Abstract
BACKGROUND: A vaccine for prevention of serogroup B meningococcal disease is not available in the United States, and indications for the use of mass chemoprophylaxis for control of meningococcal outbreaks are not well-defined. In response to an outbreak of six cases of enzyme type 5 serogroup B meningococcal disease among students at a middle school, we implemented a program of mass rifampin prophylaxis and evaluated the effectiveness of this preventive measure. METHODS: Oropharyngeal cultures were obtained from 351 of the 900 students before prophylaxis; 196 participants were recultured 3 weeks later. Meningococcal isolates were subtyped and tested for rifampin susceptibility, and risk factors for disease or carriage among students were evaluated. RESULTS: No cases occurred after prophylaxis. Before prophylaxis 10\% (34 of 351) of students were meningococcal carriers and 3.4\% (12 of 351) carried the epidemic strain. After prophylaxis 2.5\% (5 of 196) were carriers and 1.0\% (2 of 196) carried the epidemic strain. Rifampin was 85\% effective in eradicating carriage, and the rate of acquisition of carriage during the 3-week period was low (0.5\%). Carriage persisted after prophylaxis in 4 students; 3 of these postprophylaxis isolates were rifampin-resistant. Rifampin resistance thus developed in 12\% (3 of 26) of preprophylaxis isolates. Disease/epidemic strain carriage was associated with enrollment in the school band and certain other classes. CONCLUSIONS: These findings suggests that mass chemoprophylaxis may be effective and should be considered for control of school serogroup B meningococcal outbreaks. This approach is less likely to be effective for control of outbreaks affecting larger, less well-defined populations and is associated with the rapid development of antibiotic resistance.
- adolescent,
- antibiotics,
- antitubercular,
- carrier
- child,
- disease
- drug
- factors,
- female,
- humans,
- infections,
- male,
- meningitidis,
- meningococcal
- microbial,
- neisseria
- oropharynx,
- outbreaks,
- resistance,
- rifampin,
- risk
- schools,
- serotyping
- state,
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