Chapter 136. Meningococcal Infections (Part 9) pps

Meningococcal Infections Part 9 Antimicrobial Chemoprophylaxis The attack rate for meningococcal disease among household or other close contacts of cases is >400-fold greater than that

Chapter 136 Meningococcal Infections

(Part 9)

Antimicrobial Chemoprophylaxis

The attack rate for meningococcal disease among household or other close contacts of cases is >400-fold greater than that in the population as a whole Close contacts of cases should receive chemoprophylaxis with rifampin, ciprofloxacin, ofloxacin, or azithromycin (Table 136-1) A single IM injection of ceftriaxone is also effective Close contacts include persons who live in the same household, day-care center contacts, and anyone directly exposed to a patient's oral secretions Casual contacts are not at increased risk Chemoprophylaxis should be administered as soon as possible after the case is identified Patients with meningococcal disease who have been treated with antibiotics other than ceftriaxone need some type of prophylaxis in order to eliminate meningococcal colonization in the oropharynx

Isolation Precautions

The CDC recommends that patients with meningococcal disease who are hospitalized be placed in respiratory isolation for the first 24 h

Outbreak Control

An organization- or community-based outbreak of meningococcal disease

is defined as the occurrence of three or more cases within ≤3 months in persons who have a common affiliation or reside in the same area but who are not close contacts of one another; in addition, the primary disease attack rate must exceed

10 cases per 100,000 persons, and the case strains of N meningitidis must be of

the same molecular type Mass vaccination should be considered when such outbreaks occur, and mass chemoprophylaxis may be used to control school- or other institution-based outbreaks Consultation with public health authorities is recommended when such campaigns are contemplated

Acknowledgment

The substantial contributions of David S Stephens, MD, and Robert S Munford, MD, to this chapter in previous editions are gratefully acknowledged

Further Readings

Bilukha O et al: Use of meningococcal vaccines in the United States

Pediatr Infect Dis J 26:371, 2007 [PMID: 17468644]

Gardner P: Clinical practice Prevention of meningococcal disease N Engl

J Med 355:1466, 2006 (Erratum: N Engl J Med 356:536, 2007)

Giuliani MM et al: A universal vaccine for serogroup B meningococcus Proc Natl Acad Sci USA 103:10834, 2006 [PMID: 16825336]

Schneider MC et al: Interactions between Neisseria meningitidis and the

complement system Trends Microbiol 15:233, 2007 [PMID: 17398100]

Smirnova I et al: Assay of locus-specific genetic load implicates rare Toll-like receptor 4 mutations in meningococcal susceptibility Proc Natl Acad Sci USA 100:6075, 2003 [PMID: 12730365]

Snape MD et al: Meningococcal polysaccharide-protein conjugate vaccines Lancet Infect Dis 5:21, 2005 [PMID: 15620558]

Snyder LA et al: The majority of genes in the pathogenic Neisseria species are present in non-pathogenic Neisseria lactamica, including those designated as

'virulence genes.' BMC Genomics 7:128, 2006 [PMID: 16734888]

Stephens DS et al: Epidemic meningitis, meningococcaemia, and Neisseria

meningitidis Lancet 369:2196, 2007 [PMID: 17604802]

Thompson MJ et al: Clinical recognition of meningococcal disease in children and adolescents Lancet 367:397, 2006 [PMID: 16458763]

Zimmer SM et al: Serogroup B meningococcal vaccines Curr Opin Invest Drugs 7:733, 2006 [PMID: 16955685]

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