Reporting & Investigation of Meningococcal Infection

Table of Contents

A. Purpose of Surveillance and Reporting

  • To identify close contacts of the case and provide recommendations for appropriate preventive measures and thus prevent further spread of infection.

  • To provide information about the disease, its transmission, and methods of prevention.

  • To promptly identify clusters or outbreaks of disease and initiate appropriate prevention and control measures.

B. Laboratory and Healthcare Provider Reporting Requirements

Iowa Administrative Code 641-1.3(139) stipulates that the laboratory and the healthcare provider immediately report any suspected or confirmed case. The disease reporting number for the Center for Acute Disease Epidemiology (CADE) is (800) 362-2736. After business hours, call the Iowa State Patrol Office at (515) 323-4360 and they will page a member of the on-call CADE staff.

Laboratory Testing Services Available

The State Hygienic Laboratory (SHL) will confirm and serogroup isolates of N. meningitidis.  Laboratories are required to submit all isolates cultured from normally sterile sites for serogrouping. This serogrouping aids in public health surveillance and prevention of transmission. In addition, SHL will isolate the organism from appropriate clinical samples upon request. For more information on submitting specimens, contact SHL at (319) 335-4500, or visit: www.shl.uiowa.edu/

Note: Isolates obtained from sputum or throat cultures are not considered to come from sterile sites; therefore N. meningitidis from these sites is in itself not indicative of invasive disease and is not reportable. If a patient with culture-positive sputum has an illness compatible with invasive meningococcal disease, this should be reported and the appropriate sterile sites should then be cultured.

C.  Local Public Health Agency Follow-up Responsibilities

Case Investigation

  1. Report suspect or confirmed cases of meningococcal disease immediately to CADE by calling (800) 362-2736. This disease requires immediate follow-up with prophylaxis given to contacts of the case.

  2. After notification of CADE, it is the LPHA, along with the hospital infection preventionist’s, responsibility to investigate by asking the questions on and complete an Invasive Meningococcal Disease case investigation by interviewing the case and/or others who may be able to provide pertinent information. CADE staff is available 24/7 to assist in the follow-up of a case. The preferred method of case investigation is by using the Iowa Disease Surveillance System (IDSS).

  3. The main focus when following up a case of invasive meningococcal disease is to prevent additional cases of disease in contacts of the case. The investigation form will assist in collecting the appropriate information for complete contact identification and referral.
  4. The first step to following up a case of invasive meningococcal infection is to confirm the diagnosis.  Often, reported cases of “meningitis” are ultimately found to be caused by bacteria other than Neisseria meningitidis or by a virus. Ask for antigen testing if antibiotics were started before cultures were taken.  When N. meningitidis is suspected or confirmed, public health actions need to be taken quickly to protect contacts.
  5. Use the following guidelines to assist in completing the Meningococcal Disease Case Investigation.
    • Record the demographic information, collecting as much case information as possible, including address, place of work, occupation, and child care or school information.
    • If the case is hospitalized, collect hospital and transfer hospital information, if applicable. Hospital laboratories, direct caregivers and infection prevention practitioners are key in obtaining information for confirming a diagnosis.
    • Collect clinical information on the case including laboratory data, clinical manifestations, and onset date information. This information is best collected from the infection prevention practitioner at the hospital or the case’s healthcare provider.
    • Collect as much information as possible about the case’s activities and contacts during the 7 days prior to the onset of illness.  This information may be obtained from the case, the case’s family and friends, school or child care personnel, or others involved with the case. Those who meet the definition of a close contact (see Section 4B below) of a case of invasive meningococcal disease must be educated on risk of disease and the importance of receiving prophylaxis. They should immediately be referred to their healthcare provider for appropriate post-exposure antibiotic therapy. Sample letters for notifying contacts in a school, child care or office are at the end of this chapter.
  6. Use the following guidelines to assist you in completing the Meningococcal Disease case investigation and entering the information into the Iowa Disease Surveillance System (IDSS)
    • Specify the type of infection caused by N. meningitidis. 
    • Indicate the type of specimen from which N. meningitidis was isolated/identified.
    • List the laboratory tests performed.  For example, N. meningitidis was culture-confirmed or identified by bacterial antigen screen. Also include the date the specimen was drawn for the first positive culture.
    • If known, provide the serogroup and antibiotic resistance information.
    • If the case attends child care or school, list the child care/school name and provide a contact name and phone number.
    • If the case attends college, indicate the name of the college, the case’s year in school, and the case’s living situation.
    • If the case has received meningococcal vaccine, record the type of vaccine used, date administered, and reason for administration.
    • If several attempts have been made to obtain case information, but have been unsuccessful (e.g., the case or healthcare provider does not return calls or respond to a letter, or the case refuses to divulge information or is too ill to be interviewed), call CADE and then enter as much information as is possible. Note in IDSS the reason why specific information could not be entered.  Contact CADE immediately if key information is difficult to obtain.
  7. After completing the Meningococcal Disease case investigation,  enter information into IDSS or fax to (515) 281-5698.
  8. Institution of disease control measures is an integral part of case investigation. It is the LPHA responsibility to understand and institute the control guidelines listed below in Section 4).