Neisseria Meningitidis

Meningococcal Infections: The Ongoing Saga

Chemoprophylaxis for Health Care Workers Exposed to N. meningitidis

by Trish M. Perl, MD, MSc

Rationale:

• 1.3 to 5.8% “secondary” cases result from exposure to a N. meningitidis case

•  the attack rate in persons exposed to a case with close contact (i.e. household) is 500 to 800 times that of the general population

• up to 85% of persons with “close” contact carry N. meningitidis in their oropharynx after exposure to a case whereas 5-11% of persons living in crowded conditions carry N. meningitidis in the oropharynx.

• In general, hospital personnel have the same risk of developing disease as the general population unless they have contact with respiratory secretions.  However, disease in health care workers is rare and thought to be in part due to patient isolation and treatment that decrease the chance of becoming a carrier.

A prophylactic agent must

          • be safe

          • eliminate carriage rapidly and for a prolonged period

          • achieve bactericidal concentrations in saliva and tears

          • cost effective

          • limit change of antimicrobial resistance

In the health care setting, an agent also should be

          • practical (to assure compliance)

Review of the literature: see attached sheet

          • Sulfonamides are no longer used because of wide spread drug resistance.

References:

Pusley, Dworzack, Horowitz et al.. Efficacy of Ciprofloxacin in the treatment of nasopharyngeal carriers of N. Meningitidis JID 1987:211-213.

Pusley, Dworzack, Roccaforte et al.. An Open study of the efficacy of a single dose of Ciprofloxacin in eliminating the chronic nasopharyngeal carriage of N. Meningitidis JID 1988 157:852-3.

Gutter, Beaty.  Minocycline in the chemoprophylaxis of meningococcal disease. AAC 1972397-402

Gaunt, Lambert.  Single dose of Ciprofloxacin for the eradication of pharynceal carriage of N. Meningitidis.  J Antimicrob Chemother 1988 21:489-96.

Judson, Ehret. Single dose ceftriaxone to eradicate pharyngeal N. Meningitidis  Lancet 1984.22/29:1462-3.

Devine, Johnson, Hagerman etal.  The effect of minocycline on meningococcal nasopharyngeal carrier state in naval personnel.  Am J Epidemiol 1971;93:337-45