North yorkshire health protection unit
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 UNIVERSITY OF YORK NORTH YORKSHIRE HEALTH PROTECTION UNITPROTOCOL FOR DEALING WITH MENINGITISAND MENINGOCOCCAL DISEASE Adopted: October 2004 Review: October 2006 1. GENERAL BACKGROUND 1.1 Meningitis means inflammation of the meninges, the brain lining. It can be caused by a variety of organisms. Viral meningitis 1.2 This is the most common type. Symptoms are usually mild and most cases do not require admission to hospital. Recovery is normally complete without any specific treatment, but headaches, tiredness and depression may persist. No public health action is usually needed. Bacterial meningitis 1.3 There are two main forms: pneumococcal and meningococcal. Both bacteria can also cause disease elsewhere in the body. ^ 1.4 The pneumococcal bacterium is better known as a cause of pneumonia. It affects mainly infants and elderly people, but people with certain forms of chronic disease or immune deficiencies are also at increased risk. It does not normally spread from person to person and public health action is therefore not usually needed. There is a vaccine available to protect people at high risk. ^ 1.5 The meningococcal bacterium causes two main types of illness: meningitis and septicaemia (blood poisoning). Septicaemia is the more serious form of illness and can occur on its own or in combination with meningitis. Meningococcal disease is fatal in about one in ten cases. 1.6 The bacteria can spread from person to person in circumstances where there is intimate contact. Infection is usually acquired from a healthy carrier rather than from a person with the disease. 1.7 Public health action is always required to identify and provide antibiotic treatment to close contacts of a case of meningococcal disease. 1.8 Further details about meningococcal disease are given in Annex 1. ^ Principles
2.2 Delay in notification sometimes occurs because of difficulty in diagnosis or oversight by the attending doctor. This is particularly the case for viral meningitis. Action 2.3 During office hours, the CCDC will immediately inform the Director of Health & Safety of any suspect or confirmed case of meningococcal disease in a student or staff member of the university. 2.4 Out-of-hours, the duty public health doctor will immediately contact the University’s 24-hour report centre on 01904 434444 or 0800 433333. 2.5 Further details of contact numbers and individual responsibilities are given in Annex 2 and Annex 3 respectively. ^ Principles 3.1 Prompt communication with students is desirable both to alert those at risk and to allay concerns. A variety of means including meetings, letters, bulletin boards and email should be used to ensure speedy transmission of accurate information to all. Updates may be necessary when new information becomes available. Staff and parents will also need to be kept informed. In the event of a death from meningococcal disease or an outbreak, a helpline will probably be necessary. 3.2 The North Yorkshire Health Protection Unit has primary responsibility for identifying, alerting and advising anyone in direct, close contact with a case of meningitis or meningococcal disease. The University of York will provide assistance as necessary. 3.3 The University of York is responsible for communicating with other students, staff and parents. The North Yorkshire Health Protection Unit will provide appropriate medical information and advice. 3.4 The communication response to an incident will depend upon a number of factors including the diagnosis and place of residence of the case. Action to be taken is outlined in detail below. 3.5 A case should be considered a College resident if they have been living in a College residence in the seven days before becoming ill. 3.6 Other people in the same accommodation1, or sharing the same kitchen and bathroom facilities as the case, and close friends or regular social contacts will usually be treated as close contacts and dealt with individually. 3.7 Other students in the same teaching groups as the case will usually be regarded as casual contacts. The level of risk to these students is likely to be very low unless such students are also in close social contact with the case. Only where student contacts have regularly participated in small group activities in a confined space e.g. certain tutorial and seminar groups, might there be any cause for genuine concern. The main purpose of informing such students is therefore to provide reassurance. 3.8 The university, the North Yorkshire Health Protection Unit and Selby & York Primary Care Trust will work in partnership in any communication with the media, including the issue of press statements and convening of press conferences. ^ Principles 4.1 A possible case is a clinical diagnosis of meningococcal meningitis or septicaemia without microbiological confirmation where the clinician and public health doctor consider that diagnoses other then meningococcal disease are at least as likely. 4.2 No public health measures are necessary and contacts do not need antibiotics unless or until further evidence emerges that changes the diagnostic category. Action 4.3 The university will issue COMMUNICATION 1 via notice boards and email to students in the same residence (where relevant) and as soon as possible (same or next working day) to students in the same teaching groups. The College provost will be responsible for the former, the Student Support Office for the latter. 4.4 No follow-up action is required unless there is a change in diagnosis. 4.5 The university will issue further information if a suspect case is subsequently diagnosed as not due to meningococcal disease. This should be done as soon as possible in order to allay any concern, and those responsible are as in 4.3 above. ^ Principles 5.1 A probable case is a clinical diagnosis of meningococcal meningitis or septicaemia without microbiological confirmation where the clinician and public health doctor consider that meningococcal disease is the most likely diagnosis. 5.2 A confirmed case is a clinical diagnosis of meningococcal meningitis or septicaemia which has been confirmed microbiologically. 5.3 If the patient dies follow-up action e.g. setting up a helpline, will be necessary. The university’s policy on dealing with the death of a student should be followed. 5.4 If further suspect cases are admitted to hospital, the situation will need to be reviewed and further action taken as outlined in Sections 6 and 7. Action 5.5 The CCDC on being notified of the case by the hospital will inform the University’s Director of Health & Safety Services or (out of hours) Security Centre immediately. 5.6 The CCDC or duty public health doctor will arrange for the issue of antibiotics to close contacts. 5.7 The university (i.e. College Provost) will issue COMMUNICATION 2 urgently (same day) to students in the same residence (where relevant) and the Student Support Office will issue COMMUNICATION 2 as soon as possible (same day or next working day) to students in the same teaching groups. Information should be provided by the next working day to all departments and other Colleges via York Extra.
5.8 The university Director of Communications will draw up a reserve press statement in consultation with North Yorkshire Health Protection Unit’s press officer. ^ Principles 6.1 Cases of meningococcal disease will normally be considered UNRELATED if any of the following apply: 6.1.1 Two confirmed cases caused by different serogroups, whatever the interval between them. 6.1.2 Two confirmed or probable cases more than three months apart. 6.1.3 Two confirmed or probable cases more than four weeks apart and without links between cases (e.g. no social contact, different halls of residence, different courses). 6.1.4 Two possible cases, irrespective of the interval between them. 6.2 In these instances the CCDC or duty public health doctor will advise on further action. In exceptional circumstances, an Outbreak Control Team may be convened. 6.3 Wider public health action, other than issuing antibiotics to close contacts of individual cases, will not usually be indicated. 6.4 Follow-up action such as issuing further information or convening an Outbreak Control Team will be necessary if a patient dies, if further suspect cases are admitted to hospital or if new evidence linking cases comes to light.
6.7 The CCDC will then review the situation and the Student Support Office will issue COMMUNICATION 3 as soon as the circumstances have been clarified. 6.8 The Manager, Student Support Services, in discussion with the CCDC, will consider the need to set up a helpline for students and parents. 6.9 The CCDC will alert all general practices serving university students. 6.10 The University’s Director of Communications will issue a press statement drawn up in consultation with the North Yorkshire Health Protection Unit’s press officer. ^ Principles 7.1 Cases of meningococcal disease will be considered RELATED and an outbreak declared if the following applies: 7.1.2 Two confirmed or probable cases within a four-week period, which are, or could be, caused by the same serogroup. 7.2 Further information on the management of an outbreak are given in the North Yorkshire Health Protection Unit Outbreak Control Plan. Action 7.3 The CCDC will activate the Outbreak Control Plan and convene the Outbreak Control Team. 7.4 The Outbreak Control Team will:
b) Convene a meeting with students and staff in the target group c) Check for potential cases in target group d) Issue appropriate antibiotics to the target group f) Offer vaccine to student contacts where appropriate g) Alert local hospitals as appropriate h) Alert all general practices serving students, the general practice out of hours service and other practices in the area i) Inform other Health Protection Units, as appropriate 7.5 The university will alert all students and staff and make information available to parents (see below). 7.6 The university (i.e. College Provost) will issue COMMUNICATION 4A immediately (within four hours) to students in the target group e.g. same residence and the Student Support Office will issue COMMUNICATION 4B urgently (same day) to students in the same teaching groups, all departments and all Colleges. 7.7 The Manager, Student Support Services will set up a helpline for students and parents if it is considered necessary under the particular circumstances. 7.8 The university’s Director of Communications and the North Yorkshire Health Protection Unit’s public relations officer will issue a joint press statement, and will consider convening a joint press conference. ANNEX 1 ^ How is the diagnosis made? Laboratory tests are required to confirm the diagnosis either by growing the organism from patient specimens (culture diagnosis), detecting polysaccharide antigen from the organism (latex agglutination test diagnosis), detecting a rise in levels of antibody to the organism (serological diagnosis) or detecting minute quantities of the genetic material of the organism (polymerase chain reaction (PCR) diagnosis). Public health action is taken as soon as there is strong suspicion that a person is suffering from meningococcal disease, and often before the diagnosis is confirmed. How is meningococcal infection acquired? Meningococcal bacteria colonise the back of the throat or nose in up to 10% of the general population (and up to 20% of young people). Only rarely does colonisation give rise to disease. Illness usually occurs within 7 days of first acquiring the bacteria, but asymptomatic carriage can persist for many months. It is not known why some people become ill and others remain healthy carriers. The bacteria do not survive for long outside the body and most people acquire infection from intimate contact with an asymptomatic carrier. How likely is meningococcal disease to spread? Most cases of meningococcal disease are sporadic. However, the risk of a second case in a close household contact is much higher than the risk in the general population. In spite of this, clusters of disease are uncommon, occurring only occasionally in households and rarely in schools and colleges. What action can be taken to prevent spread? a) Antibiotics Oral antibiotics (one dose of Ciprofloxacin or a very short course of Rifampicin) are recommended for close contacts of a case of meningococcal disease in order to prevent further spread of the bacteria. If only one case has occurred, antibiotic prophylaxis is recommended only for those who have had prolonged, intimate contact with the case. As the bacteria does not easily spread from person to person there is generally no need for wide-scale preventive measures. b) Immunisation There are effective vaccines against group A, C, W135 and Y meningococcal disease, but not against group B. Immunisation is recommended for close contacts of cases, and in an outbreak, immunisation may be offered to those who have not been immunised in the defined high risk population. It takes five to seven days to produce an immune response. Are there guidelines for dealing with meningococcal disease? The Health Protection Agency’s Public Health Laboratory Service Meningococcus Forum has published guidance on the control of meningococcal disease. The most recent guidance issued in September 2002, brings together guidance for the management of meningococcal disease in different settings. Public health management of meningococcal disease in the UK Public Health Laboratory Service Meningococcus Forum http://www.hpa.org.uk/cdph/issues/CDPHVol5/no3/Meningococcal_Guidelines.pdf Guidance on the management of meningococcal disease in universities and colleges was published in 1998 jointly produced by the Committee of Vice-Chancellors, the Public Health Laboratory Service (now part of the Health Protection Agency) and others. This is being updated. PHLS, PHMEG, AMOSSHE, CVCP. Managing meningitis in higher education institutions. Committee of Vice-Chancellors and Principals of the Universities of the United Kingdom, 1998 ANNEX 2 ^During Normal Working Hours Director of Health and Safety Services 01904 434251 Director of Communications 01904 434462 Academic Registrar 01904 432134 Manager, Student Support Services 01904 432150 Out of Hours - Contact Security Centre 01904 434444 or 0800 433333 ^ Ambulance 999 University Health Centre: 01904 432190 Local General Practitioners: North Yorkshire Emergency Doctor 01904 621621 Hospitals: York General Hospital 01904 631313 North Yorkshire Health Protection Unit 01904 567 675 Out of hours (via TENYAS ambulance control) 01904 666026 (ask for the on-call public Health doctor ^ NHS DIRECT 0845 4647 MENINGITIS RESEARCH FOUNDATION 0808 800 3344 NATIONAL MENINGITIS TRUST 0845 6000 800 ANNEX 3: LIST OF INDIVIDUAL RESPONSIBILITIES CONSULTANT IN COMMUNICABLE DISEASE CONTROL (CCDC) It is the responsibility of the CCDC or duty public health doctor to: a) Out of hours, to inform and remain in contact with the University’s Director of Health and Safety via the university’s 24-hour contact. b) Obtain details of all close contacts and decide who needs to be issued with antibiotics (and offered vaccine). c) Arrange for close contacts to be alerted and to be issued with antibiotics, and, if appropriate, offered vaccine. d) Inform and alert the general practitioners of all close contacts who are thus treated. e) Provide information and advice to the university. f) Where appropriate, convene the Outbreak Control Team ^ When the director is unavailable these duties will fall to the University Health and Safety Officer a) Inform and liaise with the Academic Registrar’s office, Manager, Student Support Services, Director of Communications, or named deputy where appropriate and where possible the relevant College Provost and Head of Department. c) Liaise with the CCDC or duty public health doctor. ^ When the Academic Registrar is unavailable these duties will fall to Manager, Student Support Services. e) Ensure that information is issued speedily to students, as appropriate. f) Inform the Meningitis Research Foundation and National Meningitis Trust of the incident (see Annex 2). g) Where appropriate, convene the University Incident Response Team (Annex 4) (in consultation with colleagues). h) Participate as a member of the Outbreak Control Team, if convened. ^ When the Director of Communications is unavailable these duties will fall to the University Press Officer a) Liaise with the Academic Registrar (or Manager, Student Support Services), CCDC (or duty public health doctor) and North Yorkshire Health Protection Unit’s public relations officer. b) Ensure that press statements are prepared and issued and press conferences arranged as appropriate. c) Participate as a member of the University Incident Response Team (Annex 4), if convened. ^ The security officer in the University’s 24-hour control centre will perform the following functions: a) Receive information from and remain in communication with the CCDC or duty public health doctor. b) Inform and remain in communication with Director of Health & Safety Services or nominated deputy. ANNEX 4 ^ Academic Registrar deputy: Manager, Student Support Services Director of Health & Safety Services deputy: Health and Safety Officer Director of Communications deputy: Press Officer Manager, Student Support Services deputy: Head of Counselling Service (for students) College Co-ordinator deputy: College Provost/Manager Student Support Services COMMUNICATION 1 ^ A .............. (year of study) year student living in .............................................. (at home / in private rented accommodation/ in ...... College) was admitted to hospital on ................... (date) with suspected meningitis/ septicaemia. The cause of the illness is considered unlikely to be meningococcal disease. Other students and staff are therefore not thought to be at any risk from this incident even if they were in close contact with the student concerned. The North Yorkshire Health Protection Unit has advised us that antibiotics will not be necessary at the present time for contacts of the student concerned. Should there be any change in the diagnosis we will keep you informed. For further information about meningitis and septicaemia, contact Meningitis Research Foundation or National Meningitis Trust, or visit their web sites. Meningitis Research Foundation: phone 0808 800 3344, web site: http://www.meningitis.org/ National Meningitis Trust: phone 0845 6000 800, web site: http://www.meningitis-trust.org/ . If you need any medical advice, please contact your general practitioner or NHS Direct – 0845 4647. COMMUNICATION 2 ^ A .............. (year of study) year .............. (study subject) student living in .............................................. (at home / in private rented accommodation/ in ...... College) was admitted to hospital on ................... (date) with confirmed/probable meningococcal meningitis/ septicaemia. The meningococcal bacterium lives in the nose and throat and is only passed on by prolonged, close contact. The North Yorkshire Health Protection Unit are issuing antibiotics to all the intimate contacts of the student concerned. If you have been in close contact with the case you are advised to be especially vigilant over the next few days and to LOOK OUT FOR YOUR FRIENDS. The important thing to know is that the disease can develop very rapidly, sometimes within a matter of hours. Early symptoms may be similar to those you get with a flu or hangover:
If any of the following symptoms develop:
^ If you are not feeling well consult your general practitioner or NHS Direct – 0845 4647. If you need further information or advice about meningitis ring one of these 24-hour meningitis helplines: National Meningitis Trust 0845 6000 800 Meningitis Research Foundation 0808 800 3344 COMMUNICATION 3 ^ Two students from UNIVERSITY have recently been admitted to hospital with meningococcal meningitis/septicaemia. One is a .............. (year of study) year .............. (study subject) student living in .............................................. (at home / in private rented accommodation/ in ...... College). The other is a .............. (year of study) year .............. (study subject) student living in .............................................. (at home / in private rented accommodation/ in ...... hall of residence). The North Yorkshire Health Protection Unit has advised us that these cases are not considered to be connected because t  hey were due to two entirely different strains of the meningococcal bacteriat hey occurred more than four weeks apartt hey were not known to each other and had no common links.Antibiotics have been issued to close contacts of both students concerned. Wider use of antibiotics or vaccine is not being recommended at this time. Remember to LOOK OUT FOR YOUR FRIENDS. If you are not feeling well consult your general practitioner or NHS Direct – 0845 4647. If you need further information or advice about meningitis ring one of these 24-hour meningitis helplines: National Meningitis Trust 0845 6000 800 Meningitis Research Foundation 0808 800 3344 COMMUNICATION 4A Dear student ^ Two students from the UNIVERSITY OF YORK have recently been admitted to hospital with meningococcal meningitis/septicaemia. Both students live in the same college are on the same programme of study / are close friends. The North Yorkshire Health Protection Unit is making urgent arrangements to give antibiotics and to offer vaccine to students in the following categories (specify target group) as soon as possible. Please attend ................................................................ (place/time) to receive your antibiotics / immunisation. You are advised to be especially vigilant over the next few days and to LOOK OUT FOR YOUR FRIENDS. The important thing to know is that the disease can develop very rapidly, sometimes within a matter of hours. Early symptoms may be similar to those you get with a flu or hangover:
If any of the following symptoms develop:
^ If you are not feeling well consult your general practitioner or NHS Direct – 0845 4647. If you need further information or advice about meningitis ring one of these 24 hour meningitis helplines: National Meningitis Trust 0845 6000 800 Meningitis Research Foundation 0808 800 3344 COMMUNICATION 4B Dear student ^ Two students from the UNIVERSITY OF YORK have recently been admitted to hospital with meningococcal meningitis/septicaemia. Both students live in the same college / are on the same programme of study / are close friends. The North Yorkshire Health Protection Unit is making urgent arrangements to give antibiotics and to offer vaccine to students in the following categories (specify target group) as soon as possible. The North Yorkshire Health Protection Unit is not recommending wider use of antibiotics or vaccine for other students in the university at this time. Should there be any change in the situation we will keep you informed. If you need further information or advice ring one of these 24-hour meningitis helplines: National Meningitis Trust 0845 6000 800 Meningitis Research Foundation 0808 800 3344 If you are not feeling well consult your general practitioner or the NHS Helpline – NHS Direct – 0845 4647. 1 For these purposes, shared accommodation is defined as sharing kitchen and or bathroom facilities. It may also include all those on the same floor in student halls of residence Page of |
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