Code of Practice

In this Code:

• Meningitis and Septicaemia
• Action to be taken before a case occurs
• Action to be taken when a case or cases occur
  • Protocol A: A single case of possible meningococcal meningitis
  • Protocol B: A single case of probable or confirmed meningococcal meningitis
  • Protocol C: Two or more unrelated cases of meningococcal meningitis
  • Protocol D: Two or more related cases (an outbreak of) meningococcal meningitis

2 Meningitis and Septicaemia

2.1 Introduction

Cases of meningococcal disease amongst students in higher education establishments are relatively rare, but the effects can be extremely serious or even fatal. This inevitably causes considerable anxiety in both students and their families, and also poses a complex medical and administrative challenge to both the University and the Health Protection Agency. Unlike cases of the disease in young children, the close circle of a victim’s contacts may be difficult to define and trace. Normal assumptions do not apply, as students will often be living in communal residences and may be part of an active social network outside these residences. Added to this, misinformation about an incident may spread quickly by word of mouth and panic can easily result.

It is the purpose of this document to reduce anxiety by explaining the nature of meningoccal disease, the risks of contracting it and the action to be taken by both the local authority public health service and the University and if one or more cases occur.

In practice the occurrence of Meningitis rarely follows a clearly defined pathway and thus the actions recommended in this document should be considered as a general guide. Key representatives from the Health Protection Agency and the University will decide, day to day, hour by hour, the most appropriate action to take.

2.2 What is Meningitis?

2.2.1 Meningitis is an inflammation of the meninges; the lining surrounding the brain and spinal cord. It can be caused by a variety of organisms such as viruses and bacteria.

2.2.2 Viral meningitis is the most common type. Symptoms are usually mild (like the common cold) and recovery is normally complete without any specific treatment (antibiotics are ineffective). In most cases admission to hospital is unnecessary (although it is still notifiable to the Health Protection Agency).

2.2.3 Bacterial meningitis is a rare disease, but it can be very serious and requires urgent treatment with antibiotics. There are two main forms of bacterium: pneumococcal and meningococcal (of which there are five groups (strains) A, B, C, Y and W₁₃₅).

• Pneumococcal meningitis mainly affects infants and elderly people, but people with certain forms of chronic disease or immune deficiencies are also at increased risk. There is a vaccine available to protect people at high risk. It does not normally spread from person to person and public health action is therefore not usually needed. The pneumococcal bacterium is better known as a cause of pneumonia.
• Meningococcal meningitis is the most dangerous type of bacterial infection. The bacterium can give rise to meningitis and/or septicaemia. Public health action is always required to identify and arrange the provision of preventive antibiotic treatment to close contacts of a case of meningococcal disease. Meningococcal disease is fatal in about one in ten cases.

2.3 What is Septicaemia?

2.3.1 Septicaemia is a type of blood poisoning caused by bacterial meningitis. The bacteria release toxins which break down the walls of the blood vessels allowing blood to leak out under the skin and reduces the amount of blood available for vital organs. Septicaemia is often more life threatening than meningitis.

2.4 How is meningococcal infection acquired?

2.4.1 Meningococcal bacteria are carried at the back of the throat or nose by up to 10% of the general population (and up to 20% of young people). Only rarely does infection (or colonisation) give rise to disease. Illness usually occurs within seven days of acquiring the bacteria, but symptom-less carriage can persist for many months. It is not known why some people become ill and others remain healthy carriers. The bacteria do not survive for long outside the body and most people acquire infection from prolonged, close contact with a symptom-less carrier. Infection is usually acquired from a healthy carrier rather than from a person with the disease.

2.5 How likely is meningococcal disease to spread?

2.5.1 Most cases of meningococcal disease are sporadic. However, the risk of a second case in a close household contact is much higher than the risk in the general population. In spite of this, clusters of disease are uncommon, occurring only occasionally in households and rarely in establishments of further or higher education.

2.6 What action can be taken to prevent spread?

2.6.1 Antibiotics: Preventive treatment with oral antibiotics (a very short course of rifampicin or one dose of ciprofloxacin) are recommended for close contacts of a case of meningococcal disease in order to reduce the risk of further spread of infection. If only one case has occurred, antibiotic preventative treatment is recommended only for those who have had close prolonged contact with the case. As the infection does not easily spread from person to person there is generally no need for wide-scale preventive measures.

2.6.2 Immunisation: There are currently vaccines against groups A and C of the disease but not against group B. Immunisation is recommended for close contacts of individual confirmed group A or C cases and to defined high risk populations in outbreaks of group A or C disease. It takes five to seven days to produce an immune response and offers short term protection. .

2.6.3 The University Policy on Immunisation: All first year students (aged under 25) should be immunised against group C meningococcal disease by their own General Practitioner, prior to arrival at the University. Those students (under 25) who arrive without immunisation should register with the Student Health Centre or a local General Practitioner and request this to be carried out as soon as possible. Based upon advice from the Department of Health, it is not considered necessary for other students or staff to receive this precautionary immunisation, but it may become necessary if a case occurs. This Policy will be continuously reviewed and amended, in accordance with recommendations from the Department of Health.

2.7 Signs and Symptoms

Meningitis is not easy to detect at first because the symptoms can be similar to those of flu. Recognising the symptoms early enough could mean the difference between life and death. Someone with meningitis will become very ill. The illness may take over one or two days to develop but it can develop very quickly with the patient becoming seriously ill in a few hours.

If the patient’s condition deteriorates, do not delay … go straight to hospital.

The following symptoms may not all appear at the same time:

The "Glass Tumbler" test: If a glass tumbler is pressed firmly against the rash, it will not fade, but remain visible through the glass. If this happens seek medical attention immediately.

2.8 Septicaemia (blood poisoning)

• High fever (not always present initially)
• Shivering and cold feet and hands
• Rash of red/purple spots or bruises
• Impaired consciousness
• Nausea and vomiting
• Rapid breathing
• Severe muscle aches
• Abdominal pain and sometimes diarrhoea

2.9 After effects

Just because meningitis patients are well enough to leave hospital, it does not always mean they are ready to return to normal life. Meningitis is often followed by a variety of after effects, which are impossible to predict. Some of these effects are permanent and cause physical disabilities, some are less obvious affecting the patient emotionally.

A range of possible side effects are:

• General tiredness
• Headaches
• Finding it difficult to concentrate
• Short-term memory loss
• Clumsiness
• Giddiness
• Balance problems
• Depression
• Violent temper tantrums
• Bouts of aggression
• Mood swings
• Learning difficulties
• Deafness
• Tinnitus (ringing in the ears)
• Sore or stiff joints
• Eyesight problems
• Epilepsy
• Brain damage

Consultants will normally see patients a few weeks after they leave hospital to determine if there are any complications. Further information will provided by the Student Health Centre.

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3 Action to be taken before a case occurs: Raising awareness among students and staff

It is important that all members of the University are aware of the nature of meningococcal disease so that vital early detection can occur. The quality of the information should be good and the facts expressed concisely. The issue of information should be well-timed (eg at the start of the new academic year) rather than continuous, so as to avoid over saturation of the message.

3.1 Students

3.1.1 At the start of the academic year all students will be encouraged to:

• acquaint themselves with the symptoms and signs of meningococcal disease;
• register with the Student Health Centre or a local General Practice;
• look out for each other’s welfare; and
• inform someone (eg a friend, Resident Tutor or Residence Manager) if they are feeling ill, so that they can be monitored and prompt medical attention sought if their condition deteriorates.

3.1.2 At the same time student awareness will be raised by:

1. distributing leaflets and symptom cards (eg by attaching to notice boards in study bedrooms, by making them available in the Student Health Centre and local General Practices);
2. holding an Annual Guild of Students Meningitis Awareness Campaign (with the assistance of the National Meningitis Charities) using the Guild of Students Newspaper (“Exeposé”), Guild of Students website (xnet), Radio Station (Xpression) and local media (newpapers and radio stations) to highlight the message; and
3. providing information on the University and Guild of Students website, using as sources, the Student Health Centre and the Health and Safety Office.

3.1.3 Parties responsible for action:

• Students
• Guild of Students; Welfare Officer and Health & Safety Co-ordinator.
• Students Health Centre
• Resident Tutors and Residence Managers
• Health and Safety Office

3.2 Staff

3.2.1 The awareness of staff will be raised by:

1. distributing leaflets and symptom cards (eg by distributing them in University buildings)
2. highlighting the issue of meningococcal disease to staff in the University Newsletter (“Extra”), the Health and Safety Office Newsletter (“Safety Net”) and the Hospitality Services Division Newsletter (“Domestic Bliss”), from time to time and particularly at the start of the academic year;
3. including training in the signs and symptoms of meningococcal disease on staff health and safety training courses (particularly Resident Tutors, Residence Managers, Residence Staff, College Deans and Personal Tutors); and
4. providing information on the University and Guild of Students website, using as sources, the Student Health Centres and the Health and Safety Office.

3.2.2 Parties responsible for action:

• Students Health Centres
• Human Resources
• Health and Safety Office

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4 Action to be taken when a case or cases occur

Who to notify

The Consultant in Communicable Disease Control (CCDC)

Meningitis is a serious public health issue and the management of a case or cases is primarily the responsibility of the local Health Protection Unit (HPU), the person in charge on behalf of the (HPU) is the Consultant (or Deputy Consultant) in Communicable Disease Control (CCDC). The CCDC (or Deputy) is the prime mover when cases occur and they will advise on what action will be taken.

The University Meningitis Policy Coordinator (and Deputy)

When a case occurs it is the University’s role to liaise with and assist the CCDC in implementing his or her recommended actions. In order to minimise the risk of an outbreak the speed of communication and implementing agreed actions are paramount. A University Meningitis Policy Coordinator (UMPC) and deputy have been appointed (ie Sue Odell and Paul Adams in the first instance) to ensure this takes place.

The Incident Control Team (ICT)

Depending on the seriousness or complexity of the case(s) the CCDC may convene the Incident Control Team (ICT) to assist in the management of the case, ensuring that the necessary resources are available. The membership of the team is given in the Key contact details and its terms of reference in the Sources of information page.

IN ALL SUSPECTED CASES OF MENINGITIS, URGENT MEDICAL ATTENTION IS REQUIRED

The following emergency protocols will be put into action and communications sent, according to circumstances of the case:

• 4.1 Protocol A:  A single case of possible meningococcal meningitis
• 4.2 Protocol B:  A single case of probable or confirmed meningococcal meningitis
• 4.3 Protocol C:  Two or more unrelated cases of meningococcal meningitis (each case dealt with separately using Protocol B)
• 4.4 Protocol D:  Two or more related cases (an outbreak of) meningococcal meningitis

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