Introduction and overview

Introduction and overview

This quality standard covers the diagnosis and management of children and young people (younger than 16 years) with bacterial meningitis or meningococcal septicaemia. For more information see the scope for this quality standard.

Introduction

Bacterial meningitis is an inflammation of the meninges, which are the membranes that cover the brain. In children and young people aged 3 months or older, bacterial meningitis is most commonly caused by Neisseria meningitidis (meningococcus). Meningococcal septicaemia is a severe systemic infection in which there is multiplication of infective organisms in the blood stream.

Meningococcal meningitis and meningococcal septicaemia are sometimes referred to as invasive meningococcal disease. Meningococcal disease most commonly presents as meningitis (15% of cases) or septicaemia (25% of cases), or as a combination of the two (60% of cases).

Meningococcal disease occurs primarily in children aged under 5 years, with a peak incidence in those aged under 1 year. There is a smaller, secondary peak in incidence in young people between 15 and 19 years. Most cases of meningococcal disease occur sporadically, with less than 5% occurring in clusters. Outbreaks are most common among young people, occurring for example in schools or universities. In 2010 there were 660 laboratory confirmed cases of invasive meningococcal disease in children and young people aged under 19 years in England and Wales.

Meningococcal disease causes death in around 1 in 10 cases, and is the leading cause of death from infection in early childhood in the UK, making its control a priority for clinical management. The identification and treatment of meningococcal disease is time-critical; emergency admission to hospital and treatment with antibiotics should be sought without delay, as the disease can be fatal within hours of the first symptoms appearing. Prompt recognition of the symptoms and signs is key to preventing death or disability.

This quality standard describes markers of high-quality, cost-effective care that, when delivered collectively, should contribute to improving the effectiveness, safety and experience of care for children and young people with bacterial meningitis and meningococcal septicaemia in the following ways:

  • Preventing people from dying prematurely.

  • Helping people to recover from episodes of ill health or following injury.

  • Ensuring that people have a positive experience of care.

  • Treating and caring for people in a safe environment and protecting them from avoidable harm.

These overarching outcomes are from the NHS Outcomes Framework.

Overview

The quality standard for bacterial meningitis and meningococcal septicaemia in children and young people requires that services should be commissioned from and coordinated across all relevant agencies encompassing the whole bacterial meningitis and meningococcal septicaemia care pathway. An integrated approach to provision of services is fundamental to the delivery of high-quality care to children and young people with bacterial meningitis and meningococcal septicaemia.

The quality standard should be read in the context of national and local guidelines on training and competencies. Implementation of this quality standard is predicated on all healthcare professionals involved in the assessment, care and treatment of children and young people with bacterial meningitis or meningococcal septicaemia (including those carrying out assessments remotely) being sufficiently and appropriately trained in recognising disease, and competent to deliver the actions and interventions described in the quality standard.