Previous Health Alerts - Meningococcal Disease Alert for Medical Practitioners

Issued: 10 August 2000

Health warning: increasing rates of Meningococcal disease in Victoria

Dear Doctor,

There has been an increase in notifications of cases of Meningococcal disease in Victoria in 2000, with 69 cases to date, with 6 deaths. This notification rate is a continuation of the marked increase seen in 1999, when 137 cases and 10 deaths occurred.

In the early stages of Meningococcal disease, there may be no specific symptoms or signs. Symptoms and signs to watch out for include:

• headache with or without photophobia
• nausea or vomiting
• neck stiffness
• altered consciousness
• joint pain
• fever
• prostration
• rash

Look for a petechial or haemorrhagic rash. Although Meningococcal disease is often associated with a non-blanching haemorrhagic rash, the rash can be non-specific, especially in the early stages of the disease. It can be macular and erythematous, and blanch on pressure, becoming haemorrhagic and non-blanching later.

In young children irritability, refusing feeds, pallor, high pitched cry or moaning are important. Doctors should encourage parents to trust their instincts about the severity of their child's illness, and to ask for a further review if they remain concerned.

Urgent antibiotic therapy should be given prior to transfer to hospital, as this can reduce mortality.

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Use one of the following antibiotics as a single dose:

• Benzylpenicillin: 60 mg / kg for all ages up to 3 g
• Ceftriaxone or Cefotaxime: 50 mg / kg for all ages up to 2 g

This therapy should be given intravenously unless IV access cannot be attained. Intramuscular administration of antibiotics is not preferred in this setting, as supervening shock and hypotension may lead to failure of absorption of the antibiotic from the injection site.

Collection of a blood sample for culture should be attempted prior to administration of antibiotics but should not delay treatment.

Please notify cases of suspected Meningococcal disease to the Communicable Diseases Section of the Department of Human Services immediately on:

1300 651 160

Or after hours by telephoning: 13 2222 and ask for pager number 46870

Yours faithfully,

Professor John Catford
Chief Health Officer