Meningococcal meningitis immunization and prophylaxis

Evaluation of the use of mass chemoprophylaxis during a school outbreak of enzyme type 5 serogroup B meningococcal disease.

Author

Jackson LA; Alexander ER; DeBolt CA; Swenson PD; Boase J; McDowell MG; Reeves MW; Wenger JD

Address

Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle 98195-7236, USA. lajack@u.washington.edu

Source

Pediatr Infect Dis J, 15(11):992-8 1996 Nov

Abstract

BACKGROUND: A vaccine for prevention of serogroup B meningococcal disease is not available in the United States, and indications for the use of mass chemoprophylaxis for control of meningococcal outbreaks are not well-defined. In response to an outbreak of six cases of enzyme type 5 serogroup B meningococcal disease among students at a middle school, we implemented a program of mass rifampin prophylaxis and evaluated the effectiveness of this preventive measure. METHODS: Oropharyngeal cultures were obtained from 351 of the 900 students before prophylaxis; 196 participants were recultured 3 weeks later. Meningococcal isolates were subtyped and tested for rifampin susceptibility, and risk factors for disease or carriage among students were evaluated. RESULTS: No cases occurred after prophylaxis. Before prophylaxis 10% (34 of 351) of students were meningococcal carriers and 3.4% (12 of 351) carried the epidemic strain. After prophylaxis 2.5% (5 of 196) were carriers and 1.0% (2 of 196) carried the epidemic strain. Rifampin was 85% effective in eradicating carriage, and the rate of acquisition of carriage during the 3-week period was low (0.5%). Carriage persisted after prophylaxis in 4 students; 3 of these postprophylaxis isolates were rifampin-resistant. Rifampin resistance thus developed in 12% (3 of 26) of preprophylaxis isolates. Disease/epidemic strain carriage was associated with enrollment in the school band and certain other classes. CONCLUSIONS: These findings suggests that mass chemoprophylaxis may be effective and should be considered for control of school serogroup B meningococcal outbreaks. This approach is less likely to be effective for control of outbreaks affecting larger, less well-defined populations and is associated with the rapid development of antibiotic resistance.

Language

Eng

Unique Identifier

97087555

MESH Headings

Adolescence*; Antibiotics, Antitubercular*; Carrier State*; Child*; Disease Outbreaks*; Drug Resistance, Microbial*; Female; Human; Male; Meningococcal Infections*; Neisseria meningitidis*; Oropharynx*; Rifampin*; Risk Factors*; Schools*; Serotyping*

Publication Type

JOURNAL ARTICLE

ISSN

0891-3668

Country of Publication

UNITED STATES

Impact of a mass immunization campaign against serogroup C meningococcus in the Province of Quebec, Canada.

Author

De Wals P; Dionne M; Douville-Fradet M; Boulianne N; Drapeau J; De Serres G

Address

Community Health Sciences Department, Centre hospitalier universitaire de Sherbrooke (C.H.U.S), Quebec, Canada.

Source

Bull World Health Organ, 74(4):407-11 1996

Abstract

A mass immunization campaign was conducted in the Province of Quebec, Canada, during the winter of 1993, following an increase in the incidence of meningococcal disease, which was mainly caused by a virulent clone of Neisseria meningitidis, serogroup C, serotype 2a. About 1.6 million doses of the polysaccharide vaccine were administered, covering 84% of the target population aged between 6 months and 20 years; the overall cost was about 25.5 million Canadian dollars. Cases notified to the regional health authorities by clinicians, hospital laboratories, and the provincial reference laboratory from January 1990 up to March 1994 have been included in the analysis. In the first year following the campaign, the incidence of the disease dropped markedly among vaccinees as well as the unvaccinated fraction of the target population, while it remained unchanged among persons aged more than 20 years. This suggests the existence of herd immunity. The overall field efficacy of the vaccine was 79%, more in teenagers and less in under-5-year-olds. A minimum of 37 cases were prevented during the first year.

Language

Eng

Unique Identifier

96421280

MESH Headings

Adolescence; Adult; Antigens, Bacterial (IM); Bacterial Vaccines (*); Child; Child, Preschool; Costs and Cost Analysis; Human; Immunization (EC/*MT); Infant; Meningitis, Meningococcal (EP/*PC); Neisseria meningitidis (IM); Polysaccharides, Bacterial (*IM); Quebec (EP); Support, Non-U.S. Gov't

Publication Type

JOURNAL ARTICLE

ISSN

0042-9686

Country of Publication

SWITZERLAND

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