The use of antibiotics has dramatically reduced mortality due to meningococcal disease. Before antibiotics were available, the case-fatality ratio for meningococcal disease was between 70% and 85%. Now with the widespread use of antibiotics, the case-fatality ratio for meningococcal disease is 10% to 14%, although mortality may be as high as 40% among patients with meningococcemia. Even with prompt treatment the case-fatality ratio for this condition remains high.
Because of the risks of severe morbidity and death, effective antibiotics should be administered promptly to patients suspected of having meningococcal disease. Multiple antimicrobial agents, including penicillins, are effective against N. meningitidis.
When a diagnosis is made, the doctor or hospital notifies the Vermont Department of Health. The doctor and the Health Department work with the patient and the patient’s family to identify close contacts who may have been exposed to the disease. Close contacts are referred to their own health care provider to receive antibiotics that will kill the bacteria if the individual was unknowingly infected.
People who are not close contacts of the patient do not need to receive antibiotics. Anyone with questions about whether they should receive treatment should talk to their own health care provider.
Persons who have had close contact with patients who have meningococcal disease are at greatly increased risk for contracting the disease. The primary means of preventing the spread of meningococcal disease is antimicrobial chemoprophylaxis. Secondary cases are rare as a result of effective chemoprophylaxis for household members, contacts at child care centers, and anyone else directly exposed to an infected patient’s oral secretions (e.g., kissing, mouth-to-mouth resuscitation).
Risk of secondary disease among close contacts is highest during the first few days after the onset of disease, which requires that chemoprophylaxis be administered as soon as possible. If given more than 14 days after the onset of disease, chemoprophylaxis is probably of limited or no benefit.