-Definition of meningococcal disease reviewed with the patient.
-The value of vaccination reviewed.
-Prevention of secondary disease discussed.
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“A 14-year-old male presents to your office with a high fever that began suddenly. He has a diffuse petechial rash and some nuchal rigidity on examination. A lumbar puncture is performed, and gram-negative diplococci are found. You admit him to the hospital for treatment.
What should you do for prevention of secondary disease at this time? Answer: Chemoprophylaxis for family members and very close contacts only.
Meningococcal disease remains a leading cause of sepsis and meningitis. Those in close contact with patients who have presumptive meningococcal disease are at heightened risk. While secondary cases have been reported, they are rare because of prompt chemoprophylaxis of household members and anyone directly exposed to the index patient’s oral secretions. The risk for secondary disease among close contacts is highest during the first few days after the onset of illness in the index patient, mandating immediate chemoprophylaxis of those exposed. There is no need to isolate family members. The delay in immunity post-vaccination makes it necessary to use other preventive measures instead.” ABFM
References
https://www.cdc.gov/meningococcal/index.html
https://www.dermnetnz.org/topics/meningococcal-disease/
https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/mening.html
https://www.cdc.gov/vaccines/vpd/mening/public/index.html#types
Prophylaxis of close contacts
http://www.cdc.gov/meningococcal/about/causes-transmission.html
https://www.cdc.gov/mmwr/preview/mmwrhtml/00046263.htm