West Virginia
Infectious Disease Epidemiology Program

West Virginia Department of Health and Human Resources Information for Health Care Providers – Managing Contacts to Patients with Invasive Meningococcal Disease

How is meningococcus spread?

Meningococcus is spread through direct exposure to secretions ("sharing saliva" or "sharing nasal secretions") or very close personal contact such as that occurring in households, daycare centers, jails, or barracks. It is not spread through casual contact such as that occurring in workplaces or classrooms.

How is a case of invasive meningococcal disease defined?

A case of invasive meningococcal disease is defined as a positive culture for meningococcus from a usually sterile site, such as blood or CSF. Meningococcal meningitis can be presumptively diagnosed on the basis of a gram stain showing gram-negative diplococci from CSF. Persons with clinically compatible illness and a positive latex agglutination test from CSF or persons with clinical purpura fulminans are considered "probable cases," in the absence of culture confirmation.

Who is most at-risk for developing invasive meningococcal disease?

Infants and toddlers are by far the most at-risk for invasive disease. Asymptomatic colonization of the respiratory tract with meningococcus is extremely common; most individuals with colonization develop antibodies to the organism and do not become ill. Only a small minority of newly colonized individuals – for example, those with intercurrent viral illness – may develop invasive infections.

There is also a small increased risk of meningococcal disease in college freshmen living on campus. For that reason, it is recommended that providers discuss the meningococcal vaccine with entering freshmen.

How should I handle an individual who thinks they have been exposed to meningococcal meningitis?

Only persons with close contact to a confirmed case of invasive meningococal disease are at risk, such as:

• Household contact, especially young children
• Child care or nursery school contact during the previous seven days
• Direct exposure to index patient's secretions through kissing or sharing toothbrushes or eating utensils, markers of close social contact
• Mouth-to-mouth resuscitation, unprotected contact during endotracheal intubation during the seven days before onset of illness
• Frequently sleeps or eats in the same dwelling as index patient

Chemoprophylaxis is not recommended for:

• Casual contact with no history of direct exposure to the index patient's oral secretions, e.g. school or work mate
• Indirect contact: only contact is with a high-risk contact, no direct contact with the index patient
• Health care personnel without direct exposure to patient's oral secretions

What medications are recommended for prophylaxis of contacts to a case of meningococcal meningitis?

– from the American Academy of Pediatrics "Redbook," 2000 Edition

How are outbreaks/clusters of meningococcal infection handled?

In the state of West Virginia, local health departments practice readiness for meningococcal outbreaks on an ongoing basis by:

• Assuring that all meningococcal isolates are referred to the Office of Laboratory Services for serogrouping (to determine if circulating strains are covered by the meningococcal vaccine);
• Assuring that all high-risk contacts are appropriately offered prophylaxis; and
• Assuring that providers are educated to report suspect and confirmed cases of invasive meningococcal disease promptly.

Guidelines for outbreak management have been developed by the Centers for Disease Control and Prevention (MMWR, 1997; Vol 46, No. RR-5); however, each situation is different. Consult your local health department if a cluster or outbreak is suspected.

How can I educate my patients about meningococcal infections?

Information on meningococcal disease is available from your local health department or on the West Virginia Department of Health and Human Resources website at www.wvdhhr.org/bph/oehp/sdc/faq.htm.

State of West Virginia (WV)
West Virginia Department of Health and Human Resources (DHHR)
Bureau for Public Health (BPH)
Office of Epidemiology and Health Promotion (OEHP)
Division of Surveillance and Disease Control (DSDC)
Infectious Disease Epidemiology Program (IDEP)

A-Z Listing of West Virginia's Reportable Diseases

This FAQ was last updated April 2002.
If you have questions or comments about the West Virginia Division of Surveillance and Disease Control, please direct them to Loretta Haddy at Loretta.E.Haddy@wv.gov.
If you have questions or comments about this Web page, please direct them to Betty Jo Tyler at Betty.J.Tyler@wv.gov.