2022 Meningococcal Season Reminder

14 June 2022

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, & urgent transfer to hospital can be lifesaving. All GPs should have benzylpenicillin in their surgeries & emergency bags.

There have been 5 cases of IMD notified in SA year to date in 2022 (all serogroup B). In 2021 & 2020, there were twelve (6 B, 6 W) & five (3 B, 2 Y) notifications of IMD, respectively.

Notifications of IMD usually increase in winter & spring. Studies suggest that higher rates of influenza virus in winter may be a causative factor for increased cases of IMD during colder months. With high rates of influenza expected in 2022, IMD rates may also increase. Peak incidence rates are in children <5 years & young adults 15-24 years.

Clinical features

  • Meningitis: fever, headache, photophobia, neck stiffness or altered mental state
  • Septicaemia: fever, sweating & chills, joint pains, petechial or purpuric rash, nausea & vomiting, & early signs of peripheral vascular shutdown (leg pain, abnormal skin colour & cold hands & feet)
  • Young children may have irritability, drowsiness, altered mental state, or pallor despite a fever
  • Less commonly, IMD can present atypically (e.g. septic arthritis, pneumonia & epiglottitis).

If a patient with a non-specific febrile illness does not require hospital referral, the carer should be told to watch the patient & seek urgent help if the patient deteriorates, especially if a rash develops. A medical review may be urgently required at any time following the initial consultation, as IMD can be associated with rapid clinical deterioration.

Management

  • Be alert for IMD. Early recognition & treatment of IMD can be lifesaving.
  • Take blood for culture & PCR, prior to antibiotics, if possible, & send with the case to hospital. Do not delay commencement of antibiotics.
  • 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 & provision of clearance antibiotics to close contacts as soon as possible after diagnosis.
  • IMD can have serious health consequences or be fatal. Doctors are urged to provide or refer people for qualified counselling.

Vaccination

  • State funded meningococcal B vaccine is available in South Australia for children aged 6 weeks to ≤ 12 months, & school students in Year 10 (who are SA residents with a Medicare card).
  • National Immunisation Program (NIP) meningococcal ACWY vaccine is available for children aged 12 months of age, school students in Year 10, & through GPs for adolescents 15-19 years.
  • NIP meningococcal B vaccine is available for Aboriginal children aged 6 weeks to < 2 years.
  • NIP meningococcal ACWY & meningococcal B vaccine is also available for people with specific medical conditions: see the Australian Immunisation Handbook for more details.

Further information

For all enquiries, please contact the CDCB on 1300 232 272 (24 hours/7 days) 

Dr Louise Flood – Director, Communicable Disease Control Branch