Primary prevention

In most developed countries, the routine childhood immunisation schedule recommends a 13-valent pneumococcal conjugate vaccine (PCV13), a suitable meningococcal vaccine, and a Haemophilus influenzae type b (Hib) conjugate vaccine. 

Local vaccination guidelines may vary and should be consulted:

Perform computed tomography or magnetic resonance imaging in patients with a history of trauma, recent neurosurgery, rhinorrhoea, or otorrhoea to identify any source of cerebrospinal fluid leak and source of contiguous spread of infection to the meninges.[16][23][24]

Secondary prevention

Report all cases of suspected Haemophilus influenzae type b (Hib) meningitis urgently to local public health authorities.[69] Immunisation with Hib vaccine should be considered in the public health management of an outbreak. Vaccinate all at-risk groups against Streptococcus pneumoniae and H influenzae type b.[25][69]

Investigate the immunological status of patients with two or more episodes of pneumococcal meningitis.[16]

Check the protocol for contact management in the country where you are based.

H influenzae type b (Hib)

In the UK, prophylactic rifampicin for household contacts will be initiated by the health protection team after notification.[16]

Hib vaccination should be given to all unvaccinated household contacts under 10 years.[16]

S pneumoniae

Contact management is not usually indicated for pneumococcal meningitis, as close contacts are not usually at increased risk of infection.[16]

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