Prevention and Treatment of Meningococcal Disease
The best approach to prevent meningococcal disease is through vaccination with quadrivalent meningococcal conjugate vaccine (MenACWY) for adolescents at age 11-12 years with a booster at age 16 years, along with prompt antimicrobial chemoprophylaxis for close contacts of infected individuals. 1
Prevention Through Vaccination
Recommended Vaccination Groups
- MenACWY is recommended for adolescents at age 11-12 years with a booster dose at age 16 years 1
- College freshmen living in dormitories and military recruits should receive MenACWY vaccination 1
- Persons with persistent complement component deficiencies and those with anatomic or functional asplenia should receive a 2-dose primary series of MenACWY administered 8-12 weeks apart 1
- International travelers to high-risk areas, particularly the "meningitis belt" of sub-Saharan Africa during dry season (December-June), should be vaccinated 1
Outbreak Management
- Vaccination should be considered if the attack rate in a population exceeds 10 cases per 100,000 persons during a 3-month period 2
- The vaccination group typically includes persons aged <30 years, as meningococcal disease outbreak cases occur predominantly in this age group 2
- For organization-based outbreaks (e.g., schools), the entire population at risk should typically be vaccinated 2
- Note that currently available MenACWY vaccines do not protect against serogroup B, which causes approximately one-third of cases in the US and over 50% of cases in infants under 1 year 1
Antimicrobial Chemoprophylaxis
Indications for Chemoprophylaxis
- Close contacts of patients with invasive meningococcal disease should receive antimicrobial chemoprophylaxis 2
- Close contacts include:
- Household members 2
- Child-care center contacts 2
- 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 2
- Healthcare personnel who were managing an airway or exposed to respiratory secretions 2
Timing and Medication Options
- Chemoprophylaxis should be administered as soon as possible, ideally within 24 hours after identification of the index patient 2, 3
- Chemoprophylaxis has limited or no value if administered >14 days after exposure 2
- Recommended regimens include:
Treatment of Meningococcal Disease
- Early recognition and prompt antibiotic treatment are crucial for reducing mortality 1
- Despite appropriate antibiotic treatment, the case-fatality ratio remains 10-14% 1
- 11-19% of survivors experience significant sequelae including neurologic disability, limb loss, and hearing loss 1
Special Considerations
Laboratory Exposures
- Laboratory workers exposed to potentially aerosolized N. meningitidis should receive antibiotic prophylaxis regardless of when the exposure occurred (up to 14 days) 3
- Droplet precautions should be implemented for all exposed individuals until they have received 24 hours of effective antibiotic prophylaxis 3
- Exposed individuals should be monitored for symptoms of meningococcal disease for at least 10 days after exposure 3
High-Risk Groups
- Persons with terminal complement component deficiencies have 1,000-10,000 times higher risk of meningococcal disease 1
- For individuals with known asplenia, complement deficiencies, or HIV infection, consideration should be given to meningococcal vaccination in addition to antibiotic prophylaxis if exposed 3
Disease Characteristics
- N. meningitidis serogroups B, C, and Y each cause approximately one-third of cases in the United States 1
- The highest incidence of invasive meningococcal disease occurs in infants 4
- Vaccination rates are much higher for infants and young children than for adolescents, highlighting the importance of effective infant vaccines 4