Epidemiology and Infection

Meningococcal infection

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. HELLENBRANDa1 c1, G. HANQUETa2, S. HEUBERGERa3, S. NIELSENa1, P. STEFANOFFa4 and J. M. STUARTa5

a1 Immunization Unit, Robert Koch Institute, Berlin, Germany

a2 Consultant epidemiologist (independent), Brussels, Belgium

a3 Meningococcal Reference Laboratory, Austrian Agency for Food and Health Safety Graz, Austria

a4 National Institute of Public Health, National Institute of Hygiene, Warsaw, Poland

a5 Consultant epidemiologist (independent), Ausseing, France

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.

(Accepted July 05 2011)

(Online publication August 11 2011)

Correspondence:

c1 Author for correspondence: Dr W. Hellenbrand, Robert Koch Institute, DGZ-Ring 1, 13086 Berlin, Germany. (Email: hellenbrandw@rki.de)

Metrics