14 November 2011
An outbreak of meningococcal disease is ongoing in the community of Olievenhoutbosch, Gauteng Province. As of 14 November 2011, 12 cases have been linked to this outbreak, which was first confined to two crèches, but now may be spreading in the wider community. All specimens/isolates tested to date have been identified as Neisseria meningitidis serogroup W135, and are fully susceptible to the recommended chemoprophylaxis antimicrobials (ciprofloxacin, ceftriaxone or rifampicin).
All healthcare facilities and laboratories in Gauteng Province are urged to be on high alert for meningococcal disease (including meningococcal meningitis and meningococcal sepsis). Healthcare workers should maintain a high index of suspicion, and should a suspected case be identified, take for the following actions:
1. Notify: Immediately notify the Department of Health (DoH) by telephone of all suspected cases. Do not wait for laboratory confirmation before notifying. This should be followed by a written notification (GW17/5 form). The contact details for the respective municipal DoH offices are as follows:
2. Confirm the diagnosis: Collect appropriate specimens (blood and/or CSF) for laboratory investigations. Request microscopy, culture and susceptibility (MC&S) and latex agglutination for suspected meningococcal disease. Laboratories have also been placed on high alert, and may refer specimens and isolates to the NICD-NHLS for confirmation and serogrouping when indicated.
3. Additional investigations: Ask the patient (or an accompanying close family member/friend) about any links to the Olievenhoutbosch community, and share this information with the DoH. This may include, e.g. living/residing in the community, attending school/day- care/crèche in the community, receiving a visitor from the community, etc.
4. Ensure correct patient treatment and infection control: Meningococcal disease may progress rapidly to death if the correct treatment is not initiated in a timely manner. Consult the“Guidelines for the Management, Prevention and Control of Meningococcal Disease in South Africa”
5. Post exposure chemoprophylaxis (PEP) to close contacts: Close contacts (i.e. those who have had prolonged close contact with respiratory secretions of the case, e.g. close household contacts) must receive an appropriate course of PEP. Transient close contracts (including healthcare/ambulance/emergency staff) only require PEP if they have been directly exposed to large droplets or secretions from the respiratory tract. Consult the guidelines for specifics on contact classifications and chemoprophylaxis choices.