Skip to main content Accessibility help
×
Home

What is the evidence for giving chemoprophylaxis to children or students attending the same preschool, school or college as a case of meningococcal disease?

  • W. HELLENBRAND (a1), G. HANQUET (a2), S. HEUBERGER (a3), S. NIELSEN (a1), P. STEFANOFF (a4) and J. M. STUART (a5)...

Summary

We performed a systematic literature review to assess the effectiveness of chemoprophylaxis for contacts of sporadic cases of invasive meningococcal disease (IMD) in educational settings. No studies directly compared IMD risk in contacts with/without chemoprophylaxis. However, compared to the background incidence, an elevated IMD risk was identified in settings without a general recommendation for chemoprophylaxis in pre-schools [pooled risk difference (RD) 58·2/105, 95% confidence interval (CI) 27·3–89·0] and primary schools (pooled RD 4·9/105, 95% CI 2·9–6·9) in the ~30 days after contact with a sporadic IMD case, but not in other educational settings. Thus, limited but consistent evidence suggests the risk of IMD in pre-school contacts of sporadic IMD cases is significantly increased above the background risk, but lower than in household contacts (pooled RD for household contacts with no chemoprophylaxis vs. background incidence: 480·1/105, 95% CI 321·5–639·9). We recommend chemoprophylaxis for pre-school contacts depending on an assessment of duration and closeness of contact.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      What is the evidence for giving chemoprophylaxis to children or students attending the same preschool, school or college as a case of meningococcal disease?
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      What is the evidence for giving chemoprophylaxis to children or students attending the same preschool, school or college as a case of meningococcal disease?
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      What is the evidence for giving chemoprophylaxis to children or students attending the same preschool, school or college as a case of meningococcal disease?
      Available formats
      ×

Copyright

Corresponding author

*Author for correspondence: Dr W. Hellenbrand, Robert Koch Institute, DGZ-Ring 1, 13086 Berlin, Germany. (Email: hellenbrandw@rki.de)

References

Hide All
1.Trotter, CL, Gay, NJ, Edmunds, WJ. The natural history of meningococcal carriage and disease. Epidemiology and Infection 2006; 134: 556566.
2.Hastings, L, et al. A retrospective survey of clusters of meningococcal disease in England and Wales, 1993 to 1995: estimated risks of further cases in household and educational settings. Communicable Disease Report 1997; 7: R195R200.
3.De Wals, P, et al. Meningococcal disease in Belgium. Secondary attack rate among household, day-care nursery and pre-elementary school contacts. Journal of Infection 1981; 3: 5361.
4.Olivares, R, Hubert, B. Clusters of meningococcal disease in France (1987–1988). European Journal of Epidemiology 1992; 8: 737742.
5.Palau, AO, Noguera, HP. Factors predictive of secondary cases of meningococcal disease in Barcelona. Epidemiology of the disease [in Spanish]. Revista española de salud pública 1998; 72: 443450.
6.Samuelsson, S, et al. An outbreak of serogroup B:15:P1.16 meningococcal disease, Frederiksborg County, Denmark, 1987–9. Epidemiology and Infection 1992; 108: 1930.
7.Purcell, B, et al. Effectiveness of antibiotics in preventing meningococcal disease after a case: systematic review. British Medical Journal 2004; 328: 13391340.
8.Stefanoff, P, et al. The detection of meningococcal household clusters and their prophylaxis in the changing epidemiological situation of invasive meningococcal disease in poland, 2003–2006. Eurosurveillance 2008; 13: 4446.
9.Bernabeu, MF, et al. Incidence of secondary meningococcal outbreak among school children younger than five years [in Spanish]. Medicina Clinica 1980; 74: 142144.
10.Cartwright, KA, Hunt, D, Fox, A. Chemoprophylaxis fails to prevent a second case of meningococcal disease in a day nursery. Communicable Disease Report CDR Review 1995; 5: R199.
11.Davison, KL, et al. Clusters of meningococcal disease in school and preschool settings in England and Wales: what is the risk? Archives of Disease in Childhood 2004; 89: 256260.
12.Granerod, J, et al. Clusters of meningococcal disease in educational establishments in the United Kingdom: April 2001 to March 2002. Communicable Disease and Public Health/PHLS 2004; 7: 5155.
13.Jacobson, JA, Filice, GA, Holloway, JT. Meningococcal disease in day-care centers. Pediatrics 1977; 59: 299300.
14.Leggiadro, RJ, et al. Invasive meningococcal disease: secondary spread in a day-care center. Southern Medical Journal 2000; 82: 511513.
15.O'Donovan, D, et al. Outbreak of group C meningococcal infection affecting two preschool nurseries. Communicable Disease and Public Health/PHLS 2000; 3: 177180.
16.Sáez-Nieto, JA, et al. Outbreak of infection caused by Neisseria meningitidis group C type 2 in a nursery. Journal of Infection 1984; 8: 4955.
17.Samuelsson, S, Gustavsen, S, Rønne, T. Epidemiology of meningococcal disease in Denmark 1980–1988. Scandinavian Journal of Infectious Diseases 1991; 23: 723730.
18.Davison, RP, et al. Using the national guidelines to manage a meningococcal group C outbreak in a Brisbane boarding school – some discretionary judgements are needed. Communicable Diseases Intelligence 2003; 27: 520523.
19.Feigin, RD, et al. Epidemic meningococcal disease in an elementary school classroom. New England Journal of Medicine 1982; 307: 12551257.
20.González de Aledo, LA, García, MJ. Control of a school outbreak of serogroup B meningococcal disease by chemoprophylaxis with azithromycin and ciprofloxacin [in Spanish]. Anales españoles de pediatría 2000; 53: 412417.
21.Hudson, PJ, et al. Evidence for school transmission of Neisseria meningitidis during a Vermont outbreak. Pediatric Infectious Disease Journal 1986; 5: 213217.
22.Jackson, LA, et al. Evaluation of the use of mass chemoprophylaxis during a school outbreak of enzyme type 5 serogroup B meningococcal disease. Pediatric Infectious Disease Journal 1996; 15: 992998.
23.Jackson, LA, et al. Serogroup C meningococcal outbreaks in the United States. An emerging threat. Journal of the American Medical Association 1995; 273: 383389.
24.Jacobson, JA, et al. The risk of meningitis among classroom contacts during an epidemic of meningococcal disease. American Journal of Epidemiology 1976; 104: 552–525.
25.Morrow, HWM, et al. Risk factors associated with a school-related outbreak of serogroup C meningococcal disease. Pediatric Infectious Disease Journal 1990; 9: 394397.
26.Oppermann, H, et al. Meningococcal carriage in high school students and possible risk factors [in German]. Das Gesundheitswesen 2006; 68: 633637.
27.Robinson, P, et al. An outbreak of serogroup C meningococcal disease associated with a secondary school. Communicable Diseases Intelligence 2001; 25: 121125.
28.Schubiger, G, et al. Meningococcal epidemic in a boarding school: a rifampicin-resistant secondary case while under chemoprophylaxis [in German]. Schweizerische Medizinische Wochenschrift 1986; 116: 11721175.
29.Sutton, T, Ip, S. A cluster of meningococcal meningitis cases in an Auckland secondary school. New Zealand Medical Journal 1987; 100: 153.
30.Zangwill, KM, et al. School-based clusters of meningococcal disease in the United States. Descriptive epidemiology and a case-control analysis. Journal of the American Medical Association 1997; 277: 389395.
31.Barker, RM, et al. Practical guidelines for responding to an outbreak of meningococcal disease among university students based on experience in Southampton. Communicable Disease and Public Health/PHLS 1999; 2: 168173.
32.Ferson, M, et al. Unusual cluster of mild invasive serogroup C meningococcal infection in a university college. Communicable Diseases Intelligence 1999; 23: 261264.
33.Riordan, T. A college outbreak of group C meningococcal infection: how widely should investigation and prophylaxis extend. Communicable Disease Report. CDR Review 1997; 7: 59.
34.Round, A, et al. Public health management of an outbreak of group C meningococcal disease in university campus residents. European Journal of Public Health 2001; 11: 431436.
35.Bruce, MG, et al. Risk factors for meningococcal disease in college students. Journal of the American Medical Association 2001; 286: 688693.
36.Kristiansen, BE, Tveten, Y, Jenkins, A. Which contacts of patients with meningococcal disease carry the pathogenic strain of Neisseria meningitidis? A population based study. British Medical Journal 1998; 317: 621625.
37.Wall, R, et al. Meningococcal infection: evidence for school transmission. Journal of Infection 1991; 23: 155159.
38.Boccia, D, et al. Effectiveness of different policies in preventing meningococcal disease clusters following a single case in day-care and pre-school settings in Europe. Epidemiology and Infection 2006; 134: 872877.
39.Hoek, M, et al. A European survey on public health policies for managing cases of meningococcal disease and their contacts. Eurosurveillance 2008; 13: 7880.
40.Atkins, D, et al. Systems for grading the quality of evidence and the strength of recommendations I: Critical appraisal of existing approaches The GRADE Working Group. BMC Health Services Research 2004; 4: 38.
41.Cochrane Collaboration. Cochrane Handbook for Systematic Reviews of Interventions, version 5.0.2 (updated September 2009), 2009.
42.Schünemann, HJ, et al. Transparent development of the WHO Rapid Advice Guidelines. PLoS Medicine 2007; 4: e119.
43.Schünemann, S, et al. WHO Rapid Advice Guidelines for pharmacological management of sporadic human infection with avian influenza A (H5N1) virus. Lancet Infectious Diseases 2007; 7: 2131.
44.European Centre for Disease Prevention and Control. Public health management of sporadic cases of invasive meningococcal disease and their contacts. Stockholm, 2010.
45.Miettinen, OS, Nurminen, M. Comparative analysis of two rates. Statistics in Medicine 1985; 4: 213226.
46.Favorova, LA, Sokova, IN, Chernyshova, TF. Results of controlled epidemiological trial on the use of placental gamma globulin in foci of meningococcal infection. Zhurnal Mikrobiologii, Epidemiologii i Immunobiologii 1975; 6: 1518.
47.Ackerman, JH. Meningococcal disease in Ohio. Ohio State Medical Journal 2010; 70: 710712.
48.Cooke, RP, et al. Secondary cases of meningococcal infection among close family and household contacts in England and Wales, 1984–7. British Medical Journal 1989; 298: 555558.
49.Hoiby, EA, et al. 23. Phenoxymethyl-penicillin treatment of household contacts of meningococcal disease patients. Antonie van Leeuwenhoek, International Journal of General and Molecular Microbiology 1986; 52: 255257.
50.Juels, C, et al. Meningococcal disease in California. Epidemiology and management. Western Journal of Medicine 1978; 128: 195202.
51.Kaiser, AB, et al. Seroepidemiology and chemoprophylaxis disease due to sulfonamide-resistant Neisseria meningitidis in a civilian population. Journal of Infectious Diseases 1974; 130: 217224.
52.Marks, MI, Frasch, CE, Shapera, RM. Meningococcal colonization and infection in children and their household contacts. American Journal of Epidemiology 1979; 109: 563571.
53.Munford, RS, et al. Spread of meningococcal infection within households. Lancet 1974; 303: 12751278.
54.Norton, JF. Meningococcus meningitis in Detroit: 1928–1929. Journal of Preventive Medicine 1931; 5: 365367.
55.Olcen, P, et al. Epidemiology of Neisseria meningitidis; prevalence and symptoms from the upper respiratory tract in family members to patients with meningococcal disease. Scandinavian Journal of Infectious Diseases 1981; 13: 105109.
56.Samuelsson, S, et al. Prevention of secondary cases of meningococcal disease in Denmark. Epidemiology and Infection 2000; 124: 433440.
57.Scholten, RJPM, et al. Upper respiratory tract infection, heterologous immunisation and meningococcal disease. Journal of Medical Microbiology 2009; 48: 943946.
58.The Meningococcal Disease Surveillance Group.Meningococcal disease. Secondary attack rate and chemoprophylaxis in the United States, 1974. Journal of the American Medical Association 1974; 235: 261265.
59.The Meningococcal Disease Surveillance Group.Analysis of endemic meningococcal disease by serogroup and evaluation of chemoprophylaxis. Journal of Infectious Diseases 1976; 134: 201204.
60.Scholten, RJ, et al. Secondary cases of meningococcal disease in the Netherlands, 1989–1990, a reappraisal of chemoprophylaxis [in Dutch]. Nederlands Tijdschrift voor Geneeskunde 1993; 137: 15051508.
61.Trotter, CL, Ramsay, ME. Vaccination against meningococcal disease in Europe: review and recommendations for the use of conjugate vaccines. FEMS Microbiology Reviews 2007; 31: 101107.
62.Health Protection Agency. Clusters of meningococcal disease in educational institutions in England, Wales and Northern Ireland, April 1995–March 2003 (http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/MeningococcalDisease/ClustersInEducationalInstitutions/menin_ClusterUpdateTables/).
63.De Wals, P, et al. Risk and prevention of meningococcal disease among educations workers: A review. Canadian Journal of Infectious Diseases 2004; 15: 8993.
64.Woodhouse, S, Hunter, PR. Risk of invasive meningococcal disease among school workers in Cheshire, United Kingdom. Clinical Infectious Diseases 2001; 32: 17951797.
65.Fraser, A, et al. Antibiotics for preventing meningococcal infections [Review]. The Cochrane Library 2005, pp. 135.
66.Burke, P, Burne, SR. Allergy associated with ciprofloxacin. British Medical Journal 2000; 320: 679.
67.Giovanetti, F. Anaphylaxis following unnecessary meningococcal chemoprophylaxis of a healthcare worker. Eurosurveillance 2009; 14: 351353.
68.Blakebrough, IS, Gilles, HM. The effect of rifampicin on meningococcal carriage in family contacts in northern Nigeria. Journal of Infection 1980; 2: 137143.
69.Guttler, RB, et al. Rifampin and minocycline on meningococcal carrier rates. Journal of Infectious Diseases 1971; 124: 199205.
70.Munford, RS, et al. Eradication of carriage of Neisseria meningitidis in families: a Study in Brazil. Journal of Infectious Diseases 1974; 129: 644649.
71.Taha, M-K, et al. Rifampin-resistant Neisseria meningitidis. Emerging Infectious Diseases 2006; 12: 859860.
72.Devine, LF, et al. Field trial of the efficacy of a previously proposed regimen using minocycline and rifampin sequentially for the elimination of meningococci from healthy carriers. American Journal of Epidemiology 1973; 97: 394401.
73.Lepe, JA, et al. Evolution of Neisseria meningitidis sensitivity to various antimicrobial drugs over the course of chemoprophylaxis during an epidemic outbreak. Enfermedades Infecciosas y Microbiologia Clinica 2006; 24: 608612.
74.Almog, R, et al. First recorded outbreaks of meningococcal disease in the Israel Defence Force: three clusters due to serogroup C and the emergence of resistance to rifampicin. Infection 1994; 22: 6971.
75.Cooper, ER, et al. Rifampin-resistant meningococcal disease in a contact patient given prophylactic rifampin. Journal of Pediatrics 1986; 108: 9396.
76.Dawson, SJ, Fey, RE, McNulty, CA. Meningococcal disease in siblings caused by rifampicin sensitive and rifampicin resistant strains. Communicable disease and public health/PHLS 1999; 2: 215–6.
77.Rainbow, J, et al. Rifampin-resistant meningococcal disease. Journal of Emerging Infectious Diseases 2005; 11: 977979.
78.Wu, HM, et al. Emergence of ciprofloxacin-resistant Neisseria meningitidis in North America. New England Journal of Medicine 2009; 360: 886892.
79.Gold, R, et al. Carriage of Neisseria meningitidis and Neisseria lactamica in infants and children. Journal of Infectious Diseases 1978; 137: 112–21.
80.Coen, PG, Cartwright, K, Stuart, J. Mathematical modelling of infection and disease due to Neisseria meningitidis and Neisseria lactamica. International Journal of Epidemiology 2000; 29: 180188.
81.Bakir, M, et al. Asymptomatic carriage of Neisseria meningitidis and Neisseria lactamica in relation to Streptococcus pneumoniae and Haemophilus influenzae colonization in healthy children: apropos of 1400 children sampled. European Journal of Epidemiology 2002; 17: 10151018.
82.Taylor-Robinson, D, et al. Students' attitudes to the communications employed during an outbreak of meningococcal disease in a UK school: a qualitative study. Journal of Public Health 2010; 32: 3237.
83.Baker, M, et al. Household crowding a major risk factor for epidemic meningococcal disease in Auckland children. Pediatric Infectious Disease Journal 2000; 19: 983990.
84.Grein, T, Flanagan, D. Day-care and meningococcal disease in young children. Epidemiology and Infection 2001; 127: 435441.
85.McCall, BJ, Neill, AS, Young, MM. Risk factors for invasive meningococcal disease in southern Queensland, 2000–2001. Internal Medicine Journal 2004; 34: 464468.
86.Hoek, M, et al. Effectiveness of vaccinating household contacts in addition to chemoprophylaxis after a case of meningococcal disease: a systematic review. Epidemiology and Infection 2008; 136: 14411447.

Keywords

Type Description Title
WORD
Supplementary Appendix

Hellenbrand Supplementary Appendix
Hellenbrand Supplementary Appendix

 Word (190 KB)
190 KB

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed