Primary prevention

Many developed countries offer routine childhood vaccination for prevention of pneumococcal and meningococcal disease. These immunization schedules also recommend the use of a Haemophilus influenzae type b (Hib) conjugate vaccine.

In the US, the childhood immunization schedule recommends routine vaccination with the pneumococcal conjugate vaccine (PCV15 or PCV20) at ages 2, 4, 6, and 12 to 15 months (4-dose series).​ The pneumococcal polysaccharide vaccine (PPSV23) may be recommended in children 2 years of age and older in special situations. The schedule recommends a 2-dose series of the meningococcal serogroup A, C, W, Y vaccine (MenACWY) at ages 11 to 12 years and 16 years. It is also recommended in children at least 2 years of age in special situations. The meningococcal serogroup B vaccine (MenB) may be considered in adolescents, and children in special situations. A pentavalent meningococcal vaccine is also available in the US for protection against serogroups A, B, C, W, and Y, for use in adults or children ages 10 years or older when MenACWY and MenB vaccines are indicated at the same visit.[51]​ The schedule recommends routine administration of a conjugate Hib vaccine series beginning at age 2 months, with either a 2-dose or 3-dose series depending on the specific vaccine used, and a later booster dose at age 12 through 15 months.

Pneumococcal vaccination is also recommended for adults ages 65 years or older; available pneumococcal vaccines for this age group include PCV15, PCV20, PCV21, and PPSV23 (recommendations vary according to previous pneumococcal vaccination history).[52]

For full details of US immunization schedules, including indications for booster doses and catch-up schedules, the Advisory Committee on Immunization Practices guidelines should be consulted:

Secondary prevention

All cases of suspected meningococcal or Haemophilus influenzae type b (Hib) meningitis should be reported urgently to local public health authorities.[104]

Chemoprophylaxis with ceftriaxone, ciprofloxacin, or rifampin is recommended for all household and day care contacts of patients with suspected or known meningococcal infections.[59]​​[165] The Centers for Disease Control (CDC) also suggests secondary prophylaxis in persons exposed to patients with meningococcal meningitis, or in patients themselves, where additional treatment may be needed to eradicate the infection from the nasopharyngeal carriage. This includes in patients where ceftriaxone or cefotaxime were not used for treatment. Ceftriaxone clears the nasopharyngeal carriage effectively after a single dose. The CDC recommends that either a course of rifampin or a single dose of either ciprofloxacin or ceftriaxone be given to these patients before hospital discharge to eradicate infection within the nasopharyngeal carriage.[105]

Chemoprophylaxis for meningococcal meningitis is generally not routinely indicated for healthcare workers. However, the CDC recommends antimicrobial prophylaxis to healthcare personnel, regardless of vaccination status, whom have had close, face-to-face exposure to Neisseria meningitidis during activities such as mouth-to-mouth resuscitation, endotracheal tube placement or management, or open airway suctioning while not wearing or correctly using recommended personal protective equipment. Brief, non-face-to-face contact, is generally not considered an exposure, including unprotected direct contact with the respiratory secretions or saliva of a person colonized with  N meningitidis, but in patients without signs of clinical disease.[166]

Immunization with meningococcal or Hib vaccine should be considered in the public health management of an outbreak. Primary vaccination against  Streptococcus pneumoniae, N meningitidis , and Hib should be given to all at-risk groups.[59]​​[104]

Use of this content is subject to our disclaimer