Guidance

Meningococcal disease: clinical and public health management

Guidance for health professionals on diagnoses, prevention and treatment of meningococcal disease.

Diagnosis

Someone with the disease will become very ill, though not all the symptoms will occur at once.

In children and adults symptoms can include:

  • sudden onset of a high fever
  • a severe headache
  • dislike of bright lights (photophobia)
  • vomiting
  • painful joints
  • fitting
  • drowsiness that can deteriorate into a coma

Symptoms are harder to identify in babies but include:

  • a fever while the hands and feet are cold
  • high pitched moaning or whimpering
  • blank staring, inactivity, hard to wake up
  • poor feeding
  • neck retraction with arching of the back
  • pale and blotchy complexion
  • septicaemia 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 tumbler test).

Symptoms can develop within hours.

Confirmation of disease requires either:

  • isolation of the organism from a normally sterile body site (usually cerebrospinal fluid (CSF) or blood) or
  • DNA detection by PCR assay (from CSF, serum, plasma, EDTA-coagulated whole blood, or joint fluids).

For more information see ‘Laboratory investigation of suspected cases’ (Section 5) in the Guidelines for public health management of meningococcal disease in the UK.

See Meningococcal Reference Unit user manual.

Surveillance

The national surveillance protocol for invasive meningococcal disease (IMD) in England has been extended in recognition of:

  • Changes to the meningococcal group C (MCC) conjugate vaccination programme, including the removal of the infant MCC dose at 4 months and the introduction of an adolescent MCC dose in June 2013.
  • The emergency introduction of a quadrivalent conjugate vaccine against meningococcal groups A, C, W, and Y (MenACWY) for 14-18 year-olds in August 2015 in response to a national outbreak of a hypervirulent MenW.
  • The introduction of a MenB vaccine, Bexsero®, into the national infant immunisation schedule in September.

MenB vaccination programme

MenACWY vaccination programme

Meningococcal disease enhanced surveillance plan

Meningococcal enhanced surveillance forms

Prevention and treatment

Includes:

  • intravenous antibiotics
  • early treatment. The earlier the treatment, the better the prospect of recovery. GPs may give treatment even before the person is admitted to hospital
  • prompt action. If you suspect someone may have meningococcal disease, contact the doctor immediately. If the doctor is unavailable they should be taken to the nearest casualty department.
  • vaccination

Patient group direction (PGD) template to supply ciprofloxacin for meningococcal disease clusters of 2 or more cases in a congregate setting.

Further information on clinical management is available on the NICE Clinical Knowledge Summaries.

Vaccination

Routine vaccination against MenC is recommended at 3 and 12 months of age with a further dose at 13 to 15 years. For further information about see Meningococcal: the green book, chapter 22.

The Joint Committee on Vaccination and Immunisation (JCVI) has recently published its position statement which includes a recommendation to offer a MenB vaccine, Bexsero, to children provided the vaccine can be secured at a cost effective price.

Meningococcal vaccines and travel

Travel to the religious festivals of Hajj and Umrah requires vaccination with a quadrivalent vaccine which protects against meningococcal disease caused by serogroups A, C, W and Y. Saudi authorities request a certificate of vaccination from visiting pilgrims. This vaccine is also recommended for travellers to parts of Africa and other countries with high meningococcal incidence.

For more information on meningococcal vaccines for those travelling abroad, see the meningococcal disease health information sheet on the National Travel Health Network and Centre (NaTHNaC) website and Chapter 22 of The Green Book. For travellers to the Hajj and Umrah festivals see the advice for pilgrims on the NaTHNaC website.

Published 30 March 2011
Last updated 21 February 2017 + show all updates
  1. Added new PGD template for the supply of ciprofloxacin.
  2. Addition of meningococcal enhanced surveillance plan
  3. New surveillance plan for meningocccoal disease effective from September 2015
  4. First published.