BACKGROUND: A vaccine for prevention of serogroup B meningococcal disease is not available in the United States, and indications for the use of mass chemoprophylaxis for control of meningococcal outbreaks are not well-defined. In response to an outbreak of six cases of enzyme type 5 serogroup B meningococcal disease among students at a middle school, we implemented a program of mass rifampin prophylaxis and evaluated the effectiveness of this preventive measure. METHODS: Oropharyngeal cultures were obtained from 351 of the 900 students before prophylaxis; 196 participants were recultured 3 weeks later. Meningococcal isolates were subtyped and tested for rifampin susceptibility, and risk factors for disease or carriage among students were evaluated. RESULTS: No cases occurred after prophylaxis. Before prophylaxis 10\% (34 of 351) of students were meningococcal carriers and 3.4\% (12 of 351) carried the epidemic strain. After prophylaxis 2.5\% (5 of 196) were carriers and 1.0\% (2 of 196) carried the epidemic strain. Rifampin was 85\% effective in eradicating carriage, and the rate of acquisition of carriage during the 3-week period was low (0.5\%). Carriage persisted after prophylaxis in 4 students; 3 of these postprophylaxis isolates were rifampin-resistant. Rifampin resistance thus developed in 12\% (3 of 26) of preprophylaxis isolates. Disease/epidemic strain carriage was associated with enrollment in the school band and certain other classes. CONCLUSIONS: These findings suggests that mass chemoprophylaxis may be effective and should be considered for control of school serogroup B meningococcal outbreaks. This approach is less likely to be effective for control of outbreaks affecting larger, less well-defined populations and is associated with the rapid development of antibiotic resistance.
%0 Journal Article
%1 jackson_evaluation_1996
%A Jackson, L A
%A Alexander, E R
%A DeBolt, C A
%A Swenson, P D
%A Boase, J
%A McDowell, M G
%A Reeves, M W
%A Wenger, J D
%D 1996
%J The Pediatric Infectious Disease Journal
%K Adolescent, Antibiotics, Antitubercular, Carrier Child, Disease Drug Factors, Female, Humans, Infections, Male, Meningococcal Microbial, Neisseria Oropharynx, Outbreaks, Resistance, Rifampin, Risk Schools, Serotyping State, meningitidis,
%N 11
%P 992--8
%R 8933547
%T Evaluation of the use of mass chemoprophylaxis during a school outbreak of enzyme type 5 serogroup B meningococcal disease
%V 15
%X BACKGROUND: A vaccine for prevention of serogroup B meningococcal disease is not available in the United States, and indications for the use of mass chemoprophylaxis for control of meningococcal outbreaks are not well-defined. In response to an outbreak of six cases of enzyme type 5 serogroup B meningococcal disease among students at a middle school, we implemented a program of mass rifampin prophylaxis and evaluated the effectiveness of this preventive measure. METHODS: Oropharyngeal cultures were obtained from 351 of the 900 students before prophylaxis; 196 participants were recultured 3 weeks later. Meningococcal isolates were subtyped and tested for rifampin susceptibility, and risk factors for disease or carriage among students were evaluated. RESULTS: No cases occurred after prophylaxis. Before prophylaxis 10\% (34 of 351) of students were meningococcal carriers and 3.4\% (12 of 351) carried the epidemic strain. After prophylaxis 2.5\% (5 of 196) were carriers and 1.0\% (2 of 196) carried the epidemic strain. Rifampin was 85\% effective in eradicating carriage, and the rate of acquisition of carriage during the 3-week period was low (0.5\%). Carriage persisted after prophylaxis in 4 students; 3 of these postprophylaxis isolates were rifampin-resistant. Rifampin resistance thus developed in 12\% (3 of 26) of preprophylaxis isolates. Disease/epidemic strain carriage was associated with enrollment in the school band and certain other classes. CONCLUSIONS: These findings suggests that mass chemoprophylaxis may be effective and should be considered for control of school serogroup B meningococcal outbreaks. This approach is less likely to be effective for control of outbreaks affecting larger, less well-defined populations and is associated with the rapid development of antibiotic resistance.
@article{jackson_evaluation_1996,
abstract = {{BACKGROUND:} A vaccine for prevention of serogroup B meningococcal disease is not available in the United States, and indications for the use of mass chemoprophylaxis for control of meningococcal outbreaks are not well-defined. In response to an outbreak of six cases of enzyme type 5 serogroup B meningococcal disease among students at a middle school, we implemented a program of mass rifampin prophylaxis and evaluated the effectiveness of this preventive measure. {METHODS:} Oropharyngeal cultures were obtained from 351 of the 900 students before prophylaxis; 196 participants were recultured 3 weeks later. Meningococcal isolates were subtyped and tested for rifampin susceptibility, and risk factors for disease or carriage among students were evaluated. {RESULTS:} No cases occurred after prophylaxis. Before prophylaxis 10\% (34 of 351) of students were meningococcal carriers and 3.4\% (12 of 351) carried the epidemic strain. After prophylaxis 2.5\% (5 of 196) were carriers and 1.0\% (2 of 196) carried the epidemic strain. Rifampin was 85\% effective in eradicating carriage, and the rate of acquisition of carriage during the 3-week period was low (0.5\%). Carriage persisted after prophylaxis in 4 students; 3 of these postprophylaxis isolates were rifampin-resistant. Rifampin resistance thus developed in 12\% (3 of 26) of preprophylaxis isolates. Disease/epidemic strain carriage was associated with enrollment in the school band and certain other classes. {CONCLUSIONS:} These findings suggests that mass chemoprophylaxis may be effective and should be considered for control of school serogroup B meningococcal outbreaks. This approach is less likely to be effective for control of outbreaks affecting larger, less well-defined populations and is associated with the rapid development of antibiotic resistance.},
added-at = {2011-03-11T10:05:34.000+0100},
author = {Jackson, L A and Alexander, E R and {DeBolt}, C A and Swenson, P D and Boase, J and {McDowell}, M G and Reeves, M W and Wenger, J D},
biburl = {https://www.bibsonomy.org/bibtex/2ff3893dbf6990eb951cacf805f52fda2/jelias},
doi = {8933547},
interhash = {9ca19b885d016ff43e5b6744c08ad0f6},
intrahash = {ff3893dbf6990eb951cacf805f52fda2},
issn = {0891-3668},
journal = {The Pediatric Infectious Disease Journal},
keywords = {Adolescent, Antibiotics, Antitubercular, Carrier Child, Disease Drug Factors, Female, Humans, Infections, Male, Meningococcal Microbial, Neisseria Oropharynx, Outbreaks, Resistance, Rifampin, Risk Schools, Serotyping State, meningitidis,},
month = nov,
note = {{PMID:} 8933547},
number = 11,
pages = {992--8},
timestamp = {2011-03-11T10:06:51.000+0100},
title = {Evaluation of the use of mass chemoprophylaxis during a school outbreak of enzyme type 5 serogroup B meningococcal disease},
volume = 15,
year = 1996
}