Guidelines for the Early Clinical and Public Health Management of ...

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Guidelines for the Early Clinical and Public Health Management of Bacterial Meningitis (including Meningococcal Disease) Table 8.1. Summary of recommended public health actions for community based outbreak Setting Community based outbreak Clustering of cases Four or more confirmed cases of ACW 135 Y in three months and incidence 40/100,000 total community population in three months *ASIR: Age Specific Incidence Rate Information Chemoprophylaxis Vaccination Mass media Limit to close contacts of cases If group C, consider booster for those already vaccinated if they have not received a dose in the last year and one dose for nonvaccinated- groups targeted may depend on ASIR*. For AW 135 Y may need to consider for those in same age group. 8.8. Documentation and review Departments of public health should liaise with both HPSC and the IMMRL in relation to the investigation and control of clusters of meningococcal disease. A final report relating to the management of each outbreak should be made and forwarded to all partners to provide an opportunity to review management and actions undertaken during the course of the outbreak. -72-
Guidelines for the Early Clinical and Public Health Management of Bacterial Meningitis (including Meningococcal Disease) Chapter 9. Chemoprophylaxis for Contacts of Meningococcal Disease Key points • There is evidence on the microbiological clearance of meningococci following the administration of appropriate antibiotics • The decision to provide chemoprophylaxis is based on a risk assessment following the notification of each case • There are three antibiotics (rifampicin, ciprofloxacin, ceftriaxone) currently used in Ireland for chemoprophylaxis of meningococcal disease • For individuals already on medications (for chronic diseases or hormonal contraceptives) the SPCs of these medications should be reviewed to determine the most suitable chemoprophylactic agent for the individual The recent ECDC guidance found the following 2 : • High evidence that rifampicin and ciprofloxacin eradicate carriage (>1 RCT, meta-analyses), and effectiveness values are very consistent across studies. • Moderate evidence suggests that ceftriaxone eradicate carriage (one RCT and open studies). • Moderate evidence suggests that there is no regimen (type of antibiotic, dosage, duration, and route) superior to others in terms of effectiveness or rate of side effects. • Moderate evidence suggests that side effects following prophylaxis are mild and transient. • Moderate evidence that ciprofloxacin is associated with a low rate of osteoarticular side effects in children no higher than as has been seen with other prophylactic drugs. There are three antibiotics currently used in Ireland for chemoprophylaxis of meningococcal disease; each agent has advantages and disadvantages. 9.1 Rifampicin Rifampicin can be used in all age groups. It is the antibiotic of choice for the majority of the population (except for those with contra-indications). For pregnant women and women on systemic hormonal contraceptives it is an alternative option. The latter include the oral contraceptive pill (OCP), contraceptive patches and implants). Rifampicin is contraindicated in the presence of jaundice or known hypersensitivity to rifampicin. It is also contraindicated when given concurrently with the combination of saquinavir/ritonavir (antiretroviral drugs). Rifampicin is a potent inducer of certain cytochrome P-450 enzymes. Coadministration of rifampicin with other drugs that are also metabolised through these cytochrome P-450 enzymes may accelerate the metabolism and reduce the activity of these other drugs. Therefore, caution should be used when prescribing rifampicin with drugs metabolised by cytochrome P-450. These drugs include anticoagulants, anticonvulsants, and hormonal contraceptives should be considered. For increased details, please refer to most recent summary of product characteristics (SPC) available at www.imb.ie or www.medicines.ie. Women taking an oral contraceptive should continue to take the OCP, omitting any pill free interval while taking rifampicin and for the seven days after the last dose of rifampicin. The users of the OCP and of other hormonal contraceptives should use additional barrier contraception while taking rifampicin and for four weeks after the last dose of rifampicin. The recommended schedule for rifampicin for chemoprophylaxis for meningococcal disease is detailed below: -73-
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