ARCHIVED - Addendum

 

Canada Communicable Disease Report

15 November 2006

Volume 32
Number 22

Update: Guidelines for the Prevention and Control of meningococcal Disease

Since the publication of the Guidelines for the Prevention and Control of Meningococcal Disease in May 20051, a change has been made in the close contacts for whom meningococcal vaccination is recommended.

Close contacts of a case of invasive meningococcal disease (IMD), as defined in the Guidelines1, include the following:

  • Household contacts of a case

  • Persons who share sleeping arrangements with the case

  • Persons who have direct contaminations of their nose or mouth with oral/nasal secretions of a case (e.g. kissing on the mouth, shared cigarettes, shared drinking bottles)

  • Health care workers (HCWs) who have had intensive, unprotected contact (without wearing a mask) with infected patients (e.g. intubating, resuscitating or closely examining the oropharynx)

  • Children and staff in child care and nursery school facilities

  • Airline passengers sitting immediately on either side of the case (but not across the aisle) when the total time spent aboard the aircraft was at least 8 hours.

Close contacts of individuals with meningococcal infections are at increased risk of acquiring IMD2-5; this risk is greatest for household contacts. The increased risk of disease for household contacts persists for up to 1 year after disease in the index case and beyond any protection from antibiotic chemoprophylaxis4-7. In general, this prolonged risk is not seen among other contacts who do not have ongoing exposure. Thus, the following individuals are considered close contacts for whom immunoprophylaxis and chemoprophylaxis should be considered when vaccination protects against the serogroup involved (i.e. serogroup C,W135, Y or A):

  • Household contacts of a case

  • Persons who share sleeping arrangements with the case

  • Persons who have direct contaminations of their nose or mouth with oral/nasal secretions of a case (e.g. kissing on the mouth, shared cigarettes, shared drinking bottles)

  • Children and staff in child care and nursery school facilities.

The vaccination status of these close contacts, including the type of meningococcal vaccine, the number of doses and age at vaccine administration, should be determined. Vaccination of susceptible close contacts, in addition to chemoprophylaxis, should be considered when the vaccine protects against the particular serogroup, as it may further reduce the risk of subsequent meningococcal disease; vaccination should be carried out as soon as possible.

The following individuals are close contacts who should receive only chemoprophylaxis (not immunoprophylaxis), as they do not have ongoing exposure:

  • HCWs who have had intensive unprotected contact (without wearing a mask) with infected patients (e.g. intubating, resuscitating or closely examining the oropharynx)

  • Airline passengers sitting immediately on either side of the case (but not across the aisle) when the total time spent aboard the aircraft was at least 8 hours.

For more detailed information related to the prevention and control of meningococcal disease and the use of meningococcal vaccines, readers are referred to the Guidelines for the Prevention and Control of Meningococcal Disease1, the sixth edition of the Canadian Immunization Guide, 20028, and the most recent statements of the National Advisory Committee on Immunization on meningococcal vaccine9-11.

References

  1. Public Health Agency of Canada. Guidelines for the prevention and control of meningococcal disease. CCDR 2005;3S1:1-26.

  2. De Wals P, Hertoghe L, Borlée-Grimée I et al. Meningococcal disease in Belgium. Secondary attack rate among household, day-care nursery and pre-elementary school contacts. J Infect 1981;3(suppl 1):53-61.

  3. Fraser A, Gafter-Gvili A, Paul M et al. Prophylactic use of antibiotics for prevention of meningococcal infections: systematic review and meta-analysis of randomised trials. Eur J Clin Microbiol Infect Dis 2005;24(3):172-81.

  4. Meningococcal Disease Surveillance Group. Meningococcal disease: Secondary attack rate and chemoprophylaxis in the United States, 1974. JAMA 1976;235:261-65.

  5. Cooke RPD, Riordan T, Jones DM et al. Secondary cases of meningococcal infection among close family and household contacts in England and Wales, 1985-1987. Br Med J 1989;298:555-8.

  6. Stroffolini T, Rosmini F, Curiano CM. A one year survey of meningococcal disease in Italy. Eur J Epidemiol 1987;3:399-403.

  7. Olivares R, Hubert B. Clusters of meningococcal disease in France (1987-1988). Eur J Epidemiol 1992;8:737-42.

  8. Health Canada. Meningococcal vaccine. In: Canadian immunization guide, 6th edition. Ottawa: Health Canada, 2002;151-65. Cat. no. H49-8/2002E.

  9. National Advisory Committee on Immunization. Statement on recommended use of meningococcal vaccines. CCDR 2001;27(ACS-6):2-36.

  10. National Advisory Committee on Immunization. Supplementary statement on conjugate meningococcal vaccines. CCDR 2003;29(ACS-6):10-11.

  11. National Advisory Committee on Immunization. Update on meningococcal C conjugate vaccines. CCDR 2005;31(ACS-3):1-4.

Report a problem or mistake on this page
Please select all that apply:

Thank you for your help!

You will not receive a reply. For enquiries, contact us.

Date modified: