 Meningococcal is a word that grabs the headlines and rattles the nerves. The stories on television and in the newspapers are always accompanied by dramatic photos. For these people, the results are devastating and they deserve all the help we can give them. However, the real picture of meningococcal generally, is quite different. All the facts are not portrayed in a 30 second story that can only glimpse at this disease.
As usual, the most reliable medical information given to the public is mostly sourced through general practice. Here are a few insights to the disease that has the nation’s attention.
Aetiology of meningococcal
About 10% of the community carries the meningococcal bacterium in their nasopharyngeal area. Not all of these are virulent. Humans are the only natural host and the organism cannot survive outside the body for any length of time. Smokers and those living in crowded conditions such as a dormitory, increase their likelihood to be carriers.
Meningococci is transferred through droplet transmission so household contacts of a sufferer have a higher risk of contraction. Usually contacts over the previous seven days are also included in the chemoprophylaxis. The evidence shows that a patient suffering meningococcal disease is not an efficient transmitter. The idea of chemoprophylaxis is to remove the virulent strain from the carrier to reduce the spread to other susceptible hosts. This therapy drastically reduces the risk of another case within the network but the possibility is present.
The importance of early recognition of symptoms should always be stressed. There is also no need for the asymptomatic contact to be quarantined. Cases are generally unrelated to each other and predominantly manifest in winter and spring.
While fever, rash and vomiting are common in young adults and children, young adults may also exhibit headache, drowsiness or confusion-coma, neck stiffness or joint pain and photophobia. Children may also suffer fretfulness, have difficulty waking, pale or blotchy skin, high pitched moaning cry and refuse feeds.
While the rash is an important marker of the disease, it is not always present in the early stages or it may blanch with pressure, where the typical rash doesn’t. The rash may start under areas of pressure so it is important to examine the patient undressed as elastic etc may hide the rash. (Wyeth produces a fridge magnet, listing the symptoms, which may be helpful in educating or reminding parents. Call 1800 250 223 to order.)
Early antibiotic treatment is essential for all suspected cases. An English study calculated that those not given parenteral penicillin before hospital admission were two times more likely to die than those give the antibiotic.*
All GPs should have benzylpenicillin in their surgeries and emergency bags, and
should be ready to administer it immediately to a patient with an acute systemic febrile illness and a petechial or purpuric rash.
Benpen (CSL) seems to be the only benzylpenicillin stable at room temp. Remember to include diluents and appropriate sized syringes. Check the patient’s history for anaphylactic or an immediate hypersensitivity reaction to Benzylpenicillin. Heat and time affect its potency so replace regularly.
“It is strongly recommended that any patient with an acute systemic febrile illness be referred urgently to hospital if any of the following are present: a hemorrhagic rash: an impaired level of consciousness; signs of meningeal irritation; clinical features not normally expected in children with acute systemic febrile illnesses; or the patient is a close contact of someone who was recently diagnosed as having meningococcal disease even if the current patient received chemoprophylaxis.”*
The local Public Health Unit should be notified immediately by phone.
Hearing loss is the most common complication of meningococcal disease (4-6%*) with half the cases bilateral and severe and more common in children that adults. Permanent motor deficits (including amputations), retardation and hydrocephalus affect less than 1% of survivors.* Mortality rates in 1999 reflected a rate of 14.9% in the serogroup C infections and 6.4% in the serogroup B. No fatalities recorded for the serogroups Y or W135.
Local cases
In our area, Grafton to the border, we average seven to eight cases a year. Since January 2002 there have been five reported cases: two in January, one in March and two in July. Despite national data none of the cases this year have been in the high risk under-4 age group with two 10-year-olds and three between 20-30 years. We are in line with the rest of the state with the majority of the serotype of meningococcal being type B (75%). Type C is 5% with 20% unknown. The Far North Coast has had no deaths resulting from meningococcal for the last eight years.
Meningococcal is a serious illness with serious complications. Early diagnosis and treatment is essential. Vaccination of young children will probably become part of the schedule next year and so will be free. Vaccination will only provide cover for serogroup C so parents still need to be educated of the early signs and not be complacent, thinking that their child is immune to all meningitis or septicaemias.
References
*Guidelines for the Early Clinical and Public Health Management of Meningococcal Disease in Australia (www.health.gov.au/pubhlth/cdi/pubs/mening.htm)
Local data supplied by Northern Rivers Division of Population Health.Gae McDonald
media@nrdgp.org.au
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