A Procedure for the management of Meningitis/Septicaemia in the University

Transcription

1 1. Introduction A Procedure for the management of Meningitis/Septicaemia in the University Meningitis/septicaemia is a rare but potentially fatal infection occurring mostly in young children. Over the past few years its incidence in teenagers, and in particular university students, appears to be increasing. At Reading University we can expect an average of one case per year. It is important that students and staff should be able to recognise the symptoms and be able to take prompt action. As the illness causes great concern among other students and their parents, it is important for the University to have a plan to manage any cases that do occur. The fear and anxiety engendered by a case of meningitis/septicaemia are often out of all proportion to the risk. It is essential, therefore, that clear, consistent and accurate information is provided within the University 2. Educating students Students need to be aware of the risks and recognise the symptoms without becoming unduly alarmed. It is vital that they appreciate that, should they feel unwell, they should inform a friend or a member of hall staff who can monitor their progress. It may be appropriate for the student to be transferred to the University Medical Practice so that this can be achieved. The University Medical Practice will provide all students registering with a leaflet explaining the symptoms of meningitis and action to be taken (Appendix 1). Information about meningitis is also posted on the Medical Practice web pages All halls should display a poster on meningitis (obtainable from the University Medical Practice) 3. Meningitis in a Hall of Residence Should a case of suspected meningitis/septicaemia occur in a hall of residence it is important that information is made quickly available to other students and their parents. This will involve the following people, who should meet as soon as possible

2 The Medical Practice Duty Doctor Will inform the Hall Warden or deputy that a case has occurred (unless he/she is already aware) Will, as the attending doctor, inform the Consultant in Communicable Disease Control that a suspected case has occurred. ( Dr. Abid : telephone ) Will inform the University Head of Communications/Press Officer on that a suspected case has occurred and at the earliest opportunity furnish her with a written summary of the present situation (example Appendix 2). Will be available to answer queries from hall staff. Will refer any press enquiries to the University Press Officer. The Hall Senior/Resident Tutor Will inform the duty physician from the University Medical Practice that a suspected case has occurred (unless he/she is already aware). Will, within 24 hours of the occurrence of a case, organise a meeting for all students in the hall to explain the situation and any action to be taken. Leaflets on meningitis will be available. Worried students should be referred to the University Practice or their GP. Should discourage students from going home, as this will not reduce any risk Will refer any press enquiries to the University Press Officer. The Consultant in Communicable Disease Control Will advise which students require preventative measures, such as antibiotics (e.g. those in an intimate kissing relationship with the affected person.) Will inform the University Practice of any cases notified to him. Will inform GPs of any of their patients given prophylaxis. The University Head of Communications will notify senior members of the University of the occurrence, and will identify other members of the University who need to be told in advance of a general statement (see Appendix 2) will deal with all enquiries from parents or media concerning the case using material supplied by the University Medical Practice and the hall concerned, or refer callers to NHS Direct where appropriate Will issue a statement within the University, distributed by via heads of department and departmental secretaries. The statement will be a pre-agreed document to which details can to be entered (see Appendix 3). This statement should also appear on the University s web site. Further statements should be issued at intervals to be determined by the level of student and parental concern. The student s name will normally have to be omitted, but where student s

3 friends will want information, the consent of the victim or the victim s parents should be sought (in a positive way, and only once it is clear that further distress will not be caused) for the name to be included in the bulletins. The statement should confirm the dangers to students (and others) of going home. Students will be advised when it is reasonable to go home. 4. Meningitis in private lodgings This is easier to control as normally only those sharing the same house, perhaps together with close family or a girl or boyfriend, will need any form of prophylaxis. No meeting need be arranged but otherwise the procedure should be as above. Should the student concerned be registered with a medical practice other than the University Medical Practice, it will be the responsibility of the attending doctor to inform the CCDC, who will in turn inform the University Medical Practice, which will inform other members of the Incident Control Team. 5. More than one case Cases which occur without any link between them or more than four weeks apart may be considered to be individual cases but two or more cases occurring within four weeks within the same hall or study group will be treated as a possible outbreak. The same considerations as above will apply but in addition the following: an Incident Control Team will be activated by the Consultant in Communicable Disease Control consisting of: CCDC Director of University Medical Practice Director of Student Services Academic Registrar Consultant Microbiologist Chief Pharmacist Hall Senior/Resident Tutor (if appropriate) Residence Manager (if appropriate) University Head of Communications University Press Officer Other members will be co-opted as necessary A target group for prophylaxis will be defined A method of giving prophylaxis to the appropriate number of people will be agreed Information will need to be widely disseminated throughout the University, by the Communications Office. The outline of the information to be distributed should be agreed in advance. Further

4 bulletins should be issued for as long as the patients condition and the level of student anxiety warrant it. An information and help line will be set up and a press conference, if appropriate, arranged by the University Press Officer. The outline of a press release should be agreed in advance, and the Information Officer should establish a relationship in advance with the public relations officer of the local Health Authority, to ensure that they can work closely together when and if the need arises. Local practices and hospitals will be informed (by the CCDC) GPs any of whose patients have been given prophylaxis will be informed. 6. Terms of reference of the Incident Control Team To develop a strategy to deal with the incident and to allocate individual responsibilities for implementing action To investigate the case, to implement control measures, and to monitor their effectiveness To ensure adequate staff and other resources are available for the management of the incident To provide appropriate information and advice for students, staff, parents, relevant outside bodies and the media To ensure that any GPs whose patients have been given prophylaxis are informed. 7. Advance planning Director of University Medical practice Distribute posters etc Agree method of prophylaxis Agree method of defining target group List contact details for the Incident Control Team Prepare a statement explaining why a programme of immunisation may not be appropriate (since there is likely to be a demand from students and parents for such a programme) Head of Communications and University Press Officer add information about meningitis to the University web site draw up appropriate outline press releases draw up a plan for a telephone helpline set up an group for all academic staff, plus halls set up a web page (which should not be linked to the University home page until required) establish a relationship with the local Health Authority s PRO 8. Evaluation of procedures and policy after the event

5 Within two months of each occurrence of meningitis/septicaemia, the Incident Control Team should evaluate the procedures and policies, and produce a report for submission to the Senior Management Board, summarising what happened, what action was taken, and what lessons were learned for the future. E. Johnston Director of the University Medical Practice October 2007

6 Appendix 1: Leaflet given to students on registration Meningitis A rare disease Meningitis is an inflammation of the membranes covering the brain caused by a variety of organisms, but the one which causes most concern is caused by a bacterium called the meningococcus. The infection is spread in droplets from the patient's breath and therefore close and prolonged contact with an infected person is required in order to acquire the illness. In recent years there has been an increase in the number of cases occurring in University students and although the risk is small it can be further reduced by being aware of the symptoms and taking prompt action. The illness starts with symptoms indistinguishable from that of a flu-like illness namely, fever, headache and aching, but progresses very rapidly leading to high temperature severe headache vomiting neck stiffness photophobia (dislike of light) a rash may also be present which does not fade when the skin is pressed or stretched. Advice should be sought urgently form the University Practice ( ) or the patient s GP if such a rash develops or in a patient who appears to have a feverish, flu-like illness who develops the above symptoms or who is deteriorating rapidly If you feel unwell, tell a friend or a member of the hall staff so that they can keep an eye on you. If a friend is unwell, watch out for him or her, and seek help if they are deteriorating

7 Appendix 2 Checklist of individuals to be informed Hall Senior/Resident Tutor and Residence Manager Director of Student Services Personal Tutor Head of Department/School secretary Advice Services Manager, Students Union VP Student Rights and Diversity The Chaplaincy Director of Residential and Commercial Services Security Services Manager

8 Appendix 3 Sample information sheet INFORMATION A single case of suspected meningitis /septicaemia has occurred in an xxth year student, resident in xxxx Hall of Residence. The student is in hospital and it is understood that although unwell, is stable. Close contacts of the patient have been given appropriate antibiotics. (E.g. those in an intimate kissing relationship with the affected person.) Students in the Hall of Residence are being informed about the case and offered an advice leaflet. The chance of another case occurring is very small. Antibiotics are not routinely normally given to other Hall residents after a single case as there is no evidence that further cases will be prevented; antibiotics may do harm by eradicating protective strains and sometimes cause serious side effects. There are vaccines that protect against some forms of meningitis and septicaemia, but although these vaccines provide excellent protection, they can't prevent all strains of these diseases. As yet there is no vaccine that can prevent all forms of meningitis and septicaemia. Vaccination is not recommended as it is only partly effective against some stains of the organism. Most cases of meningococcal disease in the UK are caused by group B meningococcal bacteria, and there is no available vaccine to protect against this, so knowing the signs and symptoms is vital. These are: a high fever severe headache a dislike of bright lights (photophobia) vomiting stiff neck back and joint pains Possibly a rash which does not fade under pressure. The management of an outbreak is the responsibility of the Consultant in Communicable Disease Control at the Health Protection Unit, Oxford. The telephone number of the Meningitis Trust is

9 Appendix 4 Generic Press Release Outline Press Release dated: Meningitis A single case of suspected meningitis /septicaemia has occurred in xxx year student resident in xxxxxx Hall of Residence at the University. The student is in hospital and although unwell, is stable. Close contacts of the patient have been given appropriate antibiotics - e.g. those in an intimate kissing relationship with the affected person. Antibiotics are not normally routinely given to other hall Residents after a single case as there is no evidence that further cases will be prevented: antibiotics may do harm by eradicating protective strains and sometimes cause serious side effects. Students in the Hall are being informed about the case and offered an advice leaflet. The chance of another case occurring is very small. Vaccination is not recommended as it is only partly effective against some strains of the organism. Meningitis Charity contact details: Meningitis Trust The Meningitis Research Foundation Lucy Ferguson, Senior Press Officer, Reading University L.Ferguson@reading.ac.uk