16. ANNEXURE C: FACTSHEET FOR SCHOOLS/ INSTITUTIONS

What is meningococcal infection?

Meningococcal disease is a serious illness caused by a bacterium known as Neisseria meningitidis (meningococcus).

Meningococci are bacteria, which, if looked for, can be found at the back of the throat or nose in about 5 to 20% of healthy adults and children. Only rarely do meningococci overcome the body’s defences and cause serious illness. Such carriage may actually prevent the spread of meningococci and subsequent disease.

When disease does occur, the bacteria usually cause inflammation of the lining of the brain (meningitis) or spread throughout the body via the blood (septicaemia or blood poisoning).

There are five different serogroups of meningococci that cause most disease (A, B, C, W135 and Y). Most cases occur in Gauteng and in Western Cape Province (WCP). In Gauteng serogroups A and W135 cause about 70% of the meningococcal disease, while in WCP the vast majority are due to serogroup B.

Who catches meningococcal infection?

Crowding, passive smoking, low socio-economic status and a preceding viral throat infection, being a new military recruit or first year student in a residence are risk factors. It is not known why some people become ill while others remain symptomless ‘carriers’ of the bacteria.

Most cases occur in children under four years of age. The next highest incidence is recorded for teenagers between 15 and 19 years of age.

95% of cases occur without any connection to other cases (sporadic cases), sometimes two or more cases are connected by those affected having close contact (outbreaks). In some areas, such as west and north Africa there are large periodic epidemics.

How can you suspect someone has meningococcal infection?

A person can become very ill very quickly.

Warning signs in children or adults include:

• Sudden onset of a high fever,
• Severe headache,
• Dislike of bright lights (photophobia), Vomiting,
• Painful joints,
• Fits or Drowsiness leading to coma

Not all the symptoms may be present

In babies illness may be less obvious eg:

• Fever while the hands and feet are cold,
• High pitched moaning or whimpering,
• Blank starring, inactivity, hard to wake up, Suddenly doesn’t want to eat,
• Neck retraction with arching of the back
• Pale and blotchy complexion

Septicaemia occurs if the bacteria enter the bloodstream. A characteristic rash develops and may start as a cluster of pinprick blood spots under the skin, spreading to form bruises under the skin. The rash can appear anywhere on the body. It can be distinguished from other rashes by the fact that it does not fade when pressed under the bottom of a glass (the drinking glass test). Many people with meningococcal infection may not have the rash.

How do you catch meningococcal infection?

Meningococcus is not highly infectious.

The bacteria are passed by close and fairly prolonged contact, so family members of a case and others who have close contacts with a case may be spreading the same germs. This usually means household or intimate kissing contacts.

Close contact in residential accommodation, such as student halls of residence, and schools can also give the opportunity for the spread of infection.

As the meningococci bacteria cannot survive for long outside the human body, infection cannot be caught from water supplies, swimming pools, or buildings.

How serious is meningococcal infection?

The bacteria only rarely give rise to meningococcal disease. But when they do, infection spreads rapidly and is fatal in about 10% of cases (can be up to 50% with septicaemia). If infection is diagnosed early and treated promptly most people make a full recovery. However, about 1 in 8 people who recover experience some long term effects. These can include headaches, stiffness in the joints, epileptic fits, deafness and learning difficulties.

Can you prevent meningococcal infection?

Meningococcal disease rarely spreads directly from person to person. Over 95% of cases are sporadic and have no identifiable contact. While even in close contacts the risk is low, it is highest in people who live in the same household as the person who became ill, but this is most likely to be due to infection spreading in the household from an asymptomatic carrier to another family member rather than from the person who became ill.

The risk is highest in the 48 hours after the index case presents. Watching household and intimate contacts is important so that early signs of possible meningococcal disease, such as fever, are recognised and treated urgently.

Who should take preventive drugs?

Antibiotics are recommended only for close respiratory contacts of a case

(a) Those who have had prolonged close respiratory type contact (possibly breathing in a fair amount of respiratory droplets) with the case in a household type setting during the seven days before onset of illness. Examples of such contacts would be those living and/or sleeping in the same household, those such as pupils, students, members of the military or police sleeping in the same dormitory, sharing a kitchen where they prepare food together, sharing eating utensils or sharing the same bathroom in a hostel, barracks or residence.

(b) Those who have had transient close contact with a case – but only if they have been directly exposed to close coughing or intimate kissing contact with large droplets or secretions from the respiratory tract within 10 days of a case becoming ill or admitted to hospital. This could include those close enough to have shared items like food and eating utensils, such as close friends at school (but not the whole class). This rule should also apply to children and teachers in crèches.

Prophylaxis NOT usually indicated for: (unless already identified as close contacts as above)

• All staff and children attending same nursery school or crèche
• All pupils or students in same school or classroom or tutorial group
• All work or school colleagues
• All friends
• All residents of nursing/residential homes
• Dry kissing on cheek or mouth. (Intimate kissing would normally bring the contact into the close contact category.)
• Attending the same social function
• All those travelling on the same plane, train, bus, or car

The advice above is based on local and international assessment of risk in contacts of actual cases. It must be remembered that taking drugs carries a risk of side effects – which although small can be serious and greater than the risk of disease!

How soon can a child be back at school after meningococcal infection?

All cases of meningococcal meningitis and septicaemia must be notified to the local health authority. Once a child has recovered from meningococcal infection and has been treated to clear the infection, they can return to school. There is no reason to exclude any healthy siblings or other close contacts of the case from school.

Adapted from the Health Protection Agency website: www.hpa.org.uk/infections/topics