Meningococcal Disease Public Health Management Guideline
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Meningococcal Disease Public Health Management Guideline Issued by the Fiji Centre for Communicable Disease Control March 2018
Transcript of Meningococcal Disease Public Health Management Guideline
MeningococcalDiseasePublicHealthManagement
GuidelineIssuedbytheFijiCentreforCommunicableDiseaseControl
March2018
Acknowledgement
TheFijiCentreforCommunicableDiseaseControlthanksthemembersoftheMeningococcal
TaskforceandtheClinicalTechnicalWorkingGroupoftheNationalTaskforceforCommunicable
OutbreakProneDiseasefortheircontributionstothisguideline.Thesupportandtechnical
guidanceoftheWorldHealthOrganisationisalsoacknowledged.SpecialthanksalsototheFiji
NationalUniversityCollegeofMedicineNursingandHealthSciences,inparticulartoDrAneley
Getahun.ThefulllistofcontributorstotheformulationofthisguidelineisincludedinAnnex8.
Disclaimer
Theinformationcontainedwithintheseguidelinesisnotintendedtobeasubstituteforadvice
fromotherrelevantsourcesincluding,butnotlimitedto,theadvicefromahealthprofessional.
Whileeveryefforthasbeenmadetoensurethattheinformationcontainedintheseguidelinesis
correctandinaccordancewithcurrentevidencebasedclinicalpractice,thedynamicnatureof
medicinerequiresthatusersinallcasesemployindependentprofessionaljudgmentwhenusing
theseguidelines.TheFijiCentreforCommunicableDiseaseControl,andmembersofthe
MeningococcalTaskforce,andClinicalTechnicalWorkingGroupoftheNationalTaskforcefor
CommunicableOutbreakProneDisease,donotwarrantorassumeanylegalliabilityor
responsibilityfortheaccuracy,completeness,orusefulnessofanyinformation,orprocess
disclosedatthetimeofviewingbyinterestedparties.TheMinistryofHealthandMedicalServices
expresslydisclaimsallandanyliabilitytoanyperson,inrespectofanythingandofthe
consequencesofanythingdoneoromittedtobedonebyanypersoninreliance,whetherinwhole
orinpart,uponthewholeoranypartofthecontentsofthispublication.
REVISIONHISTORY
Version Date Revisedby
1 December2014 DevelopedbytheClinicalManagementTechnicalWorking
GroupoftheNTCOPD(interim)
2 March2018 RevisedbytheMeningococcalTaskforce and the Clinical
TechnicalWorkingGroupoftheNTCOPD
ScopeandPurpose
TheFijiCentreforCommunicableDiseaseControl(FCCDC)hasdevelopedtheseguidelinesin
collaborationwiththeMeningococcalTaskforce,andtheClinicalManagementTechnicalWorking
GroupoftheNationalTaskforceforCommunicableOutbreakProneDiseases(NTCOPD),which
includesmembersfromtheWorldHealthOrganisation(SouthPacific)andFijiNationalUniversity
CollegeofMedicineNursingandHealthSciences(CMNHS).
Theguidelinescapturetheknowledgeofexperiencedprofessionals,andprovideadviceonbest
practicebaseduponthebestavailableevidenceatthetimeofcompletion.Theguidelinesarebased
oninternationalbestpracticeguidelinesforthemanagementofmeningococcaldiseaseincluding:
InvasiveMeningococcalDiseaseGuidelinesforPublicHealthUnits(Australia)1,Guidanceforthe
publichealthmanagementofmeningococcaldiseaseintheUK2,andReportontheCommitteeon
InfectiousDiseasesCommitteeonInfectiousDiseases-AmericanAcademyofPediatrics.3
Thepurposeoftheguidelineistoprovidestandardisedguidancetocliniciansin,publicorprivate
healthfacilitiesoutsideaDivisionalHospitalfortheearlydiagnosisandmanagementofsuspected
meningococcaldiseasepatients,withemphasisonearlyreferraltoaDivisionalHospital.The
guidelinealsoprovidesstandardstopublichealthpractitionersforpublichealthresponsethrough
notification,caseinvestigation,contacttracing,andchemoprophylaxisforhigh-riskcontacts.
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TableofContentsListofTablesandFigures.....................................................................................................................................2
ListofAbbreviations...............................................................................................................................................3
Introduction................................................................................................................................................................4
LocalEpidemiology.............................................................................................................................................4
Causativeagent.....................................................................................................................................................4
ModeofTransmission........................................................................................................................................5
Reservoir..................................................................................................................................................................5
ClinicalDiagnosisandCaseDefinition............................................................................................................6
Pre-HospitalCaseManagement..........................................................................................................................8
Pre-Hospital(early)antibiotictreatment..................................................................................................8
ClinicalManagementinDivisionalHospital(Pleaserefertorelevantin-hospital
guideline.).............................................................................................................................................................11
LaboratoryDiagnostics...................................................................................................................................11
PublicHealthResponse.......................................................................................................................................11
Notification..........................................................................................................................................................11
CaseInvestigation.............................................................................................................................................12
ContactTracing..................................................................................................................................................12
Contactdefinition.........................................................................................................................................12
Risktocontacts..............................................................................................................................................12
Responsibility.................................................................................................................................................14
Chemoprophylaxis(provisionofantibioticsforcontacts).............................................................14
Vaccination...........................................................................................................................................................16
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Outbreaks.............................................................................................................................................................17
Communicationandeducation...................................................................................................................18
Annex1.NationalNotifiableDiseaseSurveillanceSchedule.............................................................19
Annex2.MeningococcalDiseaseCaseInvestigationForm.................................................................20
Annex3.MeningococcalDiseaseLinelist...................................................................................................23
Annex4:Flowchartforthenotificationandsurveillanceofsuspected
meningococcaldiseaseathealthfacilitiesoutsideDivisionalHospitals...................24
Annex5:Flowchartfornotification&surveillanceofsuspected
meningococcaldiseaseatDivisionalHospital......................................................................25
Annex6: Flowchartofthepublichealthresponsetosuspected
meningococcaldisease.................................................................................................................26
Annex7:Riskcommunicationsframework...............................................................................................27
Annex8:Listofcontributors............................................................................................................................29
References.................................................................................................................................................................32
ListofTablesandFiguresTable1:Meningococcaldiseasehigh-riskcontacts................................................................................13
Table2:Antibioticsforchemoprophylaxis................................................................................................15
Figure1EpidemiccurveofmeningococcaldiseaseinFiji,2007-January2018...........................4
Figure2:EpidemiccurveofmeningococcaldiseaseinFijibyavailableserogroupdata,
2016-January2018.......................................................................................................................................5
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Figure3:Meningococcaldiseasecasedefinitions......................................................................................7
Figure4:Pre-DivisionalHospitalantibiotictreatment............................................................................9
Figure5:Flowchartoftheprimarycaremanagementofsuspected
meningococcaldisease...................................................................................................................10
ListofAbbreviations
CFR Casefatalityrate
DMO DivisionalMedicalOfficer
DORT DivisionalOutbreakResponseTeam
EBS EventBasedSurveillance
EWARS EarlyWarningAlertandResponseSystem
FCCDC FijiCentreforCommunicableDisease
Control
HCW HealthCareWorker
IPCO InfectionPreventionControlOfficer
MO MedicalOfficer
MS MedicalSuperintendent
NACD NationalAdvisorCommunicableDisease
NNDSS NationalNotifiableDiseasesSurveillance
System
NTCOPD NationalTaskforceforCommunicable
OutbreakProneDisease
PatisPlus PatientInformationSystem
PSHMS PermanentSecretaryforHealthandMedical
Services
SDMO SubdivisionalMedicalOfficer
SORT SubdivisionalOutbreakResponseTeam
Taskforce MeningococcalDiseaseTaskforce
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IntroductionInvasivemeningococcaldiseaseisamedicalandpublichealthemergencyandahigh-levelpublichealthpriority.Mostdeathsoccurinthefirst24-48hoursaftertheonsetsymptoms.4Earlydiagnosisandtreatmentreducescasefatalityrate(CFR).5Meningococcaldiseaseisanurgentnotifiableconditionandrequiresanimmediatepublichealthresponse.
LocalEpidemiologyTheincidenceofmeningococcaldiseasehasincreasedinFijiandisamedicalandpublichealthemergency.TherehavebeennoreportsofcasesontheNationalNotifiableDiseaseSurveillanceSystem(NNDSS)inthelast10years,howevercaseshavebeenreportedthroughthePatisPlussystems(bothmortalityandmorbidity)andbasedonthis,asearchofrecordsfromtheyears2007-2017wasconducted.Thenationalaveragefromthissearchyielded1.9reportedcasesperyearwitharangeof0-7casesperyear.Therehasbeena9-foldincreaseinincidencefrom2007to2017.In2017and2018thenumbersofreportedcasesareinexcessofwhathasbeenreportedinthepast(2007-2015).Currentsurveillancereportsindicateongoingmeningococcaldiseaseactivitynationally.Andfortheyears2017and2018thesituationhasreachedepidemicproportions
Figure1EpidemiccurveofmeningococcaldiseaseinFiji,2007-January2018
CausativeagentInvasivemeningococcaldiseaseiscausedby6(A,B,C,W-135,X,andY)ofthe13serogroupsofthegramnegativediplococcusNeiserriameningitides.1From2007–2017therewasachangeinthepredominantserogroupsinFijifromserogroupBtoserogroupC(Figure2).
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Figure2:EpidemiccurveofmeningococcaldiseaseinFijibyavailableserogroupdata,2016-January2018
ModeofTransmission
Transmissionisthroughrespiratorydropletsfromthenasopharynxandtheincubation
periodisfrom1to7days,butcanbeupto10days.Apatientwithmeningococcaldisease
isinfectiousfromtheonsetofsymptomsto24hoursaftercommencingappropriate
systemicantibiotictherapy.Somepatientsmaypresentwithpneumonia,septicarthritis,
pericarditis,conjunctivitis,orurethritis.HoweverinvasiveinfectionscausedbyN.
meningitidismostcommonlypresentasmeningitisand/orsepticaemia.1
Reservoir
HumansaretheonlynaturalhostforN.meningitidis,wherethereisacommensal
relationshipwiththeupperrespiratorytractmucosacolonizedbythebacteria.Mean
durationofcarriagehasbeenestimatedtoalmost21months,withcarriageratesvarying
from3-25%dependentonage.SomeEuropeanandNorthAmericanStudies,show
carriageratesincreasingsharplyinteenagersandreachingamaximuminages20-24.
Meningococcalcarriageisassociatedwiththemalegender,coincidentviralandrespiratory
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tractinfections,lowsocioeconomicstatus,overcrowding,smoking,numberandcloseness
ofsocialcontacts.
Thisguidelinehasbeendevelopedinresponsetotheincreaseinnumberofcasesseenover
2007-2017,andinrecognitionthatthediseaseisanemerginginfectiousdiseaseforFiji,
withaviewtoenhancesurveillance,enhanceearlyrecognition,responseandreferralsto
improvecaseoutcomesandpreventfutureoutbreaksandcontroltransmissioninpublic
healthfacilities/settings.
ClinicalDiagnosisandCaseDefinitionClinicalDiagnosis
Consideraclinicaldiagnosisofmeningococcaldiseaseifthepatienthassignsand
symptomsofmeningitisand/orsepticaemiaincluding:
• Fever,pallor,rigors,sweats• Headache,neckstiffness,photophobia,backache• Vomitingand/ornausea,diarrhoea• Lethargy,drowsiness,irritability,confusion,agitation,seizures,oralteredconscious
state• Moaning,unintelligiblespeech• Painfulorswollenjoints,myalgia;difficultywalking• Anyhaemorrhagicrashparticularlyofapinprick,petechialorpurpuricappearance.
Theabsenceofrashdoesnotruleoutmeningococcaldisease.
Theclassicmeningococcaldiseasepresentationofsepsis,purpuricrash,andmeningitismaynotalwaysoccurtogether.Someonewithasepticillnesscouldstillhavethediseaseandahighindexofsuspicionmustbemaintainedinthecontextof:
1. Ameningococcaldiseaseoutbreak2. Aknowncontactofaconfirmed/probable/suspectedcaseofmeningococcal
disease3. Arapiddeteriorationintheclinicalcondition.
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Aclinicaldiagnosisofmeningococcaldiseaseshouldbeconsideredinasickchildwho
presentswith:
• Fever• Chills• Malaise• Prostration• Arashthatinitiallymaybeurticarial,maculo-papularorpetechial.
Infulminantcases,purpura,disseminatedintravascularcoagulation,shock,comaanddeathcanensuewithinseveralhoursdespiteappropriatetherapy.
MeningococcalDiseaseCaseDefinition
Figure3:Meningococcaldiseasecasedefinitions
Suspectedcasedefinition
Suddenfever≥38degreeCelsius AND
Oneormoreofthefollowingsymptoms:drowsiness,irritabilityorfussiness,intenseheadache,legpain,vomiting,astiffneck,sensitivitytobrightlightsandareducedlevelofconsciousness
OR
Askinrashthatspreadsrapidlyandbeginsasreddish/purplishspots(petechialorpurpuricrash)thatdoesnotfadewhenpressedunderthebottomofaglass(thetumblertest).
Probablecasedefinition
A clinically compatible illness AND close contact with a laboratory confirmed case within theprevious60days.
Confirmedcasedefinition
Infantsandyoungbabieswithfloppiness,drowsinessorpoorfeedingshouldbepresumedtohaveseveresepsis.
Asickchildwhopresentswithfeverandapetechialrash(intheabsenceofaclearalternativeexplanationforthepetechiae)shouldbepresumedtohavemeningococcemiauntilprovenotherwise.
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Cultureofmeningococcus fromanormallysterilebodysite.This includesbloodorcerebrospinalfluid (CSF) or less commonly, joint, pleural (around the lungs), or pericardial (around theheart)fluid,or fluid fromthepurpuric lesionsof therash.DNAdetectionbyPCRfromasterilesitealsoconfirmsinfectionbutisnotwidelyavailable
Pre-HospitalCaseManagementInvasivemeningococcaldiseaseisamedicalandpublichealthemergencyandthatpre-hospitalclinicalcasemanagementcanbelifesaving.OncemeningococcaldiseaseissuspectedthecasemustbereferredtothenearestDivisionalHospitalassoonaspossible.Thisisclassifiedasamedicalandpublichealthemergency.
Asthesepatientsmaypresentinanacutelyillstateanddeterioraterapidly,closemonitoringofvitalsignsandpreparationsforresuscitationandmanagementofhypovolemicshockmustbemade.Achildmayoftenpresentinhypovolemicshocksoaggressivefluidmanagementisessential.Bolusesofnormalsalineat20ml/kgcanbegivenandthischildmustnotbeleftunattended.Immediatediscussionwiththepaediatriconcallteamiswarranted.
Itisrecommendedtotakebloodsampleforculturepriortoadministrationofantibiotics(butthisshouldnotdelaytreatmentandreferral).
Healthstaffshouldpracticestandardanddropletprecautionsuntilthesuspectedcasehasreceived24hoursofappropriatesystemicantibiotictherapy.
Pre-Hospital(early)antibiotictreatmentEmpiricalantibiotictherapymustcommenceasearlyaspossible(within30minutes)oncemeningococcaldiseaseissuspected,butthisshouldnotdelayreferraltohospital.Bloodculturesshouldalsobetaken,preferablybeforethefirstdose,butmustnotdelayearlyantibiotictreatmentandreferral.Antibiotictherapyshouldbegivenintravenously,butifnotpossible,giveviaintramuscularinjection.Penicillinshouldonlybewithheldifapatienthasaclearhistoryofpastallergicreactionafteradoseofpenicillin.AsuspectedcaseofmeningococcaldiseaseshouldbetransportedurgentlytothenearestDivisionalHospital.
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Figure4:Pre-DivisionalHospitalantibiotictreatment
(1)<1monthold:*Ceftriaxone100mg/kg/dorCefotaxime50mg/kg8hrlyPlusAmpicillinat50mg/kgbd.(2)>1monthold:*Ceftriaxone100mg/kg/dorCefotaxime50mg/kg6hrlyEmpirically.IfconfirmedpenicillinsensitivethenBenzylpenicillin300,000u/kg/ddivided4-6hrly(max24MU/d)(3)Childrenmorethan40kgandadults:(i)*Ceftriaxone2gIVbdorCefotaxime2gIVQ4HORifnotavailable(ii)Chloramphenicol(12.5mg/kg)1gQ6HORifnotavailable(iii)Penicillin4MUIVQ4HItisrecommendedtotakebloodsampleforculturepriortoadministrationofantibiotics(butthisshouldnotdelaytreatmentandreferral).
IfPenicillinallergic,usechloramphenicolat100mg/kg/ddivided6hrly(max4g/d)forchildrenagedover1monthsold
Ceftriaxoneisthefirstlinerecommendedantibiotic,howeverifnotavailablethenincreasingthedoseofPenicillinGto24MUIMIperdayindivideddosescouldbegivenpriortotransfer.(2MUintheguidelinesmaynotbeadequate)
FirstlineshouldbeceftriaxoneorCefotaximeatleastuntilsensitivitiesareknown
*Ceftriaxonewillbeavailableasarestricteddrugforuseforsuspectedcasesofmeningococcaldisease.Existingcasereferralprotocolsmustbefollowed,withagreementbytherelevantDivisionalHospitalRegistrar/Consultantrecordedbeforeceftriaxoneisusedasstatdosepriortotransfer.
Dexamethasone
Steroidsdonotchangeoutcomeinchildrenwithmeningococcemiawithoutmeningitis.
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Figure5:Flowchartoftheprimarycaremanagementofsuspectedmeningococcaldisease
Suspectedcaseofmeningococcaldisease
Assesspatientclinicalcondition(vitalsigns,signsofhypovolemicshock,ecchymosisetc.)
TreatasMeningococcemiaØ Givebolusesofnormal
salineat20ml/kgover½to1hourdependingonpateintsageandshockstatus.Canrepeatbolusesupto40mls/kgafterdiscussionwithConsultants
Ø Givetherecommendedempiricalantibioticimmediately:
(1)<1month-IVCeftriaxone100mg/kg/dORCefotaximeat50mg/kg8hrlyPLUSAmpicillinat50mg/kgbd(2)>1month-IMorIVCeftriaxone100mg/kg/dORCefotaxime50mg/kg/6hrlyempirically.IfconfirmedPenicillinsensitive,thenBenzylPenicillin300,000u/kg/ddivided4-6hrly(max24MU/d)(3)Childrenmorethan40kgandAdults(i)Ceftriaxone2gIVBdORCefotaxime2gIVQ4H,ORifnotavailable(ii)Chloramphenicol(12.5mg/kg)1gQ6HORifnotavailable(iii)Penicillin4MUIVQ4H
Ø Informregistrar/consultant,
Ø Informparents/caretakersØ Urgentreferraltothe
nearestdivisionalhospital
Doespatienthave
hypovolemicshock?
It is recommended to take blood sample for
culture prior to administration of antibiotics
(but this should not delay treatment and
referral).
IfPenicillinallergic,use
chloramphenicolat100mg/kg/d
divided6hrly(max4g/d)for
childrenagedover1monthsold
YES NO
TreatasMeningococcalmeningitisØ Givetherecommended
empiricalantibioticimmediately:
(1)<1month-IVCeftriaxone100mg/kg/dORCefotaximeat50mg/kg8hrlyPLUSAmpicillinat50mg/kgbd(2)>1month-IM/IVCeftriaxone100mg/kg/dORCefotaxime50mg/kg/6hrlyempirically.IfconfirmedPencillinsensitive,thenBenzylPencillin300,000u/kg/ddivided4-6hrly(max24MU/d)(3)Childrenmorethan40kgandadults(i)Ceftriaxone2gIVBdORCefotaxime2gIVQ4H,ORifnotavailable(ii)Chloramphenicol(12.5mg/kg)1gQ6HORifnotavailable(iii)Penicillin4MUIVQ4H
Ø Supportivemanagementfor:• Fever• Seizure• Hypoglycaemia• OxygentherapyifSaO2
islessthan94%
Ø PublicHealthManagementandResponse• NotifyFijiCentreforCommunicableDiseasesControl(FCCDC)
urgently(within24hours)• IPCOfillscaseinvestigationform,identifyHCWcontacts,give
recommendedchemoprophylaxistohighriskHCWcontacts• IPCOensuresinfectionpreventionandcontrolcompliance
(contact&dropletprecautions)
Ø Supportivemanagementfor:• Fever/dehydration• Seizure• Hypoglycaemia• OxygentherapyifSaO2
lessthan94%
*Ceftriaxonewillbeavailableasarestricteddrugforuseforsuspectedcasesofmeningococcaldisease.Existingcasereferralprotocolsmustbefollowed,withagreementbytherelevantDivisionalHospitalRegistrar/Consultantrecordedbeforeceftriaxoneisusedasstatdosepriortotransfer.
Ø Informregistrar/consultant,Ø Informparents/caregiversØ Urgentreferraltothe
nearestdivisionalhospital
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ClinicalManagementinDivisionalHospital(Pleaserefertorelevantin-
hospitalguideline.)
LaboratoryDiagnostics
1. Culturefrombloodand/orCSFisthegoldstandard
2. Cultureofpetechial/purpuriclesionoranysterilebodyfluid
3. Gramstainofpetechial/purpuricscraping,CSF,buffycoatofblood
4. PCRishelpfulforpatientswhohavereceivedantimicrobialtherapybefore
culturesdone(subjecttoavailabilityoftestinginFiji)
5. DirectAntigenTestingonCSFsamples(subjecttoavailabilityoftestinFiji)
PublicHealthResponseTheobjectivesofpublichealthresponsesareto:
1. Ensurebothindividualandpublicawarenessonthediseasetoenableappropriate
publicandindividualresponsestothedisease,includingearlypresentationand
adherencewithclearanceantibioticsand/orvaccination.
2. Ensurehealthcareworkerawarenesstoenableearlydetectionandresponse
3. Toidentifycontactsearlytoensureappropriatescreening,prophylaxisandpublic
healthinterventions.
FlowchartsforpublichealthresponseandnotificationareincludedinAnnex4-6
Notification
Meningococcaldiseaseisanurgentconditionthatrequiresimmediatenotificationtothe
NationalAdvisorCommunicableDisease(NACD),DirectorEpidemiology,Subdivisional
MedicalOfficer(SDMO),HeadofDepartment(HOD),DivisionalMedicalOfficer(DMO)and
HospitalMedicalSuperintendent(MS).
ThepublichealthresponsewillbedrivenbytheDivisionalOutbreakResponseTeam
(DORT)withadvice/assistancefromtheNACD.
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Onceanoutbreakorunusualincreaseincaseshasbeenestablished,allmedicalofficersin
theaffectedareamustfillinadailylinelistforallconfirmed,probable,andsuspectedcases
(Annex3).ThismustbeforwardeddailytotheNACDandtherespectiveDMO.Pleasenote
thatallcasesmustbereportedthroughtheNNDSSmechanism(Annex1)simultaneously
andcopiesoflinelistsmustbeattachedtotheNNDSSformandsentoverimmediatelyto
[email protected].*DetailoftheNotificationflowchartinAnnex4-6
CaseInvestigation
Caseinvestigationistobeginimmediatelyuponnotificationofasuspectedcasewith
interviewswiththepatientorclosecontacts,ifpatientistooill,usingthestandard
investigationform(Annex2).Contacttracingwillincludeadministrationofrecommended
clearanceantibiotictohigh-riskcontacts.Awarenesswillalsobeconductedforcontacts
withinformationofsignsandsymptomsofmeningococcaldiseaseandwhomtocontact.
ContactTracing
Theobjectivesoftracingcontactsareto:
• Determinetheirdegreeofcontactwiththecase.
• Provideawarenessandinformationaboutmeningococcaldisease,includingtheir
levelofrisk,andwhattodoiftheydevelopsymptoms.
• Recommendclearanceantibiotics,andvaccinationifindicated,forhighriskcontacts
Contactdefinition
• Contacttracingfocusesonidentifyingthesubsetof‘higher-risk’contactswho
requireinformationandclearanceantibioticsandvaccinationinsomeinstances.
Otherlower-riskcontactsgroupsmaybegiveninformationonly.
• Inestablishingthetiminganddegreeofcontactwithacase,thetimeperiodof
interestisfrom7dayspriortotheonsetofsymptomsinthecasetothetimethe
casehascompleted24hoursofappropriateantibiotictreatment.
Risktocontacts
Thehighestriskistocontactslivingwithinthesamehouseholdasthecase.Thisincludesa
household-likelivingarrangementlikedormitories.Theriskishighestinthefirst7days
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followingtheonsetofsymptomsofthecase,thenfallsrapidlybutremainselevatedfor30
daysifchemoprophylaxisisnotgiven.After30days,theriskfallsbacktogeneral
populationlevels,howeverepidemiologicallylinkedcasesmaystilloccurafterthis
period.4
Theotherhigh-riskcontactsarelistedinTable1:
Table1:Meningococcaldiseasehigh-riskcontacts
Householdcontacts
Includingrecentvisitorswhohavestayedovernightinthe7days
beforeonsetofthecase’sillness(orcontactsinahouseholdwhere
thecasehasspentthenightduringthattime).Includesroommates
indormitorystyleroom.
Travelcontacts
Passengersseatedintheseatimmediatelyadjacenttothecaseon
anyjourneymorethan8hoursdurationinthedaysbeforeonset
ofillness.
Sexualcontacts
Allsexualcontacts,includingintimatekissingpartners.
Childcare/day-care
contacts
Onlychildrenandstaffatthechildcare/daycarefacilitythatwere
withthecaseinthesameroomgroupfor4hoursorlongerinthe7
daysbeforeonsetofillness.
Schooloruniversity
Onlyschooloruniversitycontactswhocanalsobedefinedas
householdcontactse.g.boardingschools,oruniversity
dormitories/hallsofresidence,orschoolfriendswhohavestayed
thenight.
Healthcareworker
contacts
Onlymedicalpersonneldirectlyexposedtothecase’s
nasopharyngealsecretionse.g.thepersonwhointubatedthecase.
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Responsibility
Theunitsorofficersresponsibleforcontacttracingareasfollows:
DivisionalHospitalContacts(Healthcareworkers)-InfectionPreventionControlOfficer
withinthehospital
Allothercontacts(includinghouseholdcontactsandpossiblehealthcareworkercontacts
inhealthcentre/subdivisionalhospital)-DORT
Chemoprophylaxis(provisionofantibioticsforcontacts)
TheobjectiveofgivingantibioticsistoeliminatenasopharyngealcarriageofNeisseria
meningitidisfromanycarrierofavirulentstrainfromtheclosecontactsofthecase,
therebypreventingfurthertransmissionandinfection.Chemoprophylaxisshouldbegiven
toallclosecontacts(refertoTablebelow)assoonaspossible,ideallywithin24hoursof
identificationoftheindexcase.
Theappropriateantibioticprophylaxisisonlyrecommendedforhigh-riskcontacts(Table
1)assoonaspossiblewithin24hoursafterlastexposure.Itisstronglyrecommended
thatprophylaxisbegivenwithin24hours,howeverifthereareunavoidabledelays,it
maybegivenupto30daysafterthelastexposure.Anydelayingivingprophylaxiswill
increasetheriskofthecontactdevelopingthedisease.Everyeffortmustbemadeto
provideprophylaxisassoonaspossible.
Onceahigh-riskcontacthasbeenidentifiedtheappropriateantibioticshouldbe
recommendedaccordingtothefollowingguideinTable2:
Chemoprophylaxismayactintwoways:
• Eradicatescarriagefromestablished/asymptomaticcarrierswhoposeariskof
infectiontoothers
• Eradicatescarriageinthosewhohavenewlyacquiredtheinvasivestrainand
whomaythemselvesbeatriskofdevelopingmeningococcaldisease
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Table2:Antibioticsforchemoprophylaxis
Antibioticsfor
meningococcal
disease
prophylaxis:
Adults Children
1.Rifampicin*
Adults600mgorallytwicedaily
fortwodays
Rifampicinreducestheeffectof
theoralcontraceptivepilland
shouldnotbeusedinpregnancy
orsevereliverdisease.
Children<1monthofage
5mg/kg/dosetwicedailyfor2
days
Children>1monthofage
10mg/kg/dosetwicedailyfor
2days
Max600mgperdose
2.Ceftriaxone
Forpregnantwomenorif
ciprofloxacin/rifampicinis
otherwisecontraindicated
Adults250mgIMonceonly
Children<15yrs:125mgIMI
singledose
>15yrs250mgIMIsingle
dose
(offerlignocainewithdoses)
3.Ciprofloxacin**
Adults500mgorallyonceonly
Ciprofloxaciniscontraindicated
inpregnancy
Children:20mg/kg
max500mgonceonly*
*PreviouslyinFiji,ciprofloxacinwasthefirstlineantibioticforchemoprophylaxis.However,
antibioticsusceptibilitytestingofisolatescollectedin2017and2018showedresistanceor
intermediatesusceptibilitytociprofloxacin.Therefore,ciprofloxacinhasbeenreplacedby
rifampicinasfirstchoiceforchemoprophylaxis,followedbyceftriaxone.
**Ciprofloxacinisusuallynotrecommendedinchildrenduetoinducedarthropathyinjuvenile
animals.Howeverinstudies,theriskofarthropathyduetociprofloxacinwasverylow,
arthralgiawastransientandmostwerecoincidental.3
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Vaccination
Background
Vaccinationhasbeendemonstratedtobeoneofthemosteffectiveandcost-effectivepublic
healthinterventions.Worldwide,ithasbeenestimatedthatimmunizationprograms
preventapproximately2.5milliondeathseachyear.Conjugatevaccinesformeningococcal
disease,areavailableinmonovalent(AorC),quadrivalent(A,C,W135,Y),orcombination
(serogroupCandHaemophilusinfluenzaetypeb)formulations
WHOrecommendsthatcountrieswithhigh(>10casesper100,000population/year)or
intermediate(2-10casesper100,000population/year)endemicratesand/orfrequent
epidemicsofinvasivemeningococcaldiseaseconductappropriatelarge-scale
meningococcalvaccinationprograms.6
Incountrieswherethediseaseoccurslessfrequently(<2casesper100,000
population/year),meningococcalvaccinationisrecommendedfordefinedriskgroups.
Decisiontovaccinate
Vaccinationforhighriskcontacts,orasapreventativemeasurefordefinedhigh-risk
groups,willbedeterminedthroughdeliberationsbytheMeningococcalTaskforceandthe
ClinicalTWGoftheNTCOPD,andwiththeendorsementof,andimplementationby,the
NationalVaccinePreventableDiseaseCommittee.
MassVaccinationformeningococcalinfectioninoutbreaksituationwillbeconsidered
basedon:
1. ConfirmationoftheoutbreakandthefulfilmentoftheWHOcriteriaasabove
2. Theoutbreakoccursinanaturallyconfinedpopulationcohorte.g.schools,small
islandsetc.
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3. ConsiderationforvaccinationwillbediscussedandendorsedbytheNational
VaccinePreventableDiseasecommitteebeforeactualimplementation.
Outbreaks
Outbreaksofmeningococcaldiseaseareapublichealthemergencyastheycauseahigh
degreeofpublicconcernandmediainterest,andresultinsignificantmorbidityand
mortality.Onceanoutbreakissuspectedorrecognisedtheimmediateinitiationofa
coordinatedoutbreakresponseisrequired.
Theterm‘outbreak’istakentomeantheoccurrenceofmorecasesthanexpectedforthe
populationunderconsideration.Timelyandthoroughoutbreakinvestigationsaimto
interrupttransmissionandpreventfurthercases.Thefollowingchangesinepidemiologyof
meningococcaldiseasearesuggestiveofanoutbreak:1,6
- Anincreasedrateofdisease.Insmallpopulationsitmaybemoreusefultofocuson
thenumberofcasesratherthantherate;
- Clusteringofcasesinanagegrouporashiftintheagedistributionofcases;and
- Phenotypicand/orgeneticsimilarityamongstrainscausingdiseaseinthe
population.
Outbreakscanoccuras:
- Institutional-basedoutbreaks–definedastwoormoreprobableorconfirmed
caseswithanonsetinafour-weekinterval,amongpeoplewhohaveacommon
institutional-basedassociation(e.g.thesameschool,extendedfamilies/orsocial
groups)butnoclosecontactwitheachother,inagroupingthatmakes
epidemiologicalsense.
- Communityoutbreaks–Threeormoreconfirmedorprobablecaseswherethere
isnodirectepidemiologicallinkbetweenthecases,withanonsetina3month
intervalamongpersonsresidinginthesameareaandtheprimaryattackrateisat
least10per100,000.Thisisnotanabsolutethresholdandshouldbeconsideredin
thecontextofotherfactorse.g.completenessofcasereporting,continuing
occurrenceofcasesreportedbyMOs.
18
Suspectedoutbreaksshouldbereviewedbypublichealthauthorities(SORTS,DORTS,
FCCDC)toidentifythemicrobiologicalfeaturesofthecasesandanyepidemiologicallinks
betweencases.Casesthatoccurcloselyintimeandplace,butareinfectedwithdifferent
serogroups(orserotypes),shouldbemanagedassporadiccases.Dependingonthe
outbreaksizeandstrain,vaccinationofcontactsmaybeanappropriateintervention
strategy.
Communicationandeducation
Strengtheningawarenessandeducatingcommunities,healthworkers,andhigh-risk
groupsaboutmeningococcaldiseaseiscritical,asitwillsupportincreasedalertnessand
identificationofsuspectedcasesandpromotesat-riskcommunitiestoadoptpreventative
behaviours.
Educationandawarenessactivitiesshouldoccurassoonasanoutbreakissuspected.Itis
importantthoughtonotunnecessarilyraiseanxietywithinthebroadercommunitythatis
disproportionatetotherisk.Ifthereisasuspectedoutbreak,themedicalpersonnelshould
conductfollowingactivities,withsupportfromtheDORTs,andadviceandsupport
facilitatedbytheNACD.Annex6detailsthecomponentsoftheRiskCommunications
Framework.
19
Annex1.NationalNotifiableDiseaseSurveillanceScheduleOthernamesforNotifiableDiseasesareCommunicableDiseases,orinfectiousdiseases.
Themainobjectiveofthisformistomonitorthediseaseoutbreaksandforthis,surveillanceneedstobecarriedoutwith
theinformationprovidedbythefacilities.
TheformisfilledinbytheMedicalOfficersinalltheHospitalsandHealthCentres.WherethereisnoMedicalOfficerit
shouldbefilledinbytheNursePractitioners.
All theaboverequired fields tobe filledandsubmit; thewhitecopy toHIU, thePinkcopy toDMO,Yellowcopy to
SDMO, and thebluecopy tobe retained in thebook. If there areno casesnotified, shouldbe reportedasNIL case.
PLEASENOTE:Send-offweeklyNotificationsassoonaspossibleafternoononSaturdays.
TheHealthinformationunitpreparesthechecklistofthefacilitiesreportingandclarifiesthequeries.Thefeedbacksare
submittedtofacilitiesasquarterlyreports.
NOTIFIABLEDISEASES
(UnderPublicHealthOrdinance,Cap.91,orbyproclamation)
A. DISEASESSTOBENOTIFIEDIMMEDIATELY(bytelephoneortelegram)
• Cholera• Plague• FoodPoisoning(chemicalor
bacteriological)• Smallpox• Typhus(statetype)• YellowFever• AcutePoliomyelitis[a]Paralytic- [b]Non-paralytic
• Diphtheria• EntericFever[a]TyphoidFever- [b]ParatyphoidFever
B. DISEASESTOBENOTIFIEDWEEKLYINDETAIL(givennames,addresses,ages,andraces)
• Anthrax• Brucellosis(includingUndulantFever)• Dysentery[a]Amoebic- [b]Bacillary
• Encephalitis• InfectiveDiarrhoeaorenteritisunder2yrs(severeor
moderateinfections)• InfectiveHepatitis• Leprosy• Leptospirosis(Weil’sDisease)• Malaria• Meningitis(statetype)• PuerperalPyrexia(includingPuerperalFever)• RelapsingFever• Rheumatism(Acute)• Tetanus• Tetanusneonatorum• Tuberculosis[a]Pulmonary- [b]Otherthanpulmonary
• VenerealDiseases[a]Gonorrhoea- [b]GranulomaVenereum
- [c]Ophthalmianeonatorumof
- gonococcalorigin
- [d]Lymphogranulomainguinale
- [e]SoftChancre
- [f]Syphilis(statetype)
- [g]VenerealWarts
• Yaws
C. DISEASESTOBENOTIFIEDWEEKLYBYNUMBERS,RACE,ANDSEXONLY
• ChickenPox(Varicella)• DengueFever• GermanMeasles(Rubella)• Infectivediarrhoeaorenteritisunder
2yrs(mildinfections)• Influenza• Measles• Trachoma• WhoopingCough(Pertussis)
20
Annex2.MeningococcalDiseaseCaseInvestigationFormFinal Case Classification: Confirmed ☐ Probable ☐ Rejected (other diagnosis) ☐
Date of investigation: Name and position of Investigator: Primary person interviewed (if not case):
Section A: Demographic Details Patient name
Gender Age Ethnicity Occupation Current place of Residence
Number of people in the Household Phone Contact Name/Address of Employer or School or Child Care Attended:
- Section B: CLINICAL DETAILS
- Onset date (first symptom) -
- Incubation period (10 days before onset) -
- Date of first presentation to health facility -
- Date of Admission -
- Admitting Health Facility -
1. Brief history of illness:
Symptoms (if present indicate with √ or ×)
Fever/Chills ☐
Headache☐
Rash☐
Photophobia (light
sensitivity)☐
Neck stiffness
☐
Muscle/Joint
pain☐
Abdominal pain
☐
Nausea/vomiting
☐
Drowsine
ss☐
Fitting☐ Confusion or
Impaired
consciousness
☐
Behaviour
change ☐
Symptoms in
Unresponsive☐
Drowsy☐
Floppy☐
Poor feeding☐
Behaviour
21
Laboratory Results
Blood WCC:
Neutrophils:
Haemoglobin: Platelets: Culture:
Growth☐
Nogrowth☐
CSF Protein: Glucose: AST: Culture:
Growth☐
NoGrowth☐
- Section C: HISTORY OF CONTACT
1. Previouscontactwithanyonewithsimilarillness(familymember,friend,schoolcontact,workcolleague)?No☐Yes☐
Ifyes,details:
2. Attendedchildcareinthe10dayspriortoonset?No☐Yes☐ N/A☐Ifyes,details:
3. Attendedanyspecialfunctions/publicgathering/partyinthe10dayspriortoonset?No☐Yes☐
Ifyes,details:
4. Hasthecasetravelledinthe10dayspriortoonset?No☐Yes☐ Ifyes,details:
SectionD:CONTACTTRACINGDETAILS
Forsingle,sporadiccases,therecommendedantibioticshouldbegiventohighriskcontactsas
definedinthePublicHealthManagementofMeningococcalDiseaseGuideline.
Relationship
tocase
Typeofcontact
(household,childcare
groupetc.)
Name Sex Age Dateantibiotic
administered
Clearance
antibiotic
given?
Typeused:
infants and
babies change ☐
Other:
22
COMMENTS:
SectionE:PUBLICHEALTHACTIONCHECKLIST Yes No
1. Contacttracingwasdone–withallthehistoryofclosecontactsinthe7dayspriortocasesymptomonsetandbefore24hoursofcompletionofrecommendedtreatmentantibiotic
☐
☐
2. Numberwithname,ages,andsexwereobtainedfortheprocurementofdrugs.
☐ ☐
3. Awarenessforclosecontactswasdone. ☐
☐
4. Advisedtheclosecontactsonwhattodoshouldsymptomsdevelop(fever,headache,vomiting,feelingweakandunwell).
☐
☐
5. ContactofpersonatMinistryofHealthgiven–e.g.ZoneNurse
☐
☐
6. Recommendedantibioticprovidedtoallhighriskcontacts.
☐
☐
7. Vaccinationprovidedtoallhighriskcontactswhereapplicable
☐
☐
SectionF:Recommendations,challenges,orplansforfollowupifinvestigationnotcompleted.
Annex3.MeningococcalDiseaseLinelist
DateMeninigococcalDiseasesCaseDefinition
Dateofpresentation
Nameinfull
NHN Age Sex Dateofonset
Ethinicity Address Phone Casedefinition(C,P,orS)
AnyContactwithsuspectedcase?
Ifyes,comment
Sampletaken
Sampletype
Confirmedcase(C):ClinicaldiagnosisofmeningitisorsepticaemiawithisolationofNeiserriameninitidisfromanormallysterilesitee.gblood,CSF
MeninigococcalDiseasesLineList
Suspectedcase(S):Clinicaldiagnosisofmeningitisorsepticaemia,awaitingmicrobiologytestresults
ProbableCase(P):ClinicalDiagnosisofmeningitisorsepticaemiawithmicrobiologicalteststhatarenegative,notdefinitive,orwerenotdone,butmeningococcalinfectionisconsideredthemostlikelydiagnosisbyaConsultant
HealthFacility ReportingOfficer
24
Annex4:Flowchartforthenotificationandsurveillanceofsuspected meningococcaldiseaseathealthfacilitiesoutsideDivisionalHospitals
Ø PositiveculturesentforPCRatFCCDC&sero-typingatReferenceLab
Ø FeedbackofresulttorequestingMedicalOfficer
Ø MO/IPCOtonotifyDMOandNACDassoonaspossibleofallconfirmedcasesforfurtherinvestigation
YES NO
Notification
Ø Presentationofsuspectedcaseofmeningococcaldiseaseatthehealthfacility
Ø Treatand/orrefertonearestDivisionalHospital- *Refertomanagementflowchart
fortreatment
Ø Collectbloodsampleforculturepriortoadministrationofantibiotics(*thismustnotdelaytreatmentandreferral)
Ø SamplessentforcultureatDivisionalMicrobiologyLaboratory
§ IsthehealthfacilityanEWARSsite?
-
Ø ReportviaEWARSsurveillancesystemviaEventBasedSurveillancebycalling
Ø EWARSIBSAlertgeneratedasthresholdis1case
Ø EWARSEBSAlertgenerated
Ø DivisionalSurveillanceOfficersverifiedthealerttothereportinghealthfacilitiesusingtheEWARSverifiedchecklist
-
Ø NotificationofsuspectedcaseofMeningococcaldiseasewithin24hoursofpresentationtoDORT/SORTand/orhospitalinfectioncontrolunit
LaboratorySurveillance RoutineSurveillance
Key:FCCDC-FijiCentreforCommunicableDiseasesControl(MataikaHouse),DORT-DivisionalOutbreakResponseTeam,SORT-Sub-divisionalOutbreakResponseTeam,IPCO-Infection&PreventionControlOfficer,IBS-IndicatorBasedSurveillance,EBS-EventBasedSurveillance
Reportto
NNDSS
Ø ReportviaEWARSsurveillancesystemviaIBSSurveillanceasSuspectedMeningitisSyndrome
25
Annex5:Flowchartfornotification&surveillanceofsuspectedmeningococcal
diseaseatDivisionalHospital
Ø Presentation/ReferralofsuspectedcaseofmeningococcaldiseasetotheDivisionalHospital
Ø ManagetheCase.FilltheIBVPDsurveillanceFormandcollectbloodsampleand/orCSFsampleforculturepriortoadministrationofantibiotics(*thisshouldnotdelaytreatment.Refertomanagementflowchartfortreatment)
Ø SamplessentforcultureatDivisionalMicrobiologyLaboratory- *CSF sample to be sent
within1hourofcollection
§ IsthehealthfacilityanEWARSsites?
-
Ø ReportviaEWARSsurveillancesystemviaEBSSurveillance
Ø EWARSIBSAlertgeneratedasthresholdforSMSyndromeis1case
Ø EWARSEBSAlertgenerated
Ø DivisionalSurveillanceOfficersverifiedthealerttothereportinghealthfacilitiesusingtheEWARSverifiedchecklist:
-
Ø NotificationofsuspectedcaseofMeningococcaldiseasewithin24hoursofpresentationtoDORT/SORTandhospitalinfectioncontrolunit
LaboratorySurveillance RoutineSurveillance
Key:FCCDC-FijiCentreforCommunicableDiseasesControl(MataikaHouse),DORT-DivisionalOutbreakResponseTeam,SORT-Sub-
divisionalOutbreakResponseTeam,IPCO-Infection&PreventionControlOfficer,IBS-IndicatorBasedSurveillance,EBS-Event
BasedSurveillance
Ø PositiveculturesentforPCRatFCCDC&sero-typyingandgrouping(ST/SG)atReferenceLab
Ø FeedbackofresulttorequestingMedicalOfficers/Consultants
Ø ReportviaEWARSsurveillancesystemviaIBSSurveillanceassuspectedMeningitisSyndrome
Ø MO/Consultant/IPCOtonotifyDMOandNACDassoonaspossibleofallconfirmedcasesforfurtherinvestigation
Notification
Ø ReporttoNNDSS.
- RefertoAnnex1
26
Annex6: Flowchartofthepublichealthresponsetosuspectedmeningococcal disease
Ø IPCOresponsibleforpublichealthresponseforofhealthcareworkers(HCW)andensuringcompliancewithcontactanddropletprecautions
Ø Notificationofsuspectedcaseofmeningococcaldiseasewithin24hoursofpresentationto
DORT/SORTandhospitalinfectioncontrolunit
Ø ReviewifanyoftheactiontakenbyHCWmeethighriskcontact
definition
Ø ProvidechemoprophylaxistoHCWsassessedashighriskcontactsandconsidervaccinationwhereappropriate
Ø Identifyandclassifycasecontactsfromwithinthelast7days
Ø Contactmeetshighriskcontactdefinition
Ø Contactdoesnotmeethighriskcontactdefinition
Ø ProvideINFORMATIONONLYtobeawareofsignsandsymptoms
Ø Provideinformation,andchemoprophylaxisWithin24hoursorassoonaspossible
1.Rifampicin
Adults600mgorallytwicedailyfor
twodays
Rifampicinreducestheeffectofthe
oralcontraceptivepillandshould
notbeusedinpregnancyorsevere
liverdisease.
Children<1monthofage
5mg/kg/dosetwicedailyfor2days
Children>1monthofage
10mg/kg/dosetwicedailyfor2days
Max600mgperdose
2.Ceftriaxone
Forpregnantwomenorif
ciprofloxacin/rifampicinis
otherwisecontraindicated
Adults250mgIMonceonly
Children<15years:125mgIMIsingle
dose
>15years250mgIMIsingledose
(offerlignocainewithdoses)
3.Ciprofloxacin
Adults500mgorallyonceonly
Ciprofloxaciniscontraindicatedin
pregnancy
Children:20mg/kg
max500mgonceonly*
Ø Considervaccinationofhighriskcontactswhereappropriate
Continueroutinesurveillanceprotocolsandconductregularanalysisofavailabledatatoidentifyclustersofcasesthatmeetthecasedefinitionforanoutbreak.SubmitcaseinvestigationreporttoSDMO,DMO,NACDwithin72hoursofcasepresentationtohealthfacility.Provideupdatesasnecessary.Ifanoutbreakisidentified,MassVaccinationmaybeconsidered.Ifanoutbreakisidentified,theCommunicationFrameworkmustbeenactedforpublicinformation
Divisional/Sub-divisionalhospital Communitybasedresponse
(DORT/SORT)Ø IPCOresponsibleforpublichealth
responseforofhealthcareworkers(HCW)andensuringcompliancewithcontactanddropletprecautions
Annex7:Riskcommunicationsframework
NB:Proposedactivitieswillaidinsupportingtheearlyidentificationofcasesandreduceconfusionandanxietywithinhigh-riskgroups,parents,guardiansand
teachers.
Type RecommendedActivities Topics
Institutional-basedoutbreak
Responsibility:DORTs/SORTs,withadviceandsupportfacilitatedbyNACD.
Foroutbreaksinextendedfamilies/orsocialgroups:
1. Providewritteninformationtoparentsandguardiansofchildrenandyoungpersons,affectedfamiliesandsocialgroupsonidentifiedtopics.
Provideinformationon:
• signsandsymptoms• preventionandcontrolbehaviours• Importanceofincreasedalertness• Typesofcontactdefinitionstoinformclearanceantibiotics• Informationonclearanceantibiotics• Informationaboutvaccination(ifthisistooccur)MoHcontactdetails
forindividualsseekingadditionalinformation.Foroutbreaksineducationfacilitiesoranyotherinstitutions:
1. Makeimmediatecontactwiththeheadofthefacility,principal,headteacherorschool-basedhealthworkertoconductthefollowingactivities:
a. Providewritteninformationtoallinvolved,students,parentsandguardiansofchildren.
b. Providebriefingtothefacility’sstaffontherecommendedtopics.
Provideinformationon:
• signsandsymptoms• preventionandcontrolbehaviours• importanceofincreasedalertnessandimmediatereferralofsuspected
cases• Typesofcontactdefinitionstoinformclearanceantibiotics• Informationonclearanceantibiotics• Importanceofadopting/enforcingpreventativebehaviours• Informationaboutvaccination(ifthisistooccur)• Divisional/relevantcontactdetails
Communityoutbreaks
Responsibility:DORTs/SORTs,withadviceandsupportfacilitatedby
1. Alertmedicalpractitioners(includinggeneralpractitioners)andhealthworkerswithinaffectedcommunities
Provideinformationon:
• Outbreakepidemiology• needforincreasedalertnessandimmediatereferralofsuspectedcases• Typesofcontactdefinitionstoinformclearanceantibiotics• Informationonclearanceantibiotics• Informationaboutvaccination(ifthisistooccur)• Divisional/relevantcontactdetails
2. Provideprinted/writtenIECmaterialstomedicalpractitionersandhealthworkers,fortheirdisseminationtoat-riskgroups
Materialstoincludeinformationon:
• signsandsymptoms
NACD.
• preventionandcontrolbehaviours• Importanceofincreasedalertness• Informationaboutvaccination(ifthisistooccur)• MoHcontactdetailsforindividualsseekingadditionalinformation.
3. Ifappropriate,broadernotificationtothecommunityviapressconferenceorothercommunicationmeansi.e.pressrelease,bulletinetc.ActiontobedeterminedbyPSHMSinconsultationwithNACD.
Provideinformationon:
• signsandsymptoms• preventionandcontrolbehaviours• Importanceofincreasedalertness• Informationaboutvaccination(ifthisistooccur)• AppropriateMoHcontactdetailsforindividualsseekingadditional
information.
29
Annex8:Listofcontributors2014Consultations:ClinicalManagementTechnicalWorkingGroupoftheNTCOPD
DrRaviNaidu ConsultantInternalMedicine,ColonialWarMemorialHospitalSuva.
DrAalishaSahukhan
ActingSeniorMedicalOfficer,FijiCentreforCommunicableDiseaseControl
DrLisiTikoduadua ConsultantPaediatrician,ColonialWarMemorialHospitalSuva.
DrJosephKado HeadoftheDepartmentofPaediatrics,ColonialWarMemorialHospitalSuva.
DrElizabethJ.Bennett
ConsultantIntensiveCare,ColonialWarMemorialHospitalSuva
DrPabloRomakin SubdivisionalMedicalOfficerSuvaDrJemesaTudravu MedicalSuperintendentCWMHospitalDrMikeKama ActingNationalAdvisorCommunicableDiseaseDrEricRafai DeputySecretaryPublicHealthDrJosaiaSamuela ActingDivisionalMedicalOfficerCentral,Divisional
MedicalOfficerEastern.DrJoseseVuki HeadofEmergencyDepartment,ColonialWar
MemorialHospitalSuvaDipChand ChiefHealthInspectorJaneMatanaicake SurveillanceUnit-FijiCentrefor
CommunicableDiseasesControlIsireliRabukawaqa SurveillanceUnit-FijiCentreforCommunicable
DiseasesControlKylieJenkins FijiHealthSectorSupportProgramDrEricNilles WorldHealthOrganisationDrViemaBiaukula WorldHealthOrganisationDrAdamJenney VisitingProfessorofMedicine,FijiNational
UniversityCollegeofMedicine,Nursing,andHealthScience.
DrAnneCreaton, ConsultantEmergencyMedicine,FijiNationalUniversityCollegeofMedicine,Nursing,andHealthScience
30
2018Consultations: MeningococcalTaskforceandClinicalManagement TechnicalWorkingGroupoftheNTCOPD
DrAalishaSahukhan ActingNationalAdvisorCommunicableDisease
DrTorikaTamani NationalAdvisorFamilyHealth
DrIlisapeciTuibeqa,DrEvelynTuivaga,DrLailaSauduadua,DrAnnetteNaigulevu
PaediatricConsultantsandRegistrars
DrRaviNaidu,DrMikaeleMua
InternalMedicineConsultants
DrElizabethBennett,
DrAkuilaNaqasima
IntensiveCareUnitConsultants
DrDaveWhippyDrJosaiaTiko,DrSusanaNakalevu,DrTevitaQoriniasi
DivisionalMedicalOfficers
DrDanielFaktaufon ActingSeniorMedicalOfficerFijiCentreforCommunicableDiseaseControl
DrDevinaNand
DirectorEpidemiology–HealthInformationUnit
MrsTalicaCabemaiwai,
MrsSiliviaMatanitobua
NationalPublicHealthLaboratory
,DrJimaimaKailawadoko,MrIsireliRabukawaqa,,MrSamuelMcOwen,MsAshaCrabb
SurveillanceUnit-FijiCentreforCommunicableDiseasesControl
MrsMeredaniTaufa,MsJokavetiTadrauMrPeniLebaivalu,MsRejieliVuniduvu
DivisionalSurveillanceOfficers
MrsTalicaCabemaiwai,MrsSiliviaMatanitobua NationalPublicHealthLaboratory
,DrJimaimaKailawadoko,MrIsireliRabukawaqa,MrsMeredaniTaufa,MsJokavetiTadrauMrPeniLebaivalu,MsRejieliVuniduvu,MrSamuelMcOwen,MsAshaCrabb
SurveillanceUnit-FijiCentreforCommunicableDiseasesControl
DrEricRafai DeputySecretaryPublicHealth
31
DrLuisaCikamatana
DeputySecretaryHealthServices
DrJemesaTudravu,DrRigamotoTaito,DrJaojiVulibeci
MedicalSuperintendentHospitals
DrOseaVolavola EmergencyMedicineConsultant
SrSusanaVeikoso,
SrYvetteSamisoni,
ChargeMrToufiqAli
HospitalInfectionControlOfficers
DrLitiaTudravu
ConsultantPathology
MrDipChand
NationalAdvisorEnvironmentalHealth
MrVitaeleVaro,
MrLukeVonotabua,
MrRakeshKumar,
MrSuniaUbitau
DivisionalHealthInspectors
DrPabloRomakin,
DrCharlieRaisue
Sub-DivisionalMedicalOfficers
MrsSavairaRaiyawa,
MrNikoTuivuya,
MrTevitaSenico
Sub-DivisionalHealthInspectors
DrAnneleyGetahun,DrAnaseiniBatikawai
FijiNationalUniversity:CollegeofMedicine,Nursing&HealthSciences
DrAngelaMerianos,
DrViemaBiaukula,
DrPrakashValiakolleri,
MsTaraRoseAynsley
WorldHealthOrganisation
32
References
1CommunicableDiseasesNetworkAustralia(CDNA).(2017).InvasiveMeningococcalDisease
CDNANationalGuidelinesforPublicHealthUnits.
2PublicHealthEngland.(2018).GuidanceforthepublichealthmanagementofmeningococcaldiseaseintheUK
3RedBook,30thEdition(2015).2015ReportoftheCommitteeonInfectiousDiseases,30thEdition(2015).
4WorldHealthOrganisation,&GlobalHealthObservatoryData.(2010).Numberofsuspectedmeningitiscasesanddeathsreported2010epidemiologicalseason.Retrievedfromhttp://www.who.int/gho/epidemic_diseases/meningitis/suspected_cases_deaths_text/en/5Guimont,C.,Hullick,C.,Durrheim,D.,Ryan,N.,Ferguson,J.,&Massey,P.(2010).Invasivemeningococcaldisease--improvingmanagementthroughstructuredreviewofcasesintheHunterNewEnglandarea,Australia.JPublicHealth(Oxf),32(1),38-43.doi:10.1093/pubmed/fdp075
6WorldHealthOrganisation.(2015).Meningococcalmeningitis.Immunization,VaccinesandBiologicals.Retrievedfromhttp://www.who.int/immunization/diseases/meningitis/en/
