Meningococcal Disease

Meningococcal Disease Recommendations/California Department of Public Health - Medical Advisory
April 17, 2014
In response to a cluster of invasive meningococcal disease in the men who have sex with men (MSM) population in 2014 in Los Angeles County, both the County of Orange Health Care Agency and California Department of Public Health have issued recommendations emphasizing to medical providers the increased risk of invasive meningococcal disease in the MSM population .
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Meningococcal Disease Reported in Los Angeles MSM Population/Recommendations for Orange County Residents - Medical Advisory
April 11, 2014
The Los Angeles County Department of Public Health reported a cluster of invasive meningococcal disease (IMD) among men who have sex with men (MSM), and is recommending meningococcal vaccination for Los Angeles County residents who are either HIV-positive MSM or HIV-negative MSM whose activities place them at higher risk for infection. Based on the current situation, and after consultation with the California Department of Public Health, Orange County Public Health is recommending meningococcal vaccination be offered to all HIV-positive MSM who socialize regularly in Los Angeles County as well as all MSM (regardless of HIV status) who regularly have close or intimate contact with multiple partners or who seek partners through the use of digital applications (“apps”), particularly those who share cigarettes/marijuana or use illegal drugs.
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Last reviewed 2/17/11

Postexposure Prophylaxis for Meningococcal Disease

EXCERPTED FROM: Morbidity and Mortality Weekly Report, May 27, 2005 / 54(RR-7);16-17 
(See www.cdc.gov/mmwr/preview/mmwrhtml/rr5407a1.htm for entire statement, including references).

Prevention and Control of Meningococcal Disease

ANTIMICROBIAL CHEMOPROPHYLAXIS

Antimicrobial chemoprophylaxis of close contacts of sporadic cases of meningococcal disease is the primary means for prevention of meningococcal disease in the United States (see Table). Close contacts include a) household members, b) day care center contacts, and c) anyone directly exposed to the patient's oral secretions (e.g., through kissing, mouth-to-mouth resuscitation, endotracheal intubation, or endotracheal tube management). For travelers, antimicrobial chemoprophylaxis should be considered for any passenger who had direct contact with respiratory secretions from an index-patient or for anyone seated directly next to an index-patient on a prolonged flight (i.e., one lasting >8 hours). The attack rate for household contacts exposed to patients who have sporadic meningococcal disease has been estimated to be four cases per 1,000 persons exposed, which is 500-800 times greater than for the total population. Because the rate of secondary disease for close contacts is highest during the first few days after onset of disease in the primary patient, antimicrobial chemoprophylaxis should be administered as soon as possible (ideally within 24 hours after the case is identified). Conversely, chemoprophylaxis administered greater than 14 days after onset of illness in the index case-patient has little value. Oropharyngeal or nasopharyngeal cultures are not helpful in determining the need for chemoprophylaxis and may unnecessarily delay institution of this preventive measure.

Rifampin, ciprofloxacin, and ceftriaxone are 90%–95% effective in reducing nasopharyngeal carriage of N. meningitdisand are all acceptable antimicrobial agents for chemoprophylaxis. See the table below for recommended dosages and select comments about the medications. Consult a drug handbook or pharmacist for a complete list of contraindications and adverse effects.

Systemic antimicrobial therapy of meningococcal disease with agents other than ceftriaxone or other third-generation cephalosporins may not reliably eradicate nasopharyngeal carriage of N. meningitidis. If other agents have been used for treatment, the index patient should receive chemoprophylactic antibiotics for eradication of nasopharyngeal carriage before being discharged from the hospital.

TABLE. Schedule for administering chemoprophylaxis against meningococcal disease

Drug

Age group

Dosage

Duration and route of administration

Rifampin*

Children <1 month

5 mg/kg every 12 hrs



2 days, oral

Children ≥ 1 months

10 mg/kg (max 600 mg) every 12 hrs



2 days, oral

Adults

600 mg every 12 hrs



2 days, oral

Ciprofloxacin§

Adults

500 mg

Single dose, oral

 

Ceftriaxone

Children <15 years



125 mg

Single dose, intramuscular (IM)

Adults (including pregnant women)

250 mg

Single dose, intramuscular

Azithromycin Children and adults.  Limited data; not recommended routinely; consider only if resistance to other agents suspected. 10 mg/kg (maximum 500 mg) Single dose, oral

* Rifampin is not recommended for pregnant women, because it is teratogenic in laboratory animals. Rifampin changes the color of urine to reddish-orange and is excreted in tears and other body fluids; it may cause permanent discoloration of soft contact lenses. Because the reliability of oral contraceptives may be affected by rifampin therapy, consideration should be given to using alternate contraceptive measures while rifampin is being administered.

§ Ciprofloxacin is not generally recommended for persons less than 18 years of age or for pregnant and lactating women because the drug causes cartilage damage in immature laboratory animals. However, ciprofloxacin may be used for chemoprophylaxis of children when no acceptable alternative therapy is available.

Table adapted from: Morbidity and Mortality Weekly Report, May 27, 2005 / 54(RR-7);16-17 
(See www.cdc.gov/mmwr/preview/mmwrhtml/rr5407a1.htm for entire statement, including references).