General practice

Up to date meningitis information for you and your patients.




WARNING! Be vigilant for atypical presentations of a virulent type of meningococcal disease

A particularly deadly strain of MenW (Meningococcal W) disease is rising at an alarming rate in the UK.

Invasive MenW disease is associated with unusual clinical presentations compared with other meningococcal groups:

MenW cases may present with septic arthritis and severe respiratory tract infections (including pneumonia, epiglottitis and supraglottitis).1 These presentations are over-represented among MenW cases compared with other meningococcal groups.

Several adults with MenW septicaemia have presented primarily with gastrointestinal symptoms but without the characteristic non-blanching rash and progressed rapidly to death.

Clinicians are encouraged to maintain a high index of suspicion across all age groups. Early recognition and prompt initiation of antibiotics and supportive therapy for patients with invasive MenW disease can be life-saving.

Government advisors, the Joint Committee on Vaccinations and Immunisations (JCVI), have concluded that the increase in MenW disease constitutes an outbreak and a programme to immunise everyone aged 14-18 years of age is now being implemented (see MenACWY for teenagers below). MRF’s Meningococcal Genome Library was instrumental in identifying the outbreak strain.

Reference

1. Ladhani SN, Beebeejaun K, Lucidarme J, Campbell H, Gray S, Kaczmarski E, et al. Increase in endemic Neisseria meningitidis capsular group W sequence type 11 complex associated with severe invasive disease in England and Wales. Clin Infect Dis. 2014; 578–85.


Two new immunisation programmes launched in the UK in 2015

MENACWY for teenagers


A virulent strain of MenW is causing meningitis and septicaemia across all age groups especially babies, healthy teenagers and young adults and has a higher death rate associated with it than other strains of meningococcal disease.

A programme to immunise everyone aged 14-18 years of age is now being implemented in order to generate herd protection against MenW and prevent further rapid increases in disease amongst the rest of the population. Both conjugate MenACWY vaccines, Menveo and Nimenrix, can be used for this programme.

We have launched #StoptheSpread, a campaign to raise awareness of the importance of vaccination amongst school children and first year university students.

More about our #StopTheSpread campaign  
Read more about the rise in MenW disease

More in depth information on MenACWY vaccine implementation

Information and training slides for immunisers have been produced by Public Health England:

MenB vaccine - Bexsero


  • The new MenB vaccine has been available to all UK babies as part of the routine immunisation schedule from 1 September 2015
  • All babies born on or after 1 May 2015 are also eligible for the vaccine on the NHS
  • Babies born before 1 May 2015 will not be offered the vaccine on the NHS, but it is available privately for older children.*
Read our comprehensive Men B vaccine factsheet


Prophylactic paracetamol use


  • Clinical trials of the MenB vaccine Bexsero found that rates of fever after administering Bexsero alongside other childhood immunisations are higher than when existing routine vaccines are given alone. There was a 51-61% fever rate after Bexsero was given alongside routine vaccines compared to 23-36% after routine vaccines alone.
  • To reduce the likelihood of fever it is recommended that three doses of prophylactic paracetamol be given to children with the MenB doses in infancy (at the 2 and 4 month visits)
  • The first dose of paracetamol should be given at the time of vaccination or as soon as possible afterwards and the second and third doses should be given at 4-6 hourly intervals thereafter.
  • For a limited time infant paracetamol sachets were made available for practices to order centrally but these are no longer available to order from the Immform website. Parents should be advised to purchase a bottle of infant paracetamol on their way home if they don’t have some at home already, and to give the first dose to their baby as soon as they can.
  • Parents should also be given the “Using paracetamol to prevent and treat fever after MenB vaccination” leaflet at the two and four month appointment visits. Hard copies can be ordered from the following link https://www.orderline.dh.gov.uk/ecom_dh/public/home.jsf 
*Shortage in Private supply of Bexsero

There has been a shortage in the supply of Bexsero for the private market during the first half of 2016. This means that patients with children born prior to 1 May 2015 who wish to obtain the vaccine privately for the first time will need to delay starting their immunisation course until the summer.

GSK have released the following statement about this:

“Due to unexpected global demand for Bexsero during 2015, we are experiencing supply constraints during the first half of this year. 

Although vaccination through the NHS childhood programme has been prioritised and is unaffected, we have unfortunately had to ask private clinics temporarily to not start new courses of vaccination. Children who have already started their course of the vaccine privately should still be able receive their follow up doses.

We know the unexpectedly high demand for the vaccine reflects the importance parents have placed on protecting their children from meningitis B, so we are working hard to increase supply, and expect to have increased stock by summer 2016.”

More in depth information on MenB vaccine implementation

Information and training slides for immunisers have been produced by Public Health England

Information for your patients

Symptoms Resouces

NICE QS64 and QS19 both prioritise the provision of safety net advice for parents including information on when to seek further help if they have been advised to care for their feverish child at home. 
These commended resources can be useful for parents as part of the safety netting information provided by GPs:
Meningitis Baby Watch

Meningitis Baby Watch cards

The under fives are the most vulnerable age group. This card is included in around one third of all Personal Child Health Records (red books) given to new parents by local health authorities.

It helps parents and other carers, to recognise the symptoms of meningitis and septicaemia in babies and very small children who cannot explain how they are feeling.


Tot Watch

Meningitis Tot Watch 

This leaflet gives the symptoms of meningitis and septicaemia for the under fives, including the red flag symptoms.
Race Against Time

Race Against Time

A symptoms leaflet, which also addresses some of the myths that surround meningitis and septicaemia.
Symptoms card

Symptoms card


Recovering from meningitis and septicaemia resources

Some of your patients may have recovered from bacterial meningitis or meningococcal septicaemia. We can support them. Help us to help them by passing on our resources. Order or download the free resources:

Support for you

The support we can offer your patients includes:
  • Offering a listening ear and support 
  • Answering their questions and providing information
  • Helping them navigate the disability rights and benefits system
  • Putting them in touch with telephone befrienders who have been through a similar experience
 
your Guide

Your Guide: Recovering from childhood bacterial meningitis and septicaemia

The meningitis charities have produced information for parents which describes possible after effects, expected recovery patterns and how to access further care and support.

 

UK University Poster 2015

Download the poster

Order online

New

Poster encouraging freshers to get the MenACWY vaccine to protect themselves and #StopTheSpread of a deadly new strain of meningitis in the UK.

Also presents symptoms of meningitis and septicaemia.


Meningococcal meningitis and septicaemia - Guidance Notes for GPs

Download the Booklet

Download the Wallchart

Order online

Endorsed by the BMA and produced in line with the NICE Bacterial Meningitis and Meningococcal Septicaemia Guideline102.
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