UK guidelines and testing for invasive meningococcal disease

We read with interest the Article by Thomas Waterfield and colleagues on performance of clinical guidelines for invasive meningococcal disease among febrile children presenting a non-blanching rash.1Waterfield T Maney JA Fairley D et al.Validating practice management rashes in UK (PiC): prospective, multicentre cohort study.Lancet Infect Dis. 2020; (published online Nov 10.)https://doi.org/10.1016/S1473-3099(20)30474-6Summary Full Text PDF Scopus (4) Google Scholar The low specificity disease, including National Institute Health Care Excellence guidelines, is compelling. A rash has long time been considered key characteristic focus awareness-raising campaigns health-care workers, charities, parents alike. In UK, incidence declining since early 2000s, partly due to group C vaccination programme, secular declines B over same period.2Campbell H Andrews N Borrow R Trotter Miller E Updated postlicensure surveillance conjugate vaccine England Wales: effectiveness, validation serological correlates protection, modeling predictions duration herd immunity.Clin Vaccine Immunol. 2010; 17: 840-847Crossref PubMed (179) Disease rates were further suppressed following 2015 introduction infant immunisation campaign, adolescent ACWY latter additionally providing indirect (herd) protection across population.3Campbell Edelstein M Ramsay Ladhani S Emergency program teenagers control W England, 2015–2016.Emerg 2017; 23: 1184-1187Crossref (51) Despite these trends, public information have continued, reflecting need maintain high vigilance support families afflicted disease. It non-specific presentation speed progression that occupies special place psyche.4Jackson Yarwood J Saliba V Bedford parents' attitudes towards (MenB) vaccination: qualitative analysis.BMJ Open. 7e012851Crossref (12) Clinicians continue threshold considering unwell children, rightly so. As authors paper acknowledged, any delay diagnosis treatment can devastating consequences terms fatality, or severe complications such as brain damage amputations.5Edmond K Clark Korczak VS Sanderson Griffiths Rudan I Global regional risk disabling sequelae from bacterial meningitis: systematic review meta-analysis.Lancet 10: 317-328Summary (356) This cautious approach reflected number samples submitted real-time PCR at Public England's Meningococcal Reference Unit, which provides free national service patients suspected (appendix). unit consistently received 12 000–15 000 annually despite substantial reduction positivity rate 14% 2000–01 3·5% 2018–19. One could argue data simply but they also reflect difficulties diagnosing clinically anxiety both frontline clinicians highly successful programmes UK. Although future changes might reduce antibiotic use costs, more will ensure cases are not missed. reliable point-of-care tests evident ever. Until then, however, provide this important testing service. SAC, JL, RB perform contract research behalf GlaxoSmithKline, Pfizer, Sanofi Pasteur. HC SNL declare no competing interests. Download .pdf (.19 MB) Help pdf files Supplementary appendix Validating studyInvasive rare cause emergency department Current NICE poorly when compared tailored guidelines. These findings suggest guidance be improved shifting approach. Full-Text