)
4) throat (nasopharyngeal) swab for culture (within 24 hrs of antibiotics)
These should be cultured locally and any isolates sent to the Meningococcal Reference Unit. All meningococcal-positive clinical materials (including isolates, PCR-positive clinical samples and/or DNA extracts, also lysate extracted from Biofire loading syringes) should be referred to the National Meningococcal Reference Unit, Manchester for confirmation, serogrouping and further characterisation.
Post-exposure prophylaxis for healthcare staff
Post-exposure prophylaxis is recommended for healthcare workers who have not worn appropriate PPE including a fluid resistant surgical facemask as part of droplet protection, and who have been involved in airway care of suspected r confirmed patients during the time when index case had not been on appropriate antibiotics (e.g. ceftriaxone) or had been on it for less than 24 hours.
Sources of public information
Meningitis charities (, ) do tremendous work supporting those affected by meningococcal disease and their families and their web pages have more information on vaccination and epidemiology.