Page 115 - Journal of Special Operations Medicine - Spring 2017

Treatment Figure 3 Meningococcal disease incidence by age, United
States, 2005–2013.
Once a diagnosis of meningococcal disease has been
made, recommended therapy is either cefotaxime or cef-
triaxone for a 5- to 7-day course. Ceftriaxone has been
shown to clear nasopharyngeal carriage of the organism
after a single dose. Standard and droplet precautions
in the care of the patient should be maintained for 24
hours after the start of appropriate antibiotic therapy.

Chemoprophylaxis is recommended for those with
high-risk contact of those with invasive meningococcal
disease—even if vaccinated, as no vaccine has 100%
efficacy. High-risk contact includes household contact,
child care or preschool contact during the 7 days pre-
ceding onset of illness, seated next to the index case
on a plane for longer than 8 hours, kissing, or as a
healthcare provider exposed to secretions. In nonpreg-
nant adults, rifampin (600mg every 12 hours for four Source: CDC.
doses), ceftriaxone (250mg IM single dose), and cip-
rofloxacin (500mg orally single dose) are all recom- Africa during the dry and dusty period of the year, pri-
mended as effective chemoprophylaxis. Ceftriaxone is marily caused by serogroup A, although cases caused by
recommended for pregnant patients. Rifampin (5mg/ serogroups W and X have been reported in recent years
kg orally every 12 h for four doses in patients less (Figure 4).
than 1 month old or 10mg/kg in children older than
1 month) is the drug of choice for pediatric patients. Two conjugate vaccines exist for serogroups A, C, Y,
Azithromycin is not routinely recommended due to and W (Menactra, Menveo) and are interchangeable. A
noted resistance worldwide. As outbreaks can occur single dose for adults with boosters every 5 years are
over several weeks, meningococcal vaccination is also recommended for those in the military or those travel-
recommended (see later). ing to regions of high risk. A single dose is also recom-
mended for those with high-risk contact with a person
with invasive meningococcal disease, unless they have
Vaccination
In the United States, serogroups B, C, and Y each cause previously been vaccinated. Two vaccines have been ap-
approximately one-third of the 800 to 1000 cases seen proved within the past year for serogroup B (Trumenba,
annually, primarily in young children and young adults Bexsero)—there is currently no routine use for these vac-
(Figures 2 and 3). In Africa, far larger numbers of cases cines unless exposed to a known outbreak of serogroup
are seen across the “meningitis belt” of sub-Saharan B. For persons at high risk of meningococcal disease,
such as those who are asplenic or have a complement
Figure 2 Meningococcal disease incidence, United States, Figure 4 “Meningitis belt” of Africa: areas with frequent
1970–2013.
epidemics of meningococcal meningitis.

Source: https://wwwnc.cdc.gov/travel/yellowbook/2016/infectious
Source: CDC. -diseases-related-to-travel/meningococcal-disease.

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