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An incident of a day-care child having become ill with what was diagnosed as meningococcal meningitis, and the rash of questions about prophylaxis for whom and with what, emphasizes the need for a uniform message to the following:

A.  Staff personnel and attendees of the facility involved

B.  Immediate family members of the children attending the facility during the week preceding diagnosis of the index case

C.  Physician’s office managers/ receptionists who are fielding questions about prophylaxis recommendations for possibly exposed children and/or family members

_______________________________________

Standard "Redbook" recommendations apply in almost every situation.

"Exposed individual" means anyone in close contact with the index case during the week preceding the onset of the diagnosed member's illness.

Careful observation of exposed individuals is essential. Any exposed individual who develops a febrile illness should receive prompt medical evaluation. If indicated, antimicrobial therapy appropriate for the invasive meningococcal infection should be administered.

Household, daycare center, and nursery school contacts should receive antibiotic prophylaxis as soon as possible, preferably within 24 hours of the diagnosis of the primary case. Prophylaxis is also warranted for persons who have had contact with the patient’s oral secretions through kissing or sharing of food or beverages.

The chemoprophylaxis usually recommended for children is Rifampin. A liquid formulation can be made, but the antibiotic comes in tablet or capsule form. The dose for individuals over one month of age is 10 mg/kg (with a maximum of 600 mg) every 12 hours for 2 days (four doses total). The recommended adult dose is 600 mg p.o. twice daily for 2 days. Rifampin is not recommended for women who are pregnant. (Sulfisoxizole is recommended when the isolate is known to be susceptible. The 2-day dosage for sulfisoxizole is 500 mg every 12 hours for children 1 to 12 yrs; 250 mg q 12 hours for children less than 1 yr.; 1,000 mg q 12 hours for adults and children over 12 yrs. Ciprofloxin 500 mg in a single dose is an acceptable alternative antibiotic for adults over age 18.

Immunoprophylaxis with meningococcal vaccine may be considered as a possible adjunct to chemoprophylaxis because secondary cases can occur several weeks after the index case. Routine vaccination of children with meningococcal vaccine is not recommended. The vaccine should be used to control outbreaks of disease caused by serogroups represented in the vaccine. Note: all American military recruits receive the vaccine in basic training.

Roger S Case, MD
Health Officer, Island County

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