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] Gard ner 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 meningoc occal 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] Bibliography Brandtzaeg P et al: Net inflammatory capacity of human septic shock plasma evaluated by a monocyte- based target cell assay: Identification of interleukin- 10 as a major functional deactivator of human monocytes. J Exp Med 184:51, 1996 [PMID: 8691149] Caugant DA et al: Intercontinental spread of a genetically distinctive complex of clones of Neisseria meningitidis causing epidemic disease. Proc Natl Acad Sci USA 83:4927, 1986 [PMID: 3088568] Centers for Disease Control and Prevention: Prevention and control of meningococcal disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 49(RR-7):1, 2000 Fijen CA et al: Assessment of complement deficiency in patients with meningococcal disease in t he Netherlands. Clin Infect Dis 28:98, 1999 [PMID: 10028078] Goldschneider I et al: Human immunity to the meningococcus. I. The role of humoral antibodies. J Exp Med 129:1307, 1969 [PMID: 4977280] Greenwood BM et al: Meningococcal disease and season in sub- Saharan Africa. Lancet 1:1339, 1984 [PMID: 6145036] Hibberd ML et al: Association of variants of the gene for mannose- binding lectin with susceptibility to meningococcal disease. Lancet 353:1049, 1999 [PMID: 10199352] Johansson L et al: CD46 in me ningococcal disease. Science 301:373, 2003 [PMID: 12869763] MacDonald NE et al: Induction of immunologic memory by conjugated vs plain meningococcal C polysaccharide vaccine in toddlers— a randomized controlled trial. JAMA 280:1685, 1998 [PMID: 9832000] Kvalsvig AJ, Unsworth DJ: The immunopathogenesis of meningococcal disease. J Clin Pathol 56:417, 2003 [PMID: 12783966] Platonov AE et al: Mening ococcal disease and polymorphism of FcgRIIA (CD32) in late complement component– deficient individuals. Clin Exp Immunol 111:97, 1998 [PMID: 9472667] Rosenstein NE et al: Meningococcal disease. N Engl J Med 344:1378, 2001 [PMID: 11333996] Westendorp RGJ et al: Genetic influence on cytokine production and fatal meningococcal disease. Lancet 349:170, 1997 [PMID: 9111542] . Chapter 136. Meningococcal Infections (Part 9) Antimicrobial Chemoprophylaxis The attack rate for meningococcal disease among household or other. 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. 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