Meningococcal Disease: Management of Contacts
Lowell A. Glasgow MD1
1 Professor and Chairman of the Department of Pediatrics, University of Utah College of Medicine, Salt Lake City
Meningococcal disease is relatively uncommon in the United States at the present time. The epidemics which occurred at about eight to 12-year intervals during the first half of this century have not been observed since 1945, although such epidemics continue to be reported from other parts of the world. In the United States in recent years 1,400 to 1,600 cases are reported to the Communicable Disease Center annually, but it is estimated that as many as 3,000 to 6,000 cases occur each year. Approximately 50% of these cases are in children less than 4 years of age and more than two thirds of all patients are under 20 years of age.1 Unfortunately, the mortality rate remains high and the anxiety generated in contacts is striking. For these reasons, as well as the evidence that the incidence of disease is significantly increased in close contacts, an effective means of prophylaxis is needed. The efficacy of the sulfonamides in eradicating the carrier state and in preventing disease in contacts was clearly demonstrated in the 1940s. This approach to the control of meningococcal infections was effective for approximately 20 years until the appearance of sulfonamide-resistant strains. At present a new approach to prevention of meningococcal disease is evolving with the use of rifampin and the development of meningococcal vaccines.
