Finian McGrath (Dublin North Central, Independent)
Link to this: Individually | In context | Oireachtas source

199. To ask the Minister for Health if he will prioritise the prevention, treatment and aftercare for meningitis and septicaemia patients; and if he will make a statement on the matter. [12547/15]

Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

Meningococcal disease is a serious disease the incidence of which is falling in Ireland.  Ireland's introduction of Meningococcal C and Pneumococcal vaccine programmes have reduced the burden of these diseases and Meningococcal B vaccine is currently being used to control outbreaks of Meningococcal B disease.

In order to harmonise the approach to the management of meningitis in Ireland, HPSC in 2012 produced the guidance document “Guidelines for the early clinical and public health management of bacterial meningitis (including meningococcal disease)” (available at ) which gives clear and straightforward guidance on the management to reduce mortality and morbidity, during the pre-admission and continuing care phases; Investigation of suspected cases; Development of effective Case definitions; Public health action after a single case and Management of clusters of meningitis.

The key recommendations in the guidelines include:

- A presumptive diagnosis of bacterial meningitis is a medical emergency and immediate referral to hospital is required. Health care providers should ensure that all patients with an acute systemic febrile illness, particularly children, can be reassessed without delay if their condition deteriorates.

- Doctors should be encouraged to review the situation within 4-6 hours if early meningococcal disease cannot be ruled out at the first assessment (safety net approach). All GPs should carry benzylpenicillin in their surgeries and emergency bags, and should be ready to administer it without delay to patients with a systemic febrile illness and a petechial or purpuric rash. Ceftriaxone or cefotaxime are suitable alternatives if available.

- The development of signs suggestive of acute sepsis and/or meningitis is a medical emergency and mandates prompt intervention. Treatment should not be delayed while awaiting results of diagnostic tests.

- In patients with meningococcal infection, treatment to eradicate nasopharyngeal carriage is required. The department of public health (medical officer of health) should be notified immediately so that the appropriate public health response can be determined.

Public Health Management

The public health response to meningococcal disease includes: identification of close contacts, arranging appropriate chemoprophylaxis and provision of appropriate information.

Clinicians and laboratories are legally required to notify all cases of suspected bacterial meningitis, invasive meningococcal or Hib disease to the local public health department immediately without waiting for microbiological confirmation and notify all cases of pneumococcal meningitis upon microbiological confirmation.

Departments of public health should undertake enhanced surveillance on all cases and implement prompt public health interventions as appropriate.

The main reason for giving chemoprophylaxis is to eliminate meningococci from any carrier who may be in the network of contacts of each index case. This reduces the risk to other susceptible individuals, protecting them from acquiring the meningococcal strain from the carrier and possibly developing the disease.

Vaccination can also be used to control outbreaks and clusters in appropriate circumstances.

The objective of public health management of outbreaks is to interrupt the transmission of disease and prevent further cases occurring.