IDR-05

Prophylaxis - using rifampicin

Rifampicin is an antibiotic that is often prescribed to help reduce the chances of anyone else developing meningo infection. The prescribed dose of rifampicin varies with age. The amount that must be taken will be shown on the bottle or number of tablets. It is important that everyone who has been identified as requiring rifampicin takes all four doses. Everyone should start taking the medication at about the same time.

Some people should not take rifampicin: Women who are pregnant/Anyone with liver disease

Rifampicin can affect the action of some other drugs including: Oral contraceptives/Some anti-coagulants (blood thinning tablets)/Some oral anti-diabetic drugs/Steroids

With regard to oral contraceptives, some other form of birth control (such as a condom) must be used for the rest of the month during which rifampicin was being taken, while continuing to take the “pill”.

The possible effect on the other types of drug should be discussed with your own doctor before/as soon as possible after starting rifampicin.

Urine and tears can be temporarily coloured orange during treatment with rifampicin. Anyone who wears soft contact lenses must not use them whilst their tears are orange as they may become permanently stained.

Although this course of treatment will be effective in the short term it will not give long lasting protection from infection.

If you are at all unwell while taking the antibiotic, contact your doctor.

Sometimes other antibiotics may be used instead of rifampicin. The most common one is called ciprofloxacin. If you have been given this instead of rifampicin check with the doctor how much you should take because it is different.

Meningitis is a serious and statutorily notifiable disease and all cases must be reported to the local Department of Public Health.

If you need more information, please talk to your GP, area medical officer or public health nurse.

For further information about meningococcal disease, contact:

Department of Public Health, Health Service Executive Mid-Western Area, 31-33 Catherine Street, Limerick. (061) 483337

Limerick Community Care, Unit 3, St Camillus’ Hospital, Limerick. 061-483712

Clare Community Care, Sandfield Centre, Ennis, Co.Clare. 065 6868038

E.Limerick/Tipperary North Community Care, Kenyon St. Nenagh, Co.Tipperary. 067-31212

For further information: Meningitis Research Foundation 1890 413344

Department of Public Health Health Service Executive Mid-Western Area

31-33 Catherine Street, Limerick Tel: 061 483337 Fax: 061 483211

Last revised: November 2004

MENINGOCOCCAL DISEASE Health Service Executive Mid-Western Area

Information leaflet for parents

Mid-Western Area

Department of Public Health

What is happening?

Your child is believed to be suffering from an infection caused by the germ Neisseria meningitidis. This is usually known as the meningococcus or “meningo” for short. There are a number of different types of meningo (e.g. A, B, C and W135). About 300 cases are confirmed each year in Ireland. In the HSE Mid-Western Area, there are 20-30 cases confirmed annually. The peak time for this infection is September until April.

They can cause a variety of infections – meningitis, septicaemia (blood poisioning), arthritis, conjunctivits and pericarditis (heart). Of these the commonest are meningitis and septicaemia and it is quite common for both to occur in the same person at the same time.

These are serious illnesses that can be life-threatening. Despite the seriousness of the illness the majority with meningo infection get better.

Where did my child get it?

From someone else, possibly someone in the family. This is because the meningo lives at the back of the throat. In the vast majority of people it just stays there causing no problem at all. This carriage period can last for many months. Most people will carry a meningo at some stage in their lives. The carriage rate varies but can be as high as 25% during the winter months. The actual number of people who become ill is only a small fraction of this.

How does it spread?

By close and fairly prolonged contact. The germ can be coughed out and breathed in or it may be transferred in saliva, for example when kissing. Apart from this, it is not particularly efficient at spreading from one person to another. It does not spread through water of food or from environment.

Who gets it?

In the main, young children. The peak age is 6 months and teenagers but occasionally even the elderly can become ill.

Why has my child got it?

We simply do not know why some people do become ill or why so many don’t.

What is the outcome?

The great majority of people get better but the overall death rate internationally can be as high as 10%.

After recovery some people (probably less than 10%) will have some degree of hearing loss. It is routine to check children’s hearing after they have got better just to be sure.

What will happen now?

The hospital staff are going to be busy but there are some things that we have to consider away from here.

Its quite possible that the meningo may still be living in the back of the throat of a member of your household. There is a very small chance that it may cause more illness in your family.

This is not very likely but we can arrange for people to have antibiotics that can get rid of the meningo. The hospital may already have sorted some out for you but we really need your help to see if there is anyone else who needs them.

We call this business of giving out antibiotics “prophylaxis”. It can definitely reduce the chances of more illness in the short term but it does not give the same sort of protection as a vaccine.

What we need to know from you

We need to know who has had close and prolonged contact with your child during the week before they became ill. We are not concerned about people who have just visited the house for an hour or so. Nor are we interested in people you may have met with your child at the shops or on a bus.

As a guide we want to identify people who have slept under the same roof as your child in the past week. This is normally easy to work out but sometimes it can get complicated if you have had visitors or if your child was staying away from home.

We will also want to know if your child has attended a crèche in the 7 days before becoming ill as people there may need prophylaxis as well.

Because meningo tends to affect children and children go to nurseries and schools it is natural to assume that it is the school or nursery that is causing it to spread. In actual fact it is very rare for this germ to spread in schools or nurseries. Children mostly pick it up from adults, often within the family setting.

After one case in a school or nursery the chances that another will occur are just the same as before – very small indeed. Having said that, occasionally two cases do occur in the same place but usually this is due entirely to chance and, more often than not, the germs are not the same.

However, we believe that it is best to inform schools and nurseries when there has been a case of meningo because other parents naturally get worried.

If your child, or any brothers or sisters, attend school or nursery we will need the details so that we can take some information round to put everyone in the picture. Sometimes one of us will visit the school or nursery and talk to parents and teachers about this infection.

Why can’t meningo infection be prevented?

The only way to prevent a meningo infection ever occurring would be to vaccinate those who are at risk. At the moment the only vaccine currently available gives protection against Group C and this is now given as part of the routine childhood vaccination programme.

A lot of work is going on to produce an effective vaccine the Group B germs but that is some way off at the moment.

Why not give everyone prophylaxis after a case has occurred?

Most people who are carrying a meningo will not become ill but may develop immunity (resistance to infection) which will protect them in the future from that type. Prophylaxis does not give immunity. Clearing the carriage from lots of people will deprive them of the valuable long term protection that they would otherwise get. It will do more harm than good to give everyone prophylaxis.