ProphylaxisDuty to report
A patient with meningococcal infection should be isolated after initiation of antibiotic therapy, as meningocococci are easily transmitted by droplet infection and direct contact. After 24 hours no more infection should occur. During this time, hospital staff and visitors must observe certain hygiene measures, such as wearing protective gowns, nose and mouth protection, gloves and hand disinfection.
Close contact persons of the sick person are recommended to take antibiotic prophylaxis. This can be prescribed by the family doctor.Usually, either rifampicin (2x/day 600 mg over 2 days) or one tablet of ciprofloxacin (500 mg) is given as early as possible. Alternatively, a single dose of ceftriaxone can be injected into the muscle (adults 250 mg, children half).
Since the incubation period of meningococci is 2 – 10 days, antibiotic prophylaxis is no longer useful after 10 days. With other meningitis pathogens, such measures are not necessary. Furthermore, in case of justified suspicion, in case of illness or death in case of meningococcal infection (meningococcal meningitis and/or blood poisoning by meningococci), a report must be made to the responsible health authority within 24 hours in accordance with the Infection Protection Act in Germany.
If a suspicion is not confirmed, this must also be reported immediately. Vaccines (active immunization) are available against meningococcus, pneumococcus and hemophilus influenzae. However, not everyone needs to be vaccinated against meningococcus and pneumococcus.
See: Vaccination against meningococcal meningitis. Vaccination against haemophilus influenzae type B (HIB) was recommended for all children by the Standing Commission on Vaccination (STIKO) in 1990, because this bacterium (which has nothing in common with the influenza virus that causes influenza) causes dangerous purulent meningitis in young children, which, if not detected and treated in time, leads to severe consequential damage (untreated, the mortality rate is 60-90%!). In addition, some strains are now resistant to common antibiotics.
Vaccination is carried out with a dead vaccine (i.e. with capsule components of the bacterium which are coupled to a protein and thus generate an immune reaction of the body. Thus, no infection can occur during the vaccination!) from the age of two months, usually as a combination vaccination with other vaccinations commonly used at this age (tetanus, diphtheria, whooping cough, polio and hepatitis B).
Three vaccinations are given at four-week intervals, the fourth in the 2nd year of life (with a single vaccine only three vaccinations are given, the third in the 2nd year of life). Children who have not been vaccinated against HIB and are older than 18 months receive only one vaccination. In addition to meningitis, it also protects against sometimes life-threatening inflammation of the respiratory tract and epiglottitis caused by the same pathogen.
HIB infections are rare after the age of 5 years, therefore older children and healthy adults are not vaccinated. Exceptions are made for persons who have been missing the spleen from birth or through operations, which is important for the immune defence, as well as for other disorders of the infection defence (vaccinations for adults). There is a quadruple vaccine against meningococcus (Neisseria meningitidis), which includes the serotypes A,C, W-135 and Y, and a double vaccine against the serotypes A and C. Serotype (or serogroup) means that different strains of a bacterium have different surface properties (antigens) against which our body also forms different antibodies.
In Germany, meningococcal serotype B, against which no vaccine could be developed so far, is predominant with almost 70 %. The frequency of serotype C has increased in recent years to about 30 %, against which a vaccination can be developed. Meningococcal vaccination is recommended for the following risk groups:
- Persons planning to stay for a longer period of time in areas where meningococcal infections are common (so-called endemic areas), e.g. development workers in the “meningitis belt” of Africa (serotype A), employees of aid organizations, backpackers to India,
- Adolescents or young adults planning a longer stay in countries where vaccination against serotype C is recommended for this age group (e.g. semester abroad in England, Ireland, Spain, Greece),
- People with diseases of the immune system, malfunctioning or missing spleen,
- Pilgrims to Mecca. Saudi Arabia requires a maximum of three years and at least ten days prior vaccination with the quadruple vaccine,
- Endangered laboratory personnel.
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