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Epidemiology
State of Alaska Epidemiology Bulletin

Bulletin No. 6
May 20, 1977
Meningococcal Meningitis

Forty-two cases of meningococcal meningitis have occurred in Alaska since January, 1976. (See Figure) Twenty-three of the cases have been confirmed as Group A. Prior to March, 1976, no cases of Group A meningococcal disease had been reported in Alaska in the preceding 20 years. Of the 23 patients with Group A disease, 15 had a history of excessive alcohol intake. We urge all health care workers to maintain a very high index of suspicion of disease so that rapid diagnosis will be possible.

      Meningococcal Meningitis - Alaska
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    J F M A M J J A S O N D J F M A M J J A
  1 9 7 6 1 9 7 7

Meningococcal meningitis germs are spread from person to person by direct contact of droplets and discharges from the nose and throat of infected persons. The incubation period is from two to ten days. Up to 33% of secondary cases occur within four days after the hospitalization of the index case.

Chemoprophylaxis is recommended for all household members of the case of meningococcal disease. If other persons who have been in close intimate contact with a case over a substantial length of time can be identified, they should also be treated. School room classmates and hospital contacts of cases are usually not considered close contact and should not receive treatment. Prophylaxis should not be delayed while culture or sensitivity results are pending. Routine throat cultures of contacts of cases are not recommended. The drug of choice for chemoprophylaxis is Rifampin and the recommended dosage is:

Adults - 600 mg. every 12 hours for 4 doses Children - 1 year to 12 years - 10 mg./kilogram/dose every 12 hours for 4 doses Children - less than 1 year - 5 mg./kilogram/dose every 12 hours for 4 doses

If a case is diagnosed, immediately contact the Medical Epidemiologist at 272-7534, Section of Communicable Disease Control, Anchorage.

Meningococcal Meningitis at an Anchorage Daycare Center

On April 24, a four-year-old girl attending an Anchorage daycare center developed meningococcal meningitis. Family contacts were treated with Rifampin according to present recommendations.

Two weeks later, a second case occurred in the same daycare center in a four-year-old boy who had been in contact with the first patient. Little information is available about the risk to daycare center contacts of acquiring a secondary case of meningococcal meningitis. Consultation with the Center for Disease Control in Atlanta, Georgia, resulted in a recommendation to provide antibiotic prophylaxis to all children and staff of the daycare center. By the time the second patient was identified, the first patient's organism had been identified as Group B. Because of 96% of all isolates of Group B in the United States are presently sensitive to sulfa and because two cases occurred in the daycare center, CDC authorities recommended that a sulfa drug be used in this situation only. Consequently, 100 children were treated with Trisulfapyrimidine (Terfonyl) 500 mg. twice a day for three days. The 15 staff members, however, were treated with the recommended dose of Rifampin. Sulfa was used in this situation because of the number of children involved and the great likelihood that the Group B organism would be sensitive. The fact that sulfa was used in this daycare setting in no way changes our recommendation that Rifampin is the drug of choice for treatment of contacts of cases of meningococcal meningitis.

If future cases of meningococcal meningitis occur in daycare centers, all contacts should not be routinely treated with antibiotic prophylaxis. Please obtain immediate consultation from Medical Epidemiologist, at the Section of Communicable Disease Control, 272-7534. (Reported by: William Larson, MD; Royal Kiehl, MD; and Jon Lyon, MD)


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