Chemoprophylaxis

Chemoprophylaxis may be used to prevent meningococcal meningitis in individuals who have had close contact with an infected individual.

Close contact with patients who have meningococcal meningitis increases the risk of contracting this disease.  Anyone who has been in close contact should be treated with antibiotics in order to prevent them from developing meningitis – even if they show no signs of illness.  Close contact is defined as:

• household contacts (anyone living in the same household or that have slept in the same house as the index case, within 7 days prior to the onset of illness).
  
• anyone who had kissing contact of an intimate nature (adult/baby type of kissing is not considered to be a risk factor).
  
• children and adults who were part of a child-minding group attended by the index case in the 7 days prior to the onset of illness.
  
• anyone who undertook mouth-to-mouth resuscitation on the index case.
  
• people exposed to a situation comparable to household contact, for example, friends who constantly spend a large amount of time together.
  
• healthcare workers whose mouth or nose have been exposed to visible infectious respiratory droplets (not invisible aerosols) or secretions from a probable or confirmed case of meningococcal disease during resuscitation, intubation, upper airway suction or any other procedure which exposes healthcare workers to visible respiratory droplets.

Most secondary cases occur within 5–6 days of the onset of the primary case.

Recommended chemoprophylactic therapies are as follows:

H. Influenzae

All individuals, including adults, in households with at least one unvaccinated or incompletely vaccinated child aged less than 48 months of age should be treated with the appropriate course of rifampicin.

If all household contacts less than 4 years of age have been fully immunised against Hib disease, then chemoprophylaxis is not indicated for the household.

Chemoprophylaxis should also be offered when two or more cases have occurred in a playgroup, nursery or crèche within 120 days and should be given to all room contacts, both adults and children.

N. meningitidis

Chemoprophylaxis is recommended for individuals who are in close contact with the patient. This includes household contacts, day-care centre members and anyone who may have been exposed to the patient’s oral or respiratory secretions (e.g. through kissing or mouth-to-mouth resuscitation).

Contacts may be treated with relevant courses of rifampicin, ciprofloxacin or ceftriaxone.

S. pneumoniae

Chemoprophylaxis is not recommended for close contacts of patients with pneumococcal meningitis.