The Ohio Department of Health recently released a memo to all Health Commissions, Medical Directors, Directors of Nursing in Ohio’s Local Health Jurisdictions, Infection Control Practitioners and Microbiology Laboratory Directors in Ohio hospitals concerning Meningococcal Disease.
The memo reads as follows:
Cases of meningococcal disease often present an urgent situation. First, this is a Class A1 disease, meaning that suspected cases should be reported immediately by telephone to the local health department within whose jurisdiction the patient resides.
Second, when such a case is suspected, close contacts need to be located and evaluated for their need to receive antibiotic prophylaxis. This generally requires the resources of the public health department.
Third, it is important to determine the serogroup of Neisseria meningitidis involved. The use of vaccine would be considered if an outbreak occurs in a large institutional or community setting in which the cases are caused by a serogroup included in the vaccine.
For these reasons, the following is recommended:
1. If infection with Neisseria meningitidis is suspected, immediately contact by telephone the city or county health department within whose jurisdiction the patient resides. Even if it is only a suspected case, the health department can be helpful in locating close contacts who may need antibiotic prophylaxis. (If family members are being prophylaxed, there may be other close contacts who also need to be prophylaxed. The health department can help locate them.)
2. Send all isolates of Neisseria meningitidis from blood, cerebro-spinal fluid or other normally sterile sites to ODH. See the addendum which follows for more details on packaging and shipping.
3. If meningococcal disease is suspected based on the clinical presentation, but cultures are negative, save all CSF, blood and serum samples. PCR testing at the Centers for Disease Control and Prevention (CDC) may be available to assist in some situations. Call the Bureau of Infectious Disease Control at ODH immediately to discuss the case. (During working hours, call 614/466-0265; evenings or weekends, call 614/728-3463).
If you need further information about meningococcal disease or prophylaxis guidelines, please do not hesitate to call. Your assistance is appreciated.
ADDENDUM
INSTRUCTIONS FOR PACKAGING AND SHIPPING ISOLATES OF
Neisseria meningitidis
1. Please send all isolates of Neisseria meningitidis from blood, cerebro-spinal fluid or other normally sterile sites to ODH Laboratory. It is not necessary to send isolates from throat or sputum.
2. Grow and ship these sterile site N. meningitidis isolates on blood or chocolate agar slants. (Sheep blood is preferred). TSA, Kligler, and TSI slants have worked very poorly in the past with N. meningitidis isolates. Plates are acceptable but less desirable.
3. Complete and enclose the ODH Microbiology form (see the Laboratory section of the ODH Infectious Disease Control Manual, or call ODH Laboratory at 614/ 644-4659 for a copy).
4. Use shock-absorbing material and adequate packaging to prevent breakage.
5. Overnight delivery is requested as this is a fragile organism, which can be lost if transit time is extended. Ship only on Monday through Thursday, using an overnight, 24-hour carrier. Ship to:
Attention: Specimen Receiving
Ohio Dept. of Health Laboratory
1571 Perry Street
Columbus, OH 43201
6. If you have questions about shipping, call the lab at 614/ 644-4659 during working hours. Evening or weekends, call the Bureau of Infectious Disease Control, Class A1 line at 614/728-3463.
If there is no isolate:
If meningococcal disease is suspected based on the clinical presentation, but cultures are negative, save all CSF, blood and serum samples. PCR testing at the Centers for Disease Control and Prevention (CDC) may be available to assist in some situations. Call the Bureau of Infectious Disease Control at ODH immediately to discuss the case. (During working hours, call 614/466-0265; evenings or weekends, call 614/728-3463).
To ship CSF, blood or serum, see #3 - #6 above. Please ship fluids with a coolant, such as a plastic freeze pack.