Interventions for Meningitis

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Age Cohort: Pregnancy and newborn

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Community awareness on prevention and control methods of meningitis	Frequent hand washing Vaccination: pneumococcal conjugate Vaccination: haemophilus influenzae type b (Hib) Vaccination: meningococcal	Recognition of meningitis signs and symptoms	Isolate child suspected with meningitis Immediate transfer to a higher-level health care facility	Linkage with rehabilitation centres for deafness, learning impairment or behavioural problems	Psychological and emotional support for meningitis sequel
Primary Care
Health education and information on prevention and treatment of meningitis	Chemoprophylaxis for close contacts Vaccination: pneumococcal conjugate Vaccination: haemophilus influenzae type b (Hib) Vaccination: meningococcal	History Physical examination Rapid blood agglutination test	Antibiotic treatment Immediate transfer to a higher-level health care facility	Linkage with rehabilitation centres for deafness, learning impairment or behavioural problems	Psychological and emotional support for meningitis sequel
Referral Facility: General
Health education and information on prevention and treatment of meningitis	Testing for B. streptococcus when mother is at 36/37 weeks pregnant Prevent mother to child transmission of meningitis (Give antibiotics during labour to mothers who test positive for meningitis to prevent passing group B streptococcus to the newborn) Intrapartum prophylactic antibiotics in pregnant women who carry the risk of colonizing and hence risk of exposure to the neonate. (neonatal meningitis)	History Physical examination Lumbar puncture CSF analysis CSF culture CSF PCR Rapid CSF agglutination test Blood culture Throat swab, Serology. Full blood count, C reactive protein (CRP), Clotting studies, Basic metabolic panel	Parenteral antibiotics Intravenous fluids Parenteral corticosteroids	Linkage with rehabilitation centres for deafness, learning impairment or behavioural problems	Psychological support to parents of children with meningitis sequel
Referral Facility: Specialist
Health education and information on prevention and treatment of meningitis	Testing for B. streptococcus when mother is at 36/37 weeks pregnant Prevent mother to child transmission of meningitis (Give antibiotics during labour to mothers who test positive for meningitis to prevent passing group B streptococcus to the newborn) Intrapartum prophylactic antibiotics in pregnant women who carry the risk of colonizing and hence risk of exposure to the neonate. (neonatal meningitis)	History Physical examination Lumbar puncture CSF analysis CSF culture CSF PCR Rapid CSF agglutination test Blood culture Throat swab, Serology. Full blood count, C reactive protein (CRP) Clotting tests BUN Electrolytes	Parenteral antibiotics Intravenous fluids Parenteral corticosteroids	Linkage with rehabilitation centres for deafness, learning impairment or behavioural problems	Psychological support to parents of children with meningitis sequel

Age Cohort: < 5 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Community awareness on prevention and control methods of meningitis Create awareness on meningitis including prevention measures (IPC) Distribution of IEC materials Community mobilisation for routine immunisation	Frequent hand washing Vaccination: pneumococcal conjugate Vaccination: haemophilus influenzae type b (Hib) Vaccination: meningococcal Advocacy for proper sanitation and good housing Vaccination: pneumococcal conjugate Vaccination: haemophilus influenzae type b (Hib) Vaccination: meningococcal	Recognition of meningitis signs and symptoms	Isolate child suspected with meningitis Immediate transfer to a higher-level health care facility	Home-based physical rehabilitation	Psychological and emotional support for meningitis sequel
Primary Care
Health education and information on prevention and treatment of meningitis	Chemoprophylaxis for close contacts Vaccination: pneumococcal conjugate Vaccination: haemophilus influenzae type b (Hib) Vaccination: meningococcal Oral antimicrobials chemoprophylaxis for contacts "Vaccination: pneumococcal conjugate Vaccination: haemophilus influenzae type b (Hib) Vaccination: meningococcal"	History Physical examination Rapid blood agglutination test	Antibiotic treatment Immediate transfer to a higher-level health care facility	Linkage with rehabilitation centres for deafness, learning impairment or behavioural problems	Psychological and emotional support for meningitis sequel
Referral Facility: General
Health education and information on prevention and treatment of meningitis	Chemoprophylaxis for close contacts Vaccination: pneumococcal conjugate Vaccination: haemophilus influenzae type b (Hib) Vaccination: meningococcal	History Physical examination Lumbar puncture CSF analysis CSF culture CSF PCR Rapid CSF agglutination test Blood culture Throat swab Serology Full blood count C reactive protein (CRP) Clotting studies Basic metabolic panel	Parenteral antibiotics Parenteral corticosteroids	Linkage with rehabilitation centres for deafness, learning impairment or behavioural problems	Psychological support to parents of children with meningitis sequel
Referral Facility: Specialist
Health education and information on prevention and treatment of meningitis	Oral antimicrobials chemoprophylaxis for contacts "Vaccination: pneumococcal conjugate Vaccination: haemophilus influenzae type b (Hib) Vaccination: meningococcal"	History Physical examination Lumbar puncture CSF analysis CSF culture CSF PCR Rapid CSF agglutination test Blood culture Throat swab Serology Full blood count C reactive protein (CRP) Clotting tests Basic metabolic panel	Parenteral antibiotics Intravenous fluids Anti-TB treatment for TB meningitis Antifungal treatment for fungal meningitis Parenteral corticosteroids	Linkage with rehabilitation centres for deafness, learning impairment or behavioural problems	Psychological support to parents of children with meningitis sequel

Age Cohort: 5 - 11 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Community awareness on prevention and control methods of meningitis Advocacy for proper sanitation and good housing Vaccination: pneumococcal conjugate Vaccination: haemophilus influenzae type b (Hib) Vaccination: meningococcal	Frequent hand washing Vaccination: pneumococcal conjugate Vaccination: haemophilus influenzae type b (Hib) Vaccination: meningococcal Advocacy for proper sanitation and good housing Vaccination: pneumococcal conjugate Vaccination: haemophilus influenzae type b (Hib) Vaccination: meningococcal	Recognition of meningitis signs and symptoms	Isolate child suspected with meningitis Immediate transfer to a higher-level health care facility	Linkage with rehabilitation centres for deafness, learning impairment or behavioural problems	Psychological and emotional support for meningitis sequel
Primary Care
Health education and information on prevention and treatment of meningitis	Chemoprophylaxis for close contacts Vaccination: pneumococcal conjugate Vaccination: haemophilus influenzae type b (Hib) Vaccination: meningococcal Oral antimicrobials chemoprophylaxis for contacts "Vaccination: pneumococcal conjugate Vaccination: haemophilus influenzae type b (Hib) Vaccination: meningococcal"	History Physical examination Rapid blood agglutination test	Antibiotic treatment Immediate transfer to a higher-level health care facility	Linkage with rehabilitation centres for deafness, learning impairment or behavioural problems	Psychological and emotional support for meningitis sequel
Referral Facility: General
Awareness campaign on causes, signs and symptoms of meningitis including prevention measures (IPC) Distribution of IEC materials Mobilisation for routine immunisation	Chemoprophylaxis for close contacts Vaccination: pneumococcal conjugate Vaccination: haemophilus influenzae type b (Hib) Vaccination: meningococcal	History Physical examination Lumbar puncture CSF analysis CSF culture CSF PCR Rapid CSF agglutination test Blood culture Throat swab, Serology. Full blood count, C reactive protein (CRP), Clotting studies, BUN Electrolytes	Parenteral antibiotics Parenteral corticosteroids	Physiotherapy Occupational therapy Language and speech therapy Assisting in hearing devices	Psychological and emotional support for meningitis sequel
Referral Facility: Specialist
Awareness campaign on causes, signs and symptoms of meningitis including prevention measures (IPC) Distribution of IEC materials Mobilisation for routine immunisation	Oral antimicrobials chemoprophylaxis for contacts "Vaccination: pneumococcal conjugate Vaccination: haemophilus influenzae type b (Hib) Vaccination: meningococcal"	History Physical examination Lumbar puncture CSF analysis CSF culture CSF PCR Rapid CSF agglutination test Blood culture Throat swab, Serology. Full blood count, C reactive protein (CRP) Clotting tests BUN Electrolytes	Parenteral antibiotics Intravenous fluids Anti-TB treatment for TB meningitis Antifungal treatment for fungal meningitis Parenteral corticosteroids	Physiotherapy Occupational therapy Language and speech therapy Assisting in hearing devices	Psychological and emotional support for meningitis sequel

Age Cohort: 12 - 24 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Community awareness on prevention and control methods of meningitis	Frequent hand washing Vaccination: pneumococcal conjugate Vaccination: haemophilus influenzae type b (Hib) Vaccination: meningococcal	Recognition of meningitis signs and symptoms	Isolate child/adolescents suspected with meningitis Immediate transfer to a higher-level health care facility	Linkage with rehabilitation centres for deafness, learning impairment or behavioural problems	Psychological and emotional support for meningitis sequel
Primary Care
Health education and information on prevention and treatment of meningitis	Chemoprophylaxis for close contacts Vaccination: pneumococcal conjugate Vaccination: haemophilus influenzae type b (Hib) Vaccination: meningococcal	History Physical examination Rapid blood agglutination test	Antibiotic treatment Immediate transfer to a higher-level health care facility	Linkage with rehabilitation centres for deafness, learning impairment or behavioural problems	Psychological and emotional support for meningitis sequel
Referral Facility: General
Health workers training on meningitis & its management in adolescents Create Awareness among adolescents on meningitis and prevention measures Guidance on Good nutrition for adolescents Guidance on hygiene practices for adolescents to prevent meningitis	Chemoprophylaxis for close contacts Vaccination: pneumococcal conjugate Vaccination: haemophilus influenzae type b (Hib) Vaccination: meningococcal	History Physical examination Lumbar puncture CSF analysis CSF culture CSF PCR Rapid CSF agglutination test Blood culture Throat swab, Serology. Full blood count, C reactive protein (CRP), Clotting studies, BUN Electrolytes	Parenteral antibiotics Parenteral corticosteroids	Physiotherapy Occupational therapy Language and speech therapy Assisting in hearing devices	Psychological and emotional support for meningitis sequel
Referral Facility: Specialist
Create Awareness among adolescents; on meningitis and prevention measures Guidance on Good nutrition for adolescents Guidance on hygiene practices for adolescents to prevent meningitis Health workers training on meningitis & its management in adolescents	Chemo prophylaxis for adolescents who are living in a household with one or more unvaccinated children younger than 48 months. Post exposure prophylaxis for adolescents who have had close contacts with someone with Meningitis	History Physical examination Lumbar puncture CSF analysis CSF culture CSF PCR Rapid CSF agglutination test Blood culture Throat swab, Serology. Full blood count, C reactive protein (CRP) Clotting tests BUN Electrolytes	Parenteral antibiotics Intravenous fluids Anti-TB treatment for TB meningitis Antifungal treatment for fungal meningitis Parenteral corticosteroids	Physiotherapy Occupational therapy Language and speech therapy Assisting in hearing devices	Psychological and emotional support for meningitis sequel

Age Cohort: 25 - 59 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Create awareness on meningitis including prevention measures (IPC) Distribution of IEC materials	Advocacy for proper sanitation and good housing Vaccination: meningococcal		Counselling on seeking early treatment for meningitis * Isolate individuals suspected with N. meningitis Clinical assessment for early recognition of need for referral	Physiotherapy services for adults with meningitis complications who may be referred back to communities from health facilities	Psychosocial support
Primary Care
Awareness campaign on causes, signs and symptoms of meningitis including prevention measures (IPC) Distribution of IEC materials Mobilisation for routine immunisation	Oral antimicrobials chemoprophylaxis for contacts Vaccination: meningococcal"		History and physical examination for meningitis Clinical assessment for early recognition of the need for referral Basic laboratory tests
Referral Facility: General
Awareness campaign on causes, signs and symptoms of meningitis including prevention measures (IPC) Distribution of IEC materials	Oral antimicrobials chemoprophylaxis for contacts Vaccination: meningococcal		History and physical examination for meningitis Clinical assessment for early recognition of the need for referral Basic laboratory tests Lumbar puncture Systemic antibiotics for bacterial meningitis	Rehabilitation and follow up of adults with complications as a result of meningitis Physical therapy to improve motor coordination and mobility Occupational therapy to develop everyday skills Hearing rehabilitation including provision of hearing aids Referral downwards to Primary care facilities for further or continued rehabilitation	Psycho social support for adults with meningitis and their family members Counseling for adults with meningitis especially those who develop complications
Referral Facility: Specialist
Health education on meningitis Create Awareness to adults on meningitis and prevention measures Guidance on Good nutrition for the adults Health workers training on meningitis & its management among the adults Guidance on hygiene practices for adults to prevent meningitis	Oral antimicrobials chemoprophylaxis for contacts "Vaccination: pneumococcal conjugate Vaccination: haemophilus influenzae type b (Hib) Vaccination: meningococcal"		History and physical examination for meningitis Basic laboratory tests Advanced laboratory tests Lumbar puncture Computed tomography (CT) scan Systemic antibiotics for bacterial meningitis	Rehabilitation and follow up of adults with complications as a result of meningitis Physical therapy to improve motor coordination and mobility Occupational therapy to develop everyday skills Hearing rehabilitation including provision of hearing aids Referral downwards to Primary care facilities for further or continued rehabilitation	Psycho social support for adults with meningitis and their family members Counseling for adults with meningitis especially those who develop complications spiritual support

Age Cohort: 60+ years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Community health workers sensitization on meningitis including recognition of meningitis features among the elderly Create awareness to the elderly persons, their families and communities on meningitis and prevention measures Information/creation of awareness on healthy living for the elderly Awareness on good nutrition Provision of IEC materials Promote good hygiene practices including hand hygiene for the elderly	Practice good hygiene practices including cough, sneezing etiquette Hand washing with soap and water Hand washing with soap and water Limit the elderly contact with persons with meningitis		Recognition of danger signs of meningitis in the elderly which include, stiff neck, headache, neck and/or back pain, fever. Proper feeding Supportive therapy to an elderly person if immediate referral is not possible i.e. give fluids,Proper feeding,- Manage fever with medicine for fever such as paracetamol Urgent referral of elderly persons suspected to have meningitis to a health facility	Physiotherapy services for the elderly persons with meningitis complications who may be referred back to communities from health facilities	Psychosocial support counselling
Primary Care
Health workers education/sensitization on meningitis, prevention and management in the elderly persons. Create awareness to elderly persons and their families on meningitis and prevention measures Information/creation of awareness on healthy living for the elderly persons Guidance on good nutrition for the elderly Promote good hygiene practices including hand hygiene for the elderly	Post exposure prophylaxis for elderly persons in close contacts with someone with N.meningitidis Chemo prophylaxis for elderly persons living in a household with one or more unvaccinated children younger than 48 months.		Clinical examination and recognition of signs and symptoms (features) of meningitis in elderly persons including neck stiffness, neck and/or back pain, headache and feverThe priority at this level Urgent transfer to hospital is not possible (antibiotics should be given to any person with suspected bacterial meningitis) Emergency care with an aim of stabilizing the elderly person with meningitis before referral Emergency transfer of elderly persons suspected to have bacterial meningitis to a hopsital Administration of antibiotics to elderly person with meningitis if Supportive therapy to elderly person with meningitis as - use anti pyretics for fever - Use of analgesics for aches/pains - Physical examination		Psycho social support Counseling spiritual support
Referral Facility: General
Health Education on meningitis Health workers education on meningitis including its management in the elderly Create Awareness among the elderly and their families on meningitis and prevention measures Guidance on hygiene practices for the elderly to prevent meningitis Guidance on Good nutrition for the elderly	Post exposure prophylaxis for elderly persons who have had close contacts with someone with N.meningitidis Chemo prophylaxis for elderly persons living in a household with one or more unvaccinated children younger than 48 months		Clinical examination Physical examination Supportive treatment for elderly persons with meningitis including: Fluids/IV fluids therapy for elderly persons Relieve fever with anti-pyretics for elderly persons with fever due to meningitis Relieve aches/pains with analgesics for elderly persons with aches due to meningitis Provision of anti-emetics for elderly persons with vomiting due to meningitis Nutritional support for elderly persons with meningitis Long course therapy for tuberculous meningitis in elderly persons as per guidelines Treatment of non-infectious meningitis depending on the cause e.g. Use of corticosteroids for meningitis due to auto-immune diseases Treatment of specific cancer for cancer induced meningitis. Managmnet of all causes of meningitis as though they are bacterial meningitis until proven otherwise. Management of any complications of meningitis in elderly persons e.g. seizures, raised intra-cranial pressure. ICU services for management of meningitis complications in elderly persons		Psycho social support for elderly persons with meningitis and their family members or care givers Counseling for the elderly persons with meningitis and/with complications
Referral Facility: Specialist
Guidance on Good nutrition for the elderly Guidance on hygiene practices for the elderly to prevent meningitis Health Education on meningitis Create Awareness among the elderly and their families on meningitis and prevention measures Health workers education on meningitis including its management in the elderly	Post exposure prophylaxis for elderly persons who have had close contacts with someone with N.meningitidis Chemo prophylaxis for elderly persons living in a household with one or more unvaccinated children younger than 48 months		Clinical examination Physical examination Supportive treatment for elderly persons with meningitis including: Fluids /IV fluids therapy for elderly persons Relieve fever with anti-pyretics for elderly persons with fever due to meningitis Relieve aches /pains with analgesics for elderly persons with aches due to meningitis Provision of anti-emetics for elderly persons with vomiting due to meningitis Nutritional support for elderly persons with meningitis Long course therapy for tuberculous meningitis in elderly persons as per guidelines Treatment of non-infectious meningitis depending on the cause e.g. Use of corticosteroids for meningitis due to auto-immune diseases; Treatment of specific cancer for cancer induced meningitis. Managmnet of all causes of meningitis as though they are bacterial meningitis until proven otherwise. * * Management of any complications of meningitis in elderly persons e.g., seizures; raised intra-cranial pressure. ICU services for management of meningitis complications in elderly persons		Psycho social support for elderly persons with meningitis and their family members or care givers Counseling for the elderly persons with meningitis and /or with complications Spiritual support