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Guidance for Public Health Management of Meningococcal Disease in the UKTemplates for communication following cases of invasive meningococcal diseaseUpdated March 2019

Templates for communication following cases of meningococcal disease Appendix 1 and 2

About Public Health England

Public Health England exists to protect and improve the nation’s health and wellbeing, and reduce health inequalities. We do this through world-leading science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services. We are an executive agency of the Department of Health and Social Care, and a distinct delivery organisation with operational autonomy. We provide government, local government, the NHS, Parliament, industry and the public with evidence-based professional, scientific and delivery expertise and support.

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Prepared by: Helen Campbell, Sydel Parikh, Mary Ramsay and Shamez Ladhani of the PHE Immunisation Team together with Steve Grey, Ray Borrow of the PHE Meningococcal Reference Unit, NHS National Services Scotland, Public Health Wales and Public Health Agency in Northern Ireland.

For queries relating to this document, please contact: [email protected]

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Published March 2019PHE publications PHE supports the UNgateway number: GW-247 Sustainable Development Goals

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Contents

Appendix 1 GP template chemoprophalaxis letter 4

Appendix 2: Examples of drug information leaflets 6

Appendix 3: Template GP vaccination letter for close contacts of MenA, C, W or Y disease 8

Appendix 4: Template letter for GP following a local case of IMD at nursery/school/university 9

Appendix 5: Communication with GP for immunological work-up of a case 10

Appendix 6: Communication with parents following a nursery case of IMD 11

Appendix 7: Communication with parents following a school case of IMD 14

Appendix 8: Communication with students following a university case of IMD 17

Acknowledgments

We are grateful for the additional contributions made by the PHE Vaccine Preventable Invasive Bacterial Infections Forum and PHE Health Protection Teams in particular Surrey and Sussex Health Protection Unit and North East Health Protection Team. We are additionally grateful for the contributions from Meningitis Now and the Meningococcal Research Foundation and the families that they work with.

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Appendix 1 GP template chemoprophalaxis letter

Insert PHE HPT addressInsert recipient address

[Date]Dear colleague,

As discussed, I am writing to confirm the advice on chemoprophylaxis for the close contacts1 of a case of meningococcal disease, listed below:

Name Date of birth NHS number

Ciprofloxacin is the antibiotic of choice for all ages and in pregnancy. Note that ciprofloxacin is prescribed off label for children. Ciprofloxacin is contraindicated when there is known ciprofloxacin hypersensitivity and caution must be used when prescribing in epilepsy and G6PD deficiency. Please talk to a member of the Health Protection Team if ciprofloxacin is not indicated in one of your patients.

Dosages for ciprofloxacin are given below:

adults and children over 12 years 500 mg stat children aged 5 –11 years 250 mg stat children under 5yrs 30mg/kg up to maximum of 125 mg stat*Ciprofloxacin suspension contains 250mg/5ml

Your patient may find the enclosed ciprofloxacin advice sheet helpful and should be made aware of the early signs and symptoms of meningococcal disease. Advice leaflets are available from:

DH health and Social care orderline: https://www.orderline.dh.gov.uk/ecom_dh/public/home.jsfNational Meningitis Trust: www.meningitis-trust.org (Tel 0808 801 0388) Meningitis Research Foundation: www.meningitis.org (Tel 0808 800 3344).

1 Chemoprophylaxis is indicated for the following groups, irrespective of vaccination status: those who have had prolonged close contact with the case in a household type setting during the seven days

before onset of illness. For example; those living and/or sleeping in the same household (including extended household), pupils in the same dormitory, boy/girlfriends or university students sharing a kitchen in a hall of residence

those who have had transient close contact with a case only if they have been directly exposed to large particle droplets/secretions from the respiratory tract of a case around the time of admission to hospital

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http://www.meningitis.org/

http://www.meningitis-trust.org/

https://www.orderline.dh.gov.uk/ecom_dh/public/home.jsf


National guidelines on the management of meningococcal cases and their contacts can be found at: https://www.gov.uk/government/publications/meningococcal-disease-guidance-on-public-health-management

With many thanks for your assistance.Yours sincerely

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https://www.gov.uk/government/publications/meningococcal-disease-guidance-on-public-health-management



Appendix 2: Examples of drug information leaflets

Ciprofloxacin drug information leaflet

The antibiotic you will be given is called Ciprofloxacin. The meningococcal germs that cause meningitis and septicaemia can be carried in the nose and throat. This antibiotic will kill them.

It comes in tablet or liquid form. You will receive either one or two tablets of Ciprofloxacin or one dose of a liquid. Tablets are taken by mouth as a one-off dose with a glass of water. It is important to drink plenty of fluids for the rest of the day after taking this antibiotic.

Do not take the tablet or medicine if you have taken antacid/indigestion medicines or preparations containing iron or mineral supplements within the last four hours. Please see the doctor or nurse if this is the case.

You should also avoid drinking alcohol with this medication as it may make you drowsy, affecting your ability to drive or operate machinery.

Ciprofloxacin is an antibiotic that is frequently used to treat lots of different conditions. It is recommended in national guidelines for close contacts of someone with meningococcal disease.

The side effects of Ciprofloxacin may include:

tummy ache, diarrhoea and nausea tiredness and headaches rash and itching facial swelling: very rarely breathing difficulties may occur with the facial swelling

You should seek medical attention urgently if this occurs pain and inflammation around the joints

Please tell the public health doctor or nurse if you are allergic to ciprofloxacin or havehave a history of epilepsy or G6PD deficiency so that they can arrange an alternative medicine.

Ciprofloxacin does not interfere with the contraceptive pill.If you are unclear or would like further information, please contact:

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Rifampicin drug information leaflet

The antibiotic you will be given is called Rifampicin. It comes as either tablets or syrup and is suitable for people of all ages. The meningococcal germs that cause meningitis and septicaemia can be carried in the nose and throat, this antibiotic will kill them.

Rifampicin must be taken twice a day for two days (morning & evening), the instructions will be clearly written on the box or bottle. It is important that you take a two-day course. It is taken by mouth and should be taken one hour before a meal to obtain the best effect.

You may have extra medicine left, which should be disposed of safely.

Rifampicin is an antibiotic that is frequently used to treat lots of different conditions. It is recommended in national guidelines for close contacts of someone with meningococcal disease.

The side effects of Rifampicin may include:

orange/reddish staining of urine, saliva and tears* tummy upset, diarrhoea and nausea skin flushing and itching, with or without a rash very rarely, jaundice (yellowing of the skin or whites of the eyes)

*This is normal – so do not be alarmed. Rifampicin may permanently stain some contact lenses so you should not wear contact lenses whilst on treatment or for the following week

Rifampicin may reduce the effect of several medicines including:

blood thinning medication (anticoagulants) diabetic medication some types of epilepsy medication (anticonvulsants)

Rifampicin can interact with oral contraceptives. If you are taking an oral contraceptive pill, you should use an additional method of birth control (such as condoms) as well as your oral contraceptive pill during treatment with rifampicin and for at least 4 weeks after finishing the treatment.

Please tell the public health doctor or nurse if you take any medication or are allergic to rifampicin as you may need an alternative medicine.

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Appendix 3: Template GP vaccination letter for close contacts of MenA, C, W or Y disease

Insert recipient detailsInsert PHE HPT details

[Date]

Dear Colleague

RE: Name: Address: Date of Birth:

The above named patient who is registered at your practice has been identified as a close contact of a confirmed case of meningococcal serogroup insert detail disease. Your patient has received antibiotic chemoprophylaxis.

Close contacts of cases of vaccine preventable strains of N. meningitidis are offered vaccination to reduce the risk of late cases. As meningococcal serogroup insert detail disease has now been confirmed a single dose of meningococcal ACWY conjugate vaccine (Menveo® or Nimenrix®) is recommended for your patient in accordance with national guidance https://www.gov.uk/government/publications/meningococcal-disease-guidance-on-public-health-management. If this patient has been vaccinated within the last year with a vaccine that protects against serogroup [insert detail] disease then no further vaccination is required.

With many thanks in anticipation of your co-operation in arranging the necessary vaccination for your patient. Please do not hesitate to contact the Health Protection Team if you require any further information. Yours sincerely

Author’s namePosition/Title

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Appendix 4: Template letter for GP following a local case of IMD at nursery/school/university

Insert PHE HPT addressOur Ref: [HPZone No]Insert GP name and address

Insert dateDear Colleague,

Re: Case of meningococcal disease in [insert school/ nursery etc name]

I am writing to inform you that there has been a single case of suspected/confirmed meningococcal infection, in a [enter age] old child, who attends the above school/ nursery. The child has been admitted to enter name Hospital.

All close contacts have been identified and given antibiotic prophylaxis. There is no need for anyone else to receive prophylactic antibiotics at this stage. A close contact is defined as someone who has had prolonged close contact in a household type setting e.g. someone who lives with the case, or has stayed overnight in the same house in the seven days prior to onset of symptoms in the case. Normal social contacts, classmates, friends and visitors to the house are not at any greater risk than the rest of the population and do not need antibiotic prophylaxis.

If any patients come to your attention who meet the definition of a close contact and they have not already been identified for antibiotic prophylaxis, please contact us on the number above.

A letter has been sent to all parents and staff in the school/ nursery. A copy is available from PHE if required. If a parent or school/ nursery staff member contacts you requesting advice, they can be reassured that all necessary public health action has been taken.Please remind any presenting parents and patients of the signs and symptoms of meningococcal disease and the importance of seeking urgent medical attention if they are concerned. Please also use the opportunity to advise meningococcal vaccination for any previously unvaccinated patients who present. If you require any further assistance, please do not hesitate to contact us.

Further information is also available from NHS 111, PHE: https://www.gov.uk/government/publications/meningococcal-disease-guidance-on-public-health-management or the meningitis charities: www.meningitis.org and www.meningitisnow.org .

Yours sincerely[Name][Title]

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http://www.meningitisnow.org/





Appendix 5: Communication with GP for immunological work-up of a case

Our Ref: [HPZone No]Insert GP name and address

Insert date

Dear Colleague,

Recommended immunological investigation following a case of confirmed meningococcal disease: insert patient name, insert patient DOB, insert patient NHS number.

The above patient was recently confirmed as having invasive meningococcal disease. This was found to be:

☐ caused by a rare meningococcal serogroup or by non-encapsulated (non-serogroupable) meningococci☐ a repeat episode of meningococcal disease

This makes it an unusual case of meningococcal disease in an apparently healthy individual and may indicate underlying immunodeficiency. In addition to inherited complement deficiencies, a number of medical conditions and treatments (in particular Eculizumab (Soliris®; Alexion)) can lead to acquired or secondary complement deficiency, which can increase susceptibility to invasive meningococcal disease.

We understand that this patient is not on Eculizumab. Therefore, in line with the UK guidance for public health management of meningococcal disease, we would recommend that this patient is referred to a consultant immunologist so that additional immunological investigations can be undertaken (e.g. presence of spleen, splenic function, complement deficiency, HIV testing) to check for any underlying immunodeficiency.

If you have any questions about the contents of this letter, please do not hesitate to contact the Health Protection Team on [insert tel no].

Thank you for your assistance.

Yours sincerely

[Name][Title]

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Appendix 6: Communication with parents following a nursery case of IMD

IMPORTANT: MENINGOCOCCAL DISEASE INFORMATION FOLLOWING A NURSERY CASE (please read both sides)

Dear Parent or Guardian

A child who attends your child’s nursery has been admitted to hospital with suspected meningococcal disease which can cause both meningitis and septicaemia. Meningitis is when bacteria reach the meninges (the lining around the brain and spinal cord) and cause dangerous swelling. Septicaemia is when bacteria enter the bloodstream and cause blood poisoning. Both forms of meningococcal disease can trigger sepsis – an overwhelming and life-threatening immune response to infection which can lead to organ failure.

This letter gives you some information about the disease. There is no reason for you to make any change in the nursery routine and no reason for children to be kept at home.

How the disease spreads

The meningococcal bacteria very rarely spread from child to child within a nursery. The bacteria that cause the illness live naturally in the back of the throat and can spread between people in droplets from the mouth and nose. Most people carry the bacteria in their throats without becoming unwell.

Preventing the spread of meningococcal disease

The best way to stop the disease spreading is by giving antibiotics to the very close family contacts of the patient with the illness. This usually means that only people who live in the same house as the sick child need treatment. Nursery contacts are very rarely at risk, including those who have played with the case or shared toys.

The people who need treatment have already been identified and treated.

Symptoms of meningococcal disease

The risk of another case in the nursery is very small but it is sensible to be aware of the main signs and symptoms of meningococcal meningitis and septicaemia, outlined below.

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Some common signs and symptoms of meningococcal disease

High temperature Rapid or unusual breathingVomiting/ diarrhoea and stomach

crampsJoint or muscle painCold hands and feet

Severe headache Pale blotchy skin Stiff neck Confusion and/or irritability

Dislike of bright light Drowsiness or difficult to wakeRash/ bruising rash Seizures/ fits

One or more of these symptoms may develop and they can appear in any order.

Meningococcal disease can be hard to identify at first because it can be like a bad case of flu. However, anyone affected with meningococcal disease will usually become seriously ill within a few hours. You should keep checking your child if they are unwell and contact your GP (family doctor) or NHS 111 for advice if you have any concerns. If you become worried about your child’s condition, particularly if they are getting worse, seek medical help urgently at the closest A&E Department or by dialling 999. BE WATCHFUL and use your instincts. Early treatment can be life-saving.

Protecting against meningococcal disease

It is important to be aware that meningococcal disease is caused by different groups of meningococcal bacteria. In the UK meningococcal disease is almost always caused by one of four meningococcal groups commonly known as MenB, MenC, MenW or MenY. These groups of meningococcal disease can be prevented with vaccines. MenA disease is rare in the UK but this can also be prevented by vaccination.

Meningococcal vaccines offered as part of the routine UK schedule

MenB vaccine (which protects against most cases of MenB disease), routinely offered as three doses given as part of the infant immunisation programme at 8 weeks, 16 weeks and 12 months of age. Children born in the UK on or after 01/05/2015 have been offered this vaccine.

Hib-MenC vaccine (which protects against MenC disease), routinely offered at 12months as part of the routine childhood immunisation programme.

MenACWY vaccine (which protects against MenA, MenC, MenW and MenY disease) routinely offered at 13 to15 years of age.

In addition, anyone born on or after 01/09/1996 who was eligible but missed their teenage MenACWY vaccine can still have the vaccine up to their 25th birthday. Anyone who is older and starting university for the first time can still have the vaccine up to their 25th birthday. For a young person still at school speak to their school provider to arrange vaccination otherwise make an appointment with their GP practice.

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Please ensure your child is up to date with their routine vaccinations via your GP practice. Be watchful for signs and symptoms even if your child is up to date with their vaccinations as available vaccines do not protect against all causes of the disease.

All meningococcal vaccines offered to eligible children as part of routine programmes are freely available on the NHS. Vaccines may be available privately for those who are not eligible under these programmes. Meningococcal disease can affect anyone of any age but the national immunisation programmes target those most at risk.

Further information on meningococcal disease is available from:

The Meningitis Research Foundation, www.meningitis.org 0808 800 3344 Meningitis Now, www.meningitisnow.org 0808 80 10 388 helpline email address:

[email protected]

If you need further support or advice, please contact insert contact details or call us insert contact telephone number

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mailto:[email protected]




Appendix 7: Communication with parents following a school case of IMD

IMPORTANT: MENINGOCOCCAL DISEASE INFORMATION FOLLOWING A CASE IN SCHOOL (please read both sides)

Dear Parent or Guardian

A pupil at your child’s school has been admitted to hospital with suspected meningococcal disease which can cause both meningitis and septicaemia. Meningitis is when bacteria reach the meninges (the lining around the brain and spinal cord) and cause dangerous swelling. Septicaemia is when bacteria enter the bloodstream and cause blood poisoning. Both forms of meningococcal disease can trigger sepsis – an overwhelming and life-threatening immune response to infection which can lead to organ failure.

This letter gives you some information about the disease. There is no reason for you to make any change in the school routine and no reason for children to be kept at home.


The meningococcal bacteria very rarely spreadsfrom child to child within class or school. The bacteria that cause the illness live naturally in the back of the throat and can spread between people in droplets from the mouth and nose. Many people carry the bacteria in their throats without becoming unwell.

Preventing the spread of meningococcal disease

The best way to stop the disease spreading is by giving antibiotics to the very close family contacts of the patient with the illness. That usually means that only people who live in the same house as the sick child need treatment. School contacts are only very rarely at risk.

The people who need treatment have already been identified and treated.


The risk of another case in the school is very small, but it is sensible to be aware of the main signs and symptoms of meningococcal meningitis and septicaemia, outlined below.

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High temperature Rapid breathingVomiting/ diarrhoea and stomach cramps

Joint or muscle painCold hands and feet

Severe headache Pale blotchy skin Stiff neck Confusion and/or irritabiltyDislike of bright light Drowsiness or difficult to wakeRash/ bruising rash Seizures/ fits


Meningococcal disease can be hard to identify at first because it can be like a bad case of flu. However, anyone affected with meningococcal disease will usually become seriously ill within a few hours. You should keep checking your child if they are unwell and contact your GP (family doctor) or NHS 111 for advice if you have any concerns. If you become worried about your child’s condition, particularly if they are getting worse, seek medical help urgently at the closest A&E Department or by dialling 999. BE WATCHFUL and use your instincts. Early treatment can be life-saving.



The following meningococcal vaccines are offered as part of the routine UK schedule:

MenB vaccine (which protects against most cases of MenB disease), routinely offered as three doses given as part of the infant immunisation programme at 8 weeks, 16 weeks and 12 months of age. Children born in the UK on or after 01/05/2015 have been offered this vaccine.

Hib-MenC vaccine (which protects against MenC disease), routinely offered at 12 months as part of the routine childhood immunisation programme.

MenACWY vaccine (which protects against MenA, MenC, MenW and MenY disease) routinely offered at 13 to 15 years of age.

Anyone born on or after 01/09/1996 who was eligible but missed their teenage MenACWY vaccine can still have the vaccine up to their 25th birthday. Anyone who is older and starting university for the first time can still have the vaccine up to their 25th birthday. For a young person still at school speak to their school provider to arrange vaccination otherwise you will need to make an appointment with their GP practice.

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Please ensure your child is up to date with their routine vaccinations with their GP practice. Even if they had MenC vaccine when they were younger, it is important that teenagers get the MenACWY vaccine as it boosts protection against MenC disease and protects against more groups of meningococcal disease.

Be watchful for signs and symptoms even if your child is up to date with their vaccinations as available vaccines do not protect against all causes of the disease.

All meningococcal vaccines offered to eligible children as part of routine programmes are freely available on the NHS. Vaccines may be available privately for those who are not eligible under these programmes. Meningococcal disease can affect anyone of any age but the national immunisation programmes target those most at risk.



[email protected]


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Appendix 8: Communication with students following a university case of IMD

IMPORTANT: MENINGOCOCCAL DISEASE INFORMATION FOR STUDENTS FOLLOWING A UNIVERSITY CASE (please read both sides)

Dear Student

You may be aware that a student at insert name of institution has recently been admitted to hospital with suspected meningococcal disease which can cause both meningitis and septicaemia. Meningitis is when bacteria reach the meninges (the lining around the brain and spinal cord) and cause dangerous swelling. Septicaemia is when bacteria enter the bloodstream and cause blood poisoning. Both forms of meningococcal disease can trigger sepsis – an overwhelming and life-threatening immune response to infection which can lead to organ failure.

This letter gives you some information about the disease. We have been in contact with experienced staff in Public Health England and they have advised that no special measures are necessary at the present time.


Meningococcal bacteria are commonly carried in the back of the throat but only very rarely cause illness. The bacteria do not spread easily and only those who have had prolonged, close contact with the person who is ill are at a slightly greater risk of becoming ill themselves. The best way to stop the disease spreading is by giving antibiotics to the very close contacts of the person who is ill. All the close contacts for this case have already been identified and treated.

People who have not had prolonged, close contact (including classmates, friends, acquaintances, visitors to the flat etc) are NOT at any greater risk than the rest of the population and do not need antibiotics. Those who have shared drinks, e-cigarettes or cigarettes with the case but have not had prolonged close contact also have no increased risks.


Although the risk of another case in the University is very small, it is sensible to be aware of the main signs and symptoms of meningococcal meningitis and septicaemia, outlined below.

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High temperature Rapid breathingVomiting/ diarrhoea and stomach cramps

Joint or muscle painCold hands and feet

Severe headache Pale blotchy skinStiff neck Confusion and/or irritabilityDislike of bright light Drowsiness or difficult to wakeRash/ bruising rash Seizures/ fits


Meningococcal disease can be hard to identify at first because it can be like a bad case of flu. However, anyone affected with meningococcal disease will usually become seriously ill within a few hours. You should contact your GP (family doctor) or NHS 111 for advice if you have any concerns about your own or a friend’s health. If you become worried about yourself or a friend, particularly if symptoms are getting worse, seek medical help urgently at the closest A&E Department or by dialling 999. Early treatment can be life-saving.



MenACWY vaccine is routinely given at 13-15 years and was offered to older teenagers as part of a catch-up programme to ensure protection before leaving school. If you were born on or after 1 September 1996 and were eligible but missed your teenage MenACWYvaccine you can still have the vaccine up to your 25th birthday. If you are olderand starting university for the first time, you can also have the vaccine up to your25th birthday. You will need to make an appointment with your GP practice.

Even if you had MenC vaccine when you were younger it is important that you get the MenACWY vaccine as it will boost your protection against MenC disease and protects against more groups of meningococcal disease.

MenB vaccine was introduced into the UK infant programme in 2015 and has only been routinely offered to babies born on or after 1 May 2015.

Please ensure you are up to date with your vaccinations with your GP practice. Be watchful for signs and symptoms even if you are up to date with vaccinations as available vaccines do not protect against all causes of the disease.

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All meningococcal vaccines offered as part of routine programmes are freely available on the NHS. Vaccines may be available privately for those who are not eligible under these programmes. Meningococcal disease can affect anyone of any age but the national immunisation programmes target those most at risk.



[email protected]


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