Public health

• Doctor immediately notifies any suspected case of meningitis or meningococcal septicaemia by phone to the Consultant in Communicable Disease Control (CCDC), Consultant in Public Health Medicine (in Scotland) or on-call Public Health Specialist. This is the legal duty of the doctor who makes or suspects the diagnosis - usually the hospital doctor notifies even if the case was referred by a GP.
• After a single confirmed or probable (i.e. where MD is the most likely clinical diagnosis) case of meningococcal disease, only close contacts living in the same household as the case in the 7 days before disease onset, or kissing contacts need antibiotic prophylaxis³⁸.
• Healthcare staff only require prophylaxis if their mouth or nose has been splattered (clearly felt) with large particle droplets/secretions from the respiratory tract of a patient with confirmed or probable meningococcal disease, or if conjunctivitis develops within 10 days of exposure ⁴⁶. This is unlikely to occur except when using suction during airway management, inserting an oro/nasopharyngeal airway, intubating, or if the patient coughs in your face.
• Public Health, usually the CCDC/CPHM arranges for prophylactic antibiotics to be prescribed to contacts as necessary.  Rifampicin, ciprofloxacin (not in children under 2 or in pregnancy), and ceftriaxone (by injection) are all recommended for use in preventing secondary cases of meningococcal disease, but only rifampicin is licensed for this purpose.  Rifampicin interferes with the oral contraceptive pill and stains body fluids red, including urine and saliva, and permanently stains soft contact lenses.  Some individuals may experience rash or stomach upset.
• Antibiotic prophylaxis should eliminate carriage, but if the contact is already incubating the bacteria, he or she can still get the disease.  Close contacts of a case need to understand that they are at increased risk of meningitis and septicaemia, and should be alerted to the symptoms, and given a leaflet on meningitis and septicaemia.  
• The CCDC/CPHM will:
• arrange for the next of kin to be interviewed to establish other close contacts and will arrange prophylaxis for them, and for later immunisation of all close contacts if indicated
• ensure information is disseminated to appropriate local schools, work places and general practitioners
• be responsible for early detection of clusters and outbreaks of disease.