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MENINGOCOCCAL INFECTION PROPHYLAXIS

NB. The decision to initiate contact tracing in respect of meningococcal infection will be made by the Specialist Public Health Service of Tayside NHS Board in conjunction with relevant clinicians. Responsibility for contract tracing, and organising the administration of chemoprophylaxis also lies with the Board’s Specialist Public Health Service. Chemoprophylaxis will usually be prescribed either by hospital ward or primary care medical staff. It should be given as soon as possible (ideally within 24 hours) after diagnosis of index case.

Ensure that the index case receives a course of oral rifampicin prior to discharge unless treated with ceftriaxone.

Establish a list of close contacts:

Household contacts including those sharing an overnight stay with index case in 7 days prior to illness onset.
Intimate lip kissing in 7 days prior to illness onset (social lip kissing is now not regarded as significant contact).
Health care workers giving mouth to mouth resuscitation to index case unless treatment has already eradicated carriage in index case.

Give chemoprophylaxis as outlined below including pregnant contacts. Caution in anyone with severe hepatic impairment, jaundice or on other medicines such as anticoagulants, antiepileptics, contraceptives (see below). The CPHM can advise.

Adults and those over 12 years	Rifampicin	600mg orally, twice daily for 2 days
1-12 years	Rifampicin	10mg/kg* orally, twice daily for 2 days
<1 year	Rifampicin	5mg/kg* orally, twice daily for 2 days *Round up to nearest convenient dose unit (capsules and mixture available)

NB. Patients taking rifampicin must be advised that body secretions (urine, saliva, sweat) may be discoloured yellow/orange. Soft contact lenses should not be worn for up to 24 hours following the 2 day course since they may be irreversibly stained.

NB. In pregnancy or when breastfeeding, mothers should be offered chemoprophylaxis with rifampicin (as above) or ceftriaxone (250mg single dose IM).

NB. Ciprofloxacin is also known to clear the organism from the throat. The adult dose is a one-off dose of 500mg orally. Avoid in pregnancy.

NB. Neither ciprofloxacin or ceftriaxone are licensed for chemoprophylaxis.

Ref: Health Prottection Agency Meningococcus Forum. Guidance for Public Health Management of Meningococcal Disease in the UK 2006.

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