In 1999, our personal practice article, “Emergency management of meningococcal disease” was printed in this journal¹ and, although the journal considered publishing such personal practice statements to be unfashionable,² it was mostly well received and has since been cited over 60 times.

In the original article, we proposed an algorithm for identifying management priorities in treating patients with meningococcal disease, on the basis of our experiences of 425 cases and on the available published evidence wherever possible. During, the past 8 years, over 51 000 copies of the algorithm have been disseminated to accident and emergency departments, intensive care units and paediatric units in the UK and elsewhere by the charity Meningitis Research Foundation. The algorithm has also appeared in several other articles, book chapters and a handbook for junior doctors (35 000 copies distributed and now available at http://www.meningitis.org). It has now been revised for the fifth time and the updated version is included with this perspective (fig 1⇓). Furthermore, a version of the algorithm modified for the management of adults with meningococcal disease has been published³ and an interactive tool designed for education of junior doctors (see http://www.meningitis.org).

Several changes have been made since the 1999 edition of the algorithm was published. We still advocate the use of 4.5% human albumin solution as the fluid for volume resuscitation in meningococcal disease in view of the low mortality that we have observed when using this fluid.⁴ The safety of the use of albumin solution in adults has been confirmed in …