What are the prevention methods for Neisseria (N.) meningitis?

Prevention Methods for Neisseria Meningitidis

Vaccination is the most effective strategy for preventing Neisseria meningitidis infections, with specific recommendations for high-risk populations and antimicrobial chemoprophylaxis for close contacts of infected individuals. 1

Vaccination Recommendations

Routine Vaccination

• Quadrivalent meningococcal conjugate vaccine (MCV4/MenACWY) is recommended for:
  • Adolescents at age 11-12 years with a booster dose at age 16 years 1
  • College freshmen living in dormitories 1
  • Military recruits 1

High-Risk Groups Requiring Vaccination

• Persons with persistent complement component deficiencies (C3, C5-9, properdin, Factor D, and Factor H) should receive:

  • A 2-dose primary series of MenACWY administered 8-12 weeks apart (for ages 9 months through 55 years) 1
  • Booster doses every 5 years (or every 3 years for children who received primary series before age 7) 1

• Persons with anatomic or functional asplenia should receive:

  • A 2-dose primary series of MenACWY administered 8-12 weeks apart (for ages 2 through 55 years) 1
  • Appropriate timing with pneumococcal vaccines to avoid interference 1

• Microbiologists routinely exposed to N. meningitidis isolates:

  • Single dose of MenACWY with boosters every 5 years if exposure continues 1

• International travelers to high-risk areas:

  • Vaccination recommended for travelers to the "meningitis belt" of sub-Saharan Africa, particularly during dry season (December-June) 1
  • Vaccination required by Saudi Arabia for Hajj pilgrims 1

Antimicrobial Chemoprophylaxis

Chemoprophylaxis is indicated for close contacts of patients with invasive meningococcal disease to prevent secondary cases 1:

• Close contacts include:

  • Household members 1
  • Child-care center contacts 1
  • Anyone directly exposed to the patient's oral secretions (e.g., through kissing, mouth-to-mouth resuscitation, endotracheal intubation) in the 7 days before symptom onset 1
  • Healthcare personnel who were managing an airway or exposed to respiratory secretions 1

• Recommended chemoprophylaxis regimens:

  • Rifampin is indicated for treatment of asymptomatic carriers of N. meningitidis to eliminate meningococci from the nasopharynx 2
  • Should be administered as soon as possible (ideally <24 hours after identification of the index patient) 1
  • Limited value if administered >14 days after exposure 1

Important Considerations

• Chemoprophylaxis should not be used indiscriminately; diagnostic laboratory procedures, including serotyping and susceptibility testing, should be performed 2
• Chemoprophylaxis alone has limited impact on overall meningococcal disease prevention since secondary cases represent only 1-2% of all cases 3
• Vaccination is the only rational approach for broad prevention of meningococcal disease 3
• N. meningitidis serogroups B, C, and Y each cause approximately one-third of cases in the United States 1
• Over 50% of cases in infants <1 year are caused by serogroup B, for which vaccines have only recently been developed 1

Special Populations at Increased Risk

• Persons with terminal complement component deficiencies have 1,000-10,000 times higher risk of meningococcal disease 1
• College students living in dormitories have modestly increased risk compared to age-matched non-college students 1
• The case-fatality ratio for meningococcal disease is 10-14% despite appropriate antibiotic treatment 1
• 11-19% of survivors experience significant sequelae including neurologic disability, limb loss, and hearing loss 1

By implementing these vaccination and chemoprophylaxis strategies, the morbidity and mortality associated with meningococcal disease can be significantly reduced 4.