Primary prevention

Many countries, particularly in the developed world, offer routine childhood vaccination for prevention of meningococcal disease. Consult your local guidelines.

In the UK, a meningococcal serogroup B vaccine is routinely offered during early childhood, and a quadrivalent meningococcal conjugate vaccine for Neisseria meningitidis serotypes A, C, Y, and W-135 is offered at 14 years. UK Health Security Agency: complete routine immunisation schedule Opens in new window

Secondary prevention

Respiratory isolate all patients with suspected meningitis or meningococcal sepsis until meningococcal meningitis or meningococcal sepsis is excluded (or considered unlikely) or ceftriaxone (or other recommended antibiotic) has been given for 24 hours (or a single dose of ciprofloxacin).[48][49]

Take droplet precautions, including wearing a surgical mask, if likely to be in close contact with respiratory secretions or droplets, until the patient has had 24 hours of antibiotics.[48]

Antibiotic prophylaxis should be given to healthcare workers who have been exposed to respiratory secretions or droplets from a patient with confirmed meningococcal disease (e.g., during intubation or as part of CPR performed without wearing a mask).[48]

Practical tip

Suspected meningitis is one of the commonest occupational exposures for healthcare workers but healthcare-associated infection is extremely rare.

Notify:

  • Microbiology[49]

  • The relevant public health authority urgently if you have a patient with suspected meningitis or meningococcal sepsis (regardless of the aetiology).[7][9][48]​​[79]

    • Meningitis and meningococcal sepsis are notifiable diseases in the UK so this is a legal requirement under the Health Protection (Notification) Regulations 2010.[80]  

    • In the UK, contact the consultant in communicable disease control or the consultant in health protection at your local health protection team early.[48] They will initiate prophylaxis of contacts.

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.[7][96]​​​​ Chemoprophylaxis is probably of little or no benefit when administered more than 14 days after the onset of disease in the index case. 

Most meningococcal infections are sporadic; however, secondary cases may occur in contacts of patients with meningococcal infections.[7] 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 travellers seated directly next to patients on flights of over 8 hours' duration

  • Healthcare providers having unprotected contact with patients' respiratory secretions.

Patients with invasive meningococcal infections who are not treated with ceftriaxone or cefotaxime should also receive a course of prophylaxis before discharge from hospital.[97]

Although rifampicin, ceftriaxone, and ciprofloxacin are all effective in eradicating meningococcal carriage, the emergence of resistance to rifampicin has been noted following prophylactic use.[7][98]

Immunoprophylaxis

In ongoing outbreaks of meningococcal infection caused by vaccine-preventable serogroup A, B, C, Y, and W-135 organisms, immunisation of contacts may prevent secondary cases.[24]​ The preferred vaccine varies according to the individual's age and the serotype of the outbreak strain.[4][24]​​​​[99]

Screening for complement deficiency

Patients who have had more than one episode of invasive meningococcal infection, an episode cause by serogroup other than B (A, C W135, Y, X 29E), or meningococcal disease and a history of previous or recurrent serious infections should be screened for complement deficiency.[9]​ Immunisation 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.[100] Routine immunisation with tetravalent conjugate vaccine is recommended.[24]​​

Nasopharyngeal culture

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

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