Meningococcal disease prevention and control strategies for practice- based physicians

Localized outbreaks of meningococcal disease in the United States and Canada continue to cause serious alarm within communities as a result of the fulminating pattern of the disease, high mortality rate, and high incidence among adolescents. The increasing number of outbreaks since 1991 has raised questions about the management and prevention of further cases during an outbreak. The purpose of this statement is to guide primary-care physicians in their role in infection control and prevention of both sporadic cases and outbreaks of invasive meningococcal disease. This statement provides information on the epidemiology of meningococcal disease, including definitions of sporadic, secondary, and coprimary cases, clusters of cases, and outbreaks. Data are presented on identification of cases, disease risk of contacts, and agents for chemoprophylaxis, and recommendations are given for: (1) risk assessment of contacts, (2) administration of chemoprophylaxis, (3) appropriate use of meningococcal vaccine, (4) appropriate use of the microbiology laboratory, (5) the necessity for timely and appropriate reporting of invasive meningococcal disease to local public health authorities, and (6) information on counseling and public education that may be helpful during an outbreak to minimize public anxiety. An additional section, 'Information for Sharing,' which uses a question-and-answer format and which may be helpful to parents and community and health care workers during an outbreak, is also provided.