Prevention of meningococcal disease relies upon two strategies. One is the use of antibiotics for certain exposed persons (chemoprophylaxis or antibiotic prophylaxis) and the other is prevention of disease by immunization (immunoprophylaxis). Antibiotics (chemoprophylaxis) Table 2 lists persons who should receive chemoprophylaxis. Chemoprophylaxis of close contacts of sporadic cases of meningococcal disease is the primary means for prevention of meningococcal disease in the United States. Close contacts include a) household members, b) child care center contacts, and c) anyone directly exposed to a patient’s oral secretions through kissing or mouth-to-mouth resuscitation. Exposed household, school and child care contacts must be observed carefully. Exposed persons who develop an illness with fever should see a physician immediately. The attack rate for household contacts exposed to persons who have sporadic meningococcal disease is approximately four cases per 1,000 exposed persons. This rate is 500 to 800 times higher than for the general population. Since the majority of the episodes of secondary disease in close contacts is highest during the first few days after exposure and generally occurs within the first 14 days following exposure, chemoprophylaxis should be given to close contacts as soon as possible after the case is identified. Cultures of the nose and throat are not helpful in deciding whether antibiotics should be given to close contacts. Table 3 gives the schedule for administration of chemoprophylaxis against meningococcal disease.

Meningococcal Vaccine One meningococcal vaccine, known as a polysaccharide vaccine, is available commercially in the United States. The vaccine consists of four different meningococcal capsular sugars and provides protection against meningococcal serogroups A, C, Y and W-135 (Menomune® - A, C, Y, W-135, Aventis Pasteur). The vaccine is given as a single subcutaneous injection. For a vaccine to be effective, the mixture of serogroups in the vaccine must correspond to the naturally circulating meningococcal serogroups. This vaccine provides protection against approximately 70% of the serogroups causing invasive disease in the United States (figure 3 and figure 4). A vaccine is not available to prevent disease due to serogroup B. About two to three weeks after receiving the meningococcal vaccine, the recipient develops antibodies to many or all of the four meningococcal serogroups in the vaccine. The antibody response to each of the four serogroups in the vaccine is independent. Antibody levels may be lower in elderly persons, in persons with depressed immune systems, and in some persons with chronic medical conditions such as alcoholic cirrhosis or insulin-dependent diabetes mellitus. Unfortunately this vaccine cannot be used in children under two years of age because this age group does not respond to polysaccharide vaccines. Other types of meningococcal vaccines, among them being the conjugate meningococcal vaccines, are being developed and tested for use in young children. Conjugate vaccines link a protein to the sugars and make this vaccine more effective in children two years of age and younger. A conjugated vaccine is in widespread use in the United Kingdom.

Efficacy - The serogroup A and C components of the polysaccharide vaccine are 85 to 100 percent effective in older children and adults and are useful in controlling epidemics. The serogroup Y and W-135 components produce antibodies in adults and in children older than two years of age, although the full extent of clinical protection has not been documented. Safety - Adverse reactions to meningococcal vaccine are mild and consist primarily of pain and redness at the site of injection for one to two days. A short-lasting fever has been reported to develop in less than two percent of young children. Based on limited studies, no adverse consequences have been reported among newborns whose mothers received the meningococcal vaccine during pregnancy. Meningococcal vaccine can be given at the same time as other vaccines except for whole cell pertussis vaccine, which is not recommended for use in the U.S., or whole cell typhoid vaccine. Meningococcal vaccine is a killed vaccine and therefore cannot cause meningococcal disease. Who should get the vaccine? - Since 1982, all military recruits routinely have received the A, C, Y, W-135 meningococcal polysaccharide vaccine. This has resulted in a dramatic decrease in the previous high rate of meningococcal disease in this population. Routine meningococcal immunization of people not in the military service is not recommended because of its relative ineffectiveness in children less than two years of age and its short duration of protection. In general, routine use of the meningococcal polysaccharide vaccine is recommended for certain persons over two years of age who are in high-risk groups including the following:

		persons who have terminal complement deficiencies
		any person who has had his/her spleen removed or who has a spleen that doesn’t function properly
		travelers to countries in which N. meningitidis is endemic. For information concerning geographic areas for which immunization is recommended, contact a local international health clinic for travelers, state health department or the CDC at (404) 332-4559 or www.cdc.gov/.
		research, industrial and clinical laboratory personnel routinely exposed to N. meningitidis in solutions that may be aerosolized
		control of serogroup C meningococcal disease outbreaks

Should college students be immunized? - Studies have demonstrated that college freshmen, particularly those who live in dormitories or residence halls, have an increased risk of meningococcal disease compared to other persons in the same age group. The polysaccharide vaccine will decrease the risk for meningococcal disease in those who wish to be immunized. Both the American Academy of Pediatrics and the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention recommend that healthcare professionals should discuss meningococcal disease and the benefits of immunization with college freshmen and their parents, especially those who plan to live in dormitories or residence halls. Immunization should be made readily accessible and provided to those freshmen who wish to reduce the risk of meningococcal disease or in situations where the immunization is required by the college or university. Additional information about meningococcal disease and the availability of the vaccine should be available from colleges and universities for freshmen who plan to live in dormitories or residence halls. Who should not get the vaccine? - People suffering from an acute illness should wait until recovery before receiving the vaccine. People allergic to the vaccine or to one of its components should not receive the vaccine.

Counseling and Public Education When a case of invasive meningococcal disease is detected, a great deal of public anxiety often occurs. Healthcare professionals can provide accurate and timely information about meningococcal disease, including the risk of transmission to families and contacts of the index case and appropriate use of chemoprophylaxis. Public health questions, including whether a mass immunization program is needed, should be referred to local public health department personnel. Public information campaigns involving local healthcare providers, state and local health department officials, and the media may help minimize public anxiety and unrealistic or inappropriate demands for intervention.