Meningococcal Disease

For more information about meningococcal vaccine, see http://www.cdc.gov/vaccines/vpd-vac/mening/default.htm.

Postexposure Prophylaxis for Meningococcal Disease

EXCERPTED FROM: Morbidity and Mortality Weekly Report, May 27, 2005 / 54(RR-7);16-17
(See http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5407a1.htm for entire statement, including references).

Prevention and Control of Meningococcal Disease
ANTIMICROBIAL CHEMOPROPHYLAXIS

Antimicrobial chemoprophylaxis of close contacts of sporadic cases of meningococcal disease is the primary means for prevention of meningococcal disease in the United States (see Table). Close contacts include a) household members, b) day care center contacts, and c) anyone directly exposed to the patient's oral secretions (e.g., through kissing, mouth-to-mouth resuscitation, endotracheal intubation, or endotracheal tube management). For travelers, antimicrobial chemoprophylaxis should be considered for any passenger who had direct contact with respiratory secretions from an index-patient or for anyone seated directly next to an index-patient on a prolonged flight (i.e., one lasting >8 hours). The attack rate for household contacts exposed to patients who have sporadic meningococcal disease has been estimated to be four cases per 1,000 persons exposed, which is 500-800 times greater than for the total population . Because the rate of secondary disease for close contacts is highest during the first few days after onset of disease in the primary patient, antimicrobial chemoprophylaxis should be administered as soon as possible (ideally within 24 hours after the case is identified). Conversely, chemoprophylaxis administered greater than 14 days after onset of illness in the index case-patient is probably of limited or no value. Oropharyngeal or nasopharyngeal cultures are not helpful in determining the need for chemoprophylaxis and may unnecessarily delay institution of this preventive measure.

Rifampin, ciprofloxacin, and ceftriaxone are 90%--95% effective in reducing nasopharyngeal carriage of N. meningitdis and are all acceptable antimicrobial agents for chemoprophylaxis. See the table below for recommended dosages and select comments about the medications. Consult a drug handbook or pharmacist for a complete list of contraindications and adverse effects.

Systemic antimicrobial therapy of meningococcal disease with agents other than ceftriaxone or other third-generation cephalosporins may not reliably eradicate nasopharyngeal carriage of N. meningitidis. If other agents have been used for treatment, the index patient should receive chemoprophylactic antibiotics for eradication of nasopharyngeal carriage before being discharged from the hospital.

TABLE. Schedule for administering chemoprophylaxis against meningococcal disease

* Rifampin is not recommended for pregnant women, because it is teratogenic in laboratory animals. Rifampin changes the color of urine to reddish-orange and is excreted in tears and other body fluids; it may cause permanent discoloration of soft contact lenses. Because the reliability of oral contraceptives may be affected by rifampin therapy, consideration should be given to using alternate contraceptive measures while rifampin is being administered.

§ Ciprofloxacin is not generally recommended for persons less than 18 years of age or for pregnant and lactating women because the drug causes cartilage damage in immature laboratory animals. However, ciprofloxacin may be used for chemoprophylaxis of children when no acceptable alternative therapy is available.

Table adapted from: Morbidity and Mortality Weekly Report, May 27, 2005 / 54(RR-7);16-17
(See http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5407a1.htm for entire statement, including references).