Phone call received from the Out Of Hours Service (OOH) at 9:10am stating that they had received a phone call from an individual stating;
• They had visited Disneyland Paris as part of a group of 18-20 people.
• One person in the group had taken ill during the holiday and been admitted to a hospital in Paris.
• On their journey home a Doctor from the hospital in Paris contacted someone in the group to inform them that the individual who was ill had meningitis and that when they returned to England they would need to contact a Doctor and get some antibiotics.
• The OOHs Doctor then asked what do we need to do?
Action whilst on-call
• Gained contact details and contacted the individual who had initially rang the OOH Service.
• Spoke to various members of the party to establish which hotel/accommodation the group stayed in, dates they had travelled, date of when the case first became ill, date of admission to hospital, the level of contact each member of the group had with the case, who stayed with whom in which room and the details of every member of the party.
• Members of the party who had returned to the UK were spread across 5 Public Heath England Centres (regions).
• Ultimately all individuals n the group were contacted to get a full picture and details of contact with the case.
• Liaised with the Consultant in Communicable Disease Control (CCDC) throughout this process.
Following lengthy discussions with the CCDC it was felt that antibiotic chemoprophylaxis had to be prescribed to the whole party (even though some of them did not meet the standard guideline criteria for a close/household contact i.e. an overnight stay with the case or minimum of 8 hours of contact). There is limited and contradictory evidence and expert opinion whether to administer chemoprohylaxis to people just because they travelled in the same vehicle (ECDC guidance, 2010, see section 6 of the guidance1).
The reasons for this decision were:
• Two family members remained in France with the case. They had been prescribed antibiotic prophylaxis by the French authorities.
• Furthermore two contacts within the party who had returned to England had also been prescribed antibiotic prophylaxis on the evening of their return (whilst the rest of the party were still travelling north).
• As the French authorities had given antibiotics to the family members still in Paris, we had to work with the likely diagnosis being meningococcal, as this and Haemophilus influenza type b (HiB) are the only forms of meningitis for which chemoprophylaxis would be given.
• HiB was unlikely due to its rarity and also because the Doctors in France would not have had the B typing back by the time they were informing relatives of the diagnosis. Antibiotics had been administered to contacts within 48 hours of admission of the case, the typing for HiB takes several days.
• The final complication was around any communication with the French Authorities, so a pragmatic decision was made to go with the assumption that the diagnosis was meningococcal disease.
Therefore it would have been very difficult to refuse certain members of the party antibiotic prophylaxis.
• Arranged chemoprophylaxis through an Out of hours Service for members of the party who resided in region 1.
• Chemoprophylaxis for members of the party who resided in region 2 by the local public health OOH rota using the local OOH’s Service.
• Contacted the PHE Registrar on-call for region 3 to ask them to arrange prophylaxis for contacts in the party who resided locally.
• Contacted region 1 OOH’s Service for check that chemoprophylaxis for members of the party who lived locally as per the information I had been given.
When the confirmed diagnosis was received by Public Health England late the following week it was confirmed as Listeria Meningitis, so had not needed chemoprophylax.
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