School students offered meningococcal C antibiotic

Ministry of Health Media Release on behalf of Public Health South

18 August 2002

School students offered meningococcal C antibiotics

At risk students at South Otago High School and Balclutha's Rosebank Primary School are being offered antibiotic treatment to help control a suspected strain of group C meningococcal disease after six students have been admitted to Dunedin Hospital over the past week, Medical Officer of Health Dr John Holmes said today.

"Group C meningococal disease has been confirmed in three patients who attend South Otago High School. The other three patients, one who attends South Otago High School, and two who attend Rosebank Primary School, are under investigation for probable meningococcal disease. They are responding well to treatment."

Dr Holmes said at risk pupils from South Otago High School and two at risk classes at Rosebank Primary School were being offered antibiotics, also known as chemo-prophylaxis in an effort to prevent further cases.

"People who have been in close contact with someone who has a confirmed case of the meningococcal disease have an increased risk of developing the disease themselves. Antibiotics in the form of a tablet or syrup can kill the meningoccal organism if people are carrying it."

"Antibiotics will be offered to the remaining Rosebank Primary School students during the week."

Dr Holmes said it was not necessary to offer everyone in the community the antibiotics.

"Administering antibiotics to people who were not in close contact with the patients is not effective in preventing further spread."

Dr Holmes said planning is underway for vaccination of all the students and teachers at South Otago High School by the end of this week.

Dr Holmes and a team of health protection officers and public health nurses will meet with parents and staff at South Otago High School school hall at 7.30pm on Monday to discuss the vaccine being offered to the students, and how to recognise the disease.

"Vaccination is an additional approach for controlling spread of the disease and we are following best practice guidelines in deciding which at risk group to vaccinate. South Otago High School is the only institution where group C meningococcal disease vaccine is being offered."

"The situation in Balclutha is being closely monitored and we will reassess our decisions if more cases of group C meningococcal disease are confirmed."

Dr Holmes cautioned the public to be aware of the symptoms of meningococcal disease as early treatment saves lives.

A person may be seriously ill if they: - have a fever - refuse drinks or food - are sleepy or floppy - or harder to wake - vomit - are crying or unsettled - have a rash/spots - have a headache.

Dr Holmes encouraged the public to seek medical assessment if they or a member of their family was unwell.

Anyone in the South Otago region wanting more information on the disease and how it is to be managed can ring 0800 153 020 between 8am and 8pm.

ENDS

This media release has been distributed by the Ministry of Health on behalf of Public Health South. For more information contact: Hayley Brock Media Advisor Ministry of Health (04) 496 2115, 025 495 989 www.moh.govt.nz

Background

What is meningococcal disease? Meningococcal disease is a serious bacterial infection caused by a bacterium (germ) Neisseria meningitidis, known as a meningococcus. It usually affects the membrane around the brain (meningitis) or the blood (blood poisoning). It is a serious disease and can sometimes cause death or permanent disability such as deafness.

Can meningococcal disease be treated? Yes. Meningococcal disease can be treated with antibiotics. It is very important that antibiotic treatment is started early. However, even with treatment, death, disfigurement and disability can still occur.

Can meningococcal disease be prevented? The spread of meningococcal disease from person to person can be prevented once the disease has been identified and close contacts of that person are given antibiotics to clear the organism from their throat.

Some forms of meningococcal disease can be prevented by vaccine. Vaccines effective against meningococcal groups A, C, Y and W135 are currently licensed for use in New Zealand. Outbreaks of group A and C meningococcal disease have been successfully controlled by immunisation programmes. At present the type of meningococcal disease causing the majority of cases in New Zealand is a strain of group B.

How do you recognise if someone has meningococcal disease? Don't wait - take action: see a doctor if you or your child is sick. If your child is sick - check often. Meningococcal disease - early treatment saves lives. Your child may be seriously ill if they: - have a fever - refuse drinks or feeds - are sleepy or floppy - or harder to wake - vomit - are crying or unsettled - have a rash/spots - have a headache. Anyone can get meningococcal disease - though those at greatest risk are children under five and young adults. if your child gets worse - take them straight back to the doctor.

How is meningococcal disease spread? The bacteria (meningococci) can be spread by close contact with someone who is carrying it.

Close contact means: Living in the same household Sleeping in the same room Attending the same pre-school (for more than just a few hours a week) Sharing food, drink or utensils Kissing Sharing spit ? from whistles, chewing gum etc.

People often carry the meningococcal bacteria harmlessly in their nose and throat without getting ill. As many as two people in every 10 may carry the bacteria (meningococci) in their throats. This figure can sometimes be as high as five in every 10 in specific communities.

NB: Meningococcal disease cannot be caught by putting your head under the water in hot pools found in New Zealand. Amoebic meningitis may occur after exposure to a different organism from that which causes meningococcal disease.

Why do only some people get sick with meningococcal disease? Meningococci bacteria are often present in many people without causing disease, but on rare occasions they penetrate the defences of the lining of the throat to cause an invasive life-threatening illness. The reasons why this occurs in one person and not another is unclear.

Invasive disease is more common in infants and young adults, and appears to occur in the first few days of exposure of a susceptible person, after which immunity develops. In children the illness may be very nonspecific however it may quickly become life threatening. This is why it is most important to recognize the early signs of meningococcal disease and to take appropriate action.

How is this outbreak different to the group B meningococcal disease currently at epidemic levels in New Zealand? The meningococcal group C disease is different to the New Zealand-specific strain of meningococcal group B disease which is currently at epidemic level in New Zealand and for which a vaccine is currently under development.

In New Zealand the majority of meningococcal disease is due to group B for which there is currently no commercial vaccine available.

In March this year the Government signed a contract with biotechnology company Chiron clearing the way for the Ministry of Health and Chiron to implement an action plan including a series of clinical trials prior to an expected nationwide roll out of an approved vaccine.

Effective vaccines for meningococcal group C disease are available.

Immunisation programmes in the past have successfully controlled outbreaks of meningococcal group C disease.

The group C meningococcal vaccine will be used to control this outbreak in Otago. However it is important to realise this vaccine cannot control the current meningococcal group B disease epidemic."

Why offer antibiotics or chemo-prophylaxis? People who have been in close contact with someone who has a confirmed case of the meningococcal disease have a higher risk of developing the disease themselves. Antibiotics in the form of a tablet can kill the meningococcal organism if people are carrying it therefore it is an appropriate precautionary action for antibiotics to be administered to people who have been in close contact with someone who has the disease.

Almost 200 doses of antibiotic have been given out to family, friends and close contacts of the six Balclutha students who have been hospitalised.

Who else is getting the antibiotics and when? South Otago High School students will receive precautionary antibiotics on Monday and Tuesday this week. The two at risk classes at Rosebank Primary School are being offered the antibiotics today and Monday. Antibiotics will be offered to the remaining Rosebank Primary School students during the week.

How long does it take the antibiotics to work? Precautionary antibiotics work within three to four hours but have to be taken over two days to ensure complete clearance.

Do they work? No antibiotic can give a one hundred percent guarantee however past studies have shown the antibiotics are 98% effective.

How will vaccine administered? The vaccine is given via an injection. The half a ml dose of vaccine is administered in the upper arm and is relatively painless.

Are there any side effects? As with all vaccines there may be some pain and irritation at the site of the injection.

Where will the vaccine come from? All vaccine used in New Zealand comes from overseas. The vaccine to be used at South Otago High School will be sourced from within New Zealand and Australia. This vaccine has been used successfully in New Zealand to control previous outbreaks of the disease. It is already used by New Zealanders who require vaccination for meningococcal disease before travelling to countries like Central Africa where outbreaks of meningococcal disease are common.

How much does it cost? There will be no cost to the recipients of the antibiotics or vaccine. Cost of the antibiotics and vaccine in these situations are paid for by the Government.

Is consent to administer the antibiotics and vaccine needed? Consent for the precautionary antibiotics and vaccination must be obtained for people under 16 years of age from a parent or caregiver.

A consent form and information leaflet will be sent home to all parents on Monday and further copies will be available at Monday night's meeting.

Students will be vaccinated only when they produce a consent form which can then be verified. Parents or caregivers of students over the age of 16 are encouraged to give their consent however those students will be able to give consent themselves.

What about people who don't want to the precautionary antibiotics or vaccine? Meningococcal disease is a serious disease that can quickly become life threatening. If, after receiving enough information on the risks and effects of meningococcal disease, a member of the public makes an informed choice not to receive the precautionary antibiotics or vaccination, then their decision would be respected.

Who will administer the vaccine? The vaccine will be administered by a team of public health nurses trained in vaccination. Around 20 health professionals will be onsite including three or four health protection officers and a small team of clerical workers.

How long before the vaccination is effective? The vaccine takes 7-10 days before it is effective. The vaccine gives about 95 percent protection against group C meningococcal disease. The vaccine does not protect against group B meningococcal disease. Disease is still possible in people who have had both the vaccination and the antibiotics so anyone with symptoms needs to seek medical assessment.

Should you be vaccinating more people?

As of Sunday 18 August 2002 the evidence is that this particular outbreak is confined to students at South Otago High School only. Currently there is no indication that the vaccination programme should be extended outside South Otago High School.

ENDS

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