Meningococcal vaccine: New product, new recommendations
What about children under age 2? There is currently no meningococcal vaccine proven effective for children in this age group. More than 50% of invasive meningococcal disease in this age group is caused by serogroup B. Neither meningococcal vaccine offers protection against this serogroup.
Chemoprophylaxis of contacts
The universal use of conjugate meningococcal vaccine should lead to a marked decrease in the number of meningococcal infections. However, physicians should keep in mind that close contacts of patients with meningococcal infections should be given one of the antibiotic regimens described in the TABLE within 24 hours of confirming the disease. Close contacts include household members, daycare center cohorts, and those directly exposed to the patients’ oral secretions through kissing, mouth-to-mouth resuscitation, and intubations.
Patients treated for meningococcemia with other than a third-generation cephalosporin should also be treated with one of the regimens in the TABLE since other antibiotics have not been shown to eradicate nasopharyngeal carriage.
An expected result of conjugate vaccine is to decrease the nasopharyngeal carriage of Neisseria meningitidis. It is unknown if close contacts who have been vaccinated will benefit from chemoprophylaxis.
TABLE
Schedule for administering chemoprophylaxis against meningococcal disease
| DRUG | AGE GROUP | DOSAGE | DURATION/ROUTE OF ADMINISTRATION* |
|---|---|---|---|
| Rifampin† | Children <1 mo | 5 mg/kg every 12 h | 2 days |
| Children ≥1 mo | 10 mg/kg every 12 h | 2 days | |
| Adults | 600 mg every 12 h | 2 days | |
| Ciprofloxacin§ | Adults | 500 mg | Single dose |
| Ceftriaxone | Children <15 yrs | 125 mg | Single intramuscular dose |
| Ceftriaxone | Adults | 250 mg | Single intramuscular dose |
| *Oral administration unless indicated otherwise. †Rifampin is not recommended for pregnant women because the drug is teratogenic in laboratory animals. Because the reliability of oral contraceptives may be affected by rifampin therapy, consideration should be given to using alternative contraceptive measures while rifampin is being administered. §Ciprofloxacin is not generally recommended for persons aged <18 years or for pregnant and lactating women because the drug causes cartilage damage for immature laboratory animals. However, ciprofloxacin can be used for chemoprophylaxis of children when no acceptable alternative therapy is available. | |||
CORRESPONDENCE
Doug Campos-Outcalt, MD, MPA, 4001 North Third Street #415, Phoenix, AZ 85012. E-mail: dougco@u.arizona.edu.
