TAILIEUCHUNG - 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. | 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

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