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Guideline review: management of invasive meningococcal disease, SIGN
  1. J H Baumer
  1. J H Baumer, Little Luson, Nr Yealmpton, Plymouth PL8 2JD, UK; harry{at}

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Despite advances in prevention and management, invasive meningococcal disease remains an important cause of mortality and morbidity in the UK; it is the most common infectious cause of death in children aged between 1 and 5 years. The overall case fatality rate in England, Wales and Northern Ireland in 2002–2003 was 5.6%, with an annual rate of confirmed meningococcal disease of 52.9 per 100 000 in the under 1 year age group, 18.8 per 100 000 in the 1–4 years age group, and 3.1 per 100 000 in the 5–14 years age group.1 Since 1999, when specific immunisation was introduced, the number of cases due to meningococcus serogroup C has reduced considerably. Over the same time there has been a slight reduction in the number of cases caused by the B serogroup.

A widely used management algorithm was published in 1999 by the St Mary’s Paediatric Intensive Care Unit, based on their own experience as a tertiary service,2 and recently updated.3 The National Institute for Health and Clinical Excellence is due to publish a guideline on bacterial meningitis and meningococcal septicaemia in children in March 2010. In May 2008 the Scottish Intercollegiate Guidelines Network (SIGN) published an evidence-based guideline covering the management of invasive meningococcal disease including the assessment, diagnosis and treatment from first presentation, secondary prevention and follow-up.4 The full guideline contains more detail not incorporated in this review, and the reader is encouraged to refer to the full guideline. It includes a list of frequently asked questions for patients and parents, and a list of other sources of information and support, mostly in Scotland. A quick reference guide highlights the main recommendations outside intensive care.

Within the guideline the recommendations are graded. In this review the grades are indicated only for A or B grade recommendations. Grade …

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  • Competing interests: None.

  • i On scene: airway management, oxygen therapy (± assisted ventilation), rapid transfer to hospital. En route: IV or intramuscular benzylpenicillin, treat shock with IV crystalloid boluses, identify and treat hypoglycaemia, provide hospital alert message including patient’s age.

  • ii Defined as: cardiorespiratory decompensation; raised intracranial pressure (signs include fluctuating or impaired levels of consciousness, focal neurological signs or abnormal posturing, dilated or poorly reactive pupils, relative bradycardia and/or hypertension, papilloedema (although this may not be present initially despite significantly raised intracranial pressure)); coagulopathy; or purpura/petechial rash.