Chapter 136. Meningococcal Infections (Part 9)

Antimicrobial ChemoprophylaxisThe 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 patients 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...
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Chapter 136. Meningococcal Infections (Part 9) Chapter 136. Meningococcal Infections (Part 9) Antimicrobial Chemoprophylaxis The attack rate for meningococcal disease among household or other closecontacts of cases is >400-fold greater than that in the population as a whole. Closecontacts of cases should receive chemoprophylaxis with rifampin, ciprofloxacin,ofloxacin, or azithromycin (Table 136-1). A single IM injection of ceftriaxone isalso effective. Close contacts include persons who live in the same household,day-care center contacts, and anyone directly exposed to a patients oral secretions.Casual contacts are not at increased risk. Chemoprophylaxis should beadministered as soon as possible after the case is identified. Patients withmeningococcal disease who have been treated with antibiotics other thanceftriaxone need some type of prophylaxis in order to eliminate meningococcalcolonization in the oropharynx. Isolation Precautions The CDC recommends that patients with meningococcal disease who arehospitalized be placed in respiratory isolation for the first 24 h. Outbreak Control An organization- or community-based outbreak of meningococcal diseaseis defined as the occurrence of three or more cases within ≤3 months in personswho have a common affiliation or reside in the same area but who are not closecontacts of one another; in addition, the primary disease attack rate must exceed10 cases per 100,000 persons, and the case strains of N. meningitidis must be ofthe same molecular type. Mass vaccination should be considered when suchoutbreaks occur, and mass chemoprophylaxis may be used to control school- orother institution-based outbreaks. Consultation with public health authorities isrecommended 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 EnglJ 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 thecomplement 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 SciUSA 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 speciesare present in non-pathogenic Neisseria lactamica, including those designated asvirulence genes. BMC Genomics 7:128, 2006 [PMID: 16734888] Stephens DS et al: Epidemic meningitis, meningococcaemia, and Neisseriameningitidis. Lancet 369:2196, 2007 [PMID: 17604802] Thompson MJ et al: Clinical recognition of meningococcal disease inchildren and adolescents. Lancet 367:397, 2006 [PMID: 16458763] Zimmer SM et al: Serogroup B meningococcal vaccines. Curr Opin InvestDrugs 7:733, 2006 [PMID: 16955685] Bibliography Brandtzaeg P et al: Net inflammatory capacity of human septic shockplasma evaluated by a monocyte-based target cell assay: Identification ofinterleukin-10 as a major functional deactivator of human monocytes. J Exp Med184:51, 1996 [PMID: 8691149] Caugant DA et al: Intercontinental spread of a genetically distinctivecomplex of clones of Neisseria meningitidis causing epidemic disease. Proc NatlAcad Sci USA 83:4927, 1986 [PMID: 3088568] Centers for Disease Control and Prevention: Prevention and control ofmeningococcal disease: Recommendations of the Advisory Committee onImmunization Practices (ACIP). MMWR 49(RR-7):1, 2000 Fijen CA et al: Assessment of complement deficiency in patients withmeningococcal disease in the Netherlands. Clin Infect Dis 28:98, 1999 [PMID:10028078] Goldschneider I et al: Human immunity to the meningococcus. I. The roleof humoral antibodies. J Exp Med 129:1307, 1969 [PMID: 4977280] Greenwood BM et al: Meningococcal disease and season in sub-SaharanAfrica. Lancet 1:1339, 1984 [PMID: 6145036] Hibberd ML et al: Association of variants of the gene for mannose-bindinglectin with susceptibility to meningococcal disease. Lancet 353:1049, 1999[PMID: 10199352] Johansson L et al: CD46 ...