Primary prevention

Many developed countries offer routine childhood vaccination for prevention of meningococcal disease. Since the introduction of routine quadrivalent meningococcal conjugate vaccination in the US, the national incidence of meningococcal infection in adolescents and young adults has fallen 2- to 3-fold.[43] The World Health Organization (WHO) and the Advisory Committee on Immunization Practices (ACIP) also recommend meningococcal vaccination for selected high-risk populations.[20][44]

For full details of US immunization schedules, including indications for booster doses, the ACIP guidelines should be consulted.[20] CDC: adult immunization schedule by age - recommendations for ages 19 years or older Opens in new window CDC: child and adolescent immunization schedule by age - recommendations for ages 18 years or younger Opens in new window

Children

Tetravalent meningococcal conjugate vaccine (MenACWY) is recommended by the ACIP for routine vaccination of all children, preferably at age 11 or 12 years, with a booster dose at age 16 years.[20][45] MenACWY vaccination may also be recommended for younger children (from age 2 months) with high-risk conditions, or at increased risk of disease (anatomic or functional asplenia, HIV infection, receiving eculizumab or ravulizumab, or with persistent complement component deficiency), and for children traveling to countries with hyperendemic or epidemic meningococcal disease.[20][23] Serogroup B vaccination is recommended by the ACIP for children and adolescents ages over 10 years with high-risk conditions or at increased risk of disease (anatomic or functional asplenia, HIV infection, receiving complement inhibitor [e.g., eculizumab, ravulizumab], or persistent complement component deficiency), and may also be considered routinely in adolescents age 16 years or older who are not at increased risk based on shared clinical decision-making.[20]

Adults

Tetravalent meningococcal conjugate vaccine (MenACWY) and serogroup B vaccine (MenB) are recommended in adults with high-risk conditions or at increased risk of disease (anatomic or functional asplenia, HIV infection, persistent complement component deficiency, or receiving complement inhibitor [e.g., eculizumab, ravulizumab]).[20] First-year college students who live in residential housing (if not previously vaccinated at age 16 years or older) and military recruits should receive a single dose of MenACWY. MenACWY vaccination is also recommended for travel in countries with hyperendemic or epidemic meningococcal disease.[20]

Complement inhibition

Patients who will be treated with eculizumab or ravulizumab should receive meningococcal vaccines at least 2 weeks prior to commencing therapy, unless the risks of delaying this therapy outweigh the risks of developing meningococcal infection. Healthcare providers should also consider the use of antibacterial prophylaxis for patients receiving eculizumab or ravulizumab to reduce the risk of meningococcal disease.[20][23]

Secondary prevention

All patients with presumed meningococcal infections should be cared for using droplet precautions until 24 hours of effective therapy has been completed. Patients should be hospitalized in private rooms. In addition to standard precautions, people should wear surgical masks when within 3 feet of the patient or within the patient's room, and the patient should wear a mask when transport outside their room is necessary. Masks and eye protection or face shields should be worn during procedures that are likely to result in exposure to patient secretions, such as endotracheal intubation.

Reportability

Any case of invasive meningococcal disease should be reported to local and state health departments.

Antibiotic prophylaxis

Close contacts of patients with meningococcal infections should receive chemoprophylaxis as soon as feasible, ideally within 24 hours of identification of the index case.[1][32] Chemoprophylaxis is probably of little or no benefit when administered more than 14 days after the onset of disease in the index case.[32]

Most meningococcal infections in the US are sporadic; however, secondary cases may occur in contacts of patients with meningococcal infections.[32] Most secondary cases are diagnosed within 2 weeks of the index case. Close contacts include:

  • Household members

  • People with other close social contact (those who frequented the patient's residence or were directly exposed to patient's secretions by kissing or sharing of utensils within 7 days of the index case's illness)

  • Air travelers seated directly next to patients on flights of over 8 hours' duration

  • Healthcare providers having unprotected contact with patients' respiratory secretions

Give exposed healthcare providers antimicrobial prophylaxis, irrespective of their vaccination status. Exclude potentially infectious healthcare providers from work until 24 hours after the start of treatment.[32] Prior to discharge, administer a course of antimicrobial prophylaxis to patients with invasive meningococcal infections who are not treated with ceftriaxone or cefotaxime.[4][50]

Although rifampin, ceftriaxone, and ciprofloxacin are all effective in eradicating meningococcal carriage, the emergence of resistance to rifampin has been noted following prophylactic use.[32][88]

Immunoprophylaxis

In ongoing outbreaks of meningococcal infection caused by vaccine-preventable serogroup A, B, C, Y, and W-135 organisms, immunization of contacts may prevent secondary cases.[20][32] The preferred vaccine varies according to the individual's age and the serotype of the outbreak strain.[4][20][89]

Screening for complement deficiency

Some authorities advise that all patients with invasive meningococcal infections should be screened for complement deficiency.[90] Immunization of patients with complement deficiencies with meningococcal polysaccharide vaccine reduces the risk of invasive infection, but rates remain significantly higher than in the general population.[91] Routine immunization with quadrivalent conjugate vaccine is recommended.[20]

Nasopharyngeal culture

May be helpful in identifying the serogroup of Neisseria meningitidis circulating in a community and whether immunization may be helpful in the prevention of secondary cases.

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