What is the evidence for giving chemoprophylaxis to children or students attending the same preschool, school or college as a case of meningococcal disease?

Abstract

SUMMARYWe performed a systematic literature review to assess the effectiveness of chemoprophylaxis for contacts of sporadic cases of invasive meningococcal disease (IMD) in educational settings. No studies directly compared IMD risk in contacts with/without chemoprophylaxis. However, compared to the background incidence, an elevated IMD risk was identified in settings without a general recommendation for chemoprophylaxis in pre-schools [pooled risk difference (RD) 58 . 2/10 5 , 95 % confidence interval (CI) 27 . 3-89 . 0] and primary schools (pooled RD 4 . 9/10 5 , 95% CI 2 . 9-6 . 9) in the y30 days after contact with a sporadic IMD case, but not in other educational settings. Thus, limited but consistent evidence suggests the risk of IMD in pre-school contacts of sporadic IMD cases is significantly increased above the background risk, but lower than in household contacts (pooled RD for household contacts with no chemoprophylaxis vs. background incidence : 480 . 1/10 5 , 95 % CI 321 . 5-639 . 9). We recommend chemoprophylaxis for pre-school contacts depending on an assessment of duration and closeness of contact.

Public health action and mass chemoprophylaxis in response to a small meningococcal infection outbreak at a nursery in the West Midlands, England

“…4 Indirect evidence from observational studies suggests significant benefit in giving chemoprophylaxis to all close nursery contacts of even single cases, and a number of European countries have adopted this practice. 6 Considerable resources (clinical staff, public health staff and antibiotics) were allocated to this outbreak, and giving mass chemoprophylaxis in response to single cases would have further logistical and cost implications. A future evaluation of the benefits and costs of the public health interventions in similar small nursery outbreaks would be useful in informing practice.…”

Strong Public Health Recommendations from Weak Evidence? Lessons Learned in Developing Guidance on the Public Health Management of Meningococcal Disease

“…We also did not find direct evidence on the research question regarding whether chemoprophylaxis of contacts in school settings would prevent further cases (Question C). However, we obtained indirect evidence by comparing the risk of subsequent cases in school contacts (not receiving chemoprophylaxis) with the background incidence rates of IMD in the relevant population [ 26 ].…”

“…In case of heterogeneity between studies, we performed stratified analysis when possible. In particular, analyses on the effectiveness of chemoprophylaxis to contacts of an IMD case in preschool and school settings (Question C) were stratified by each educational setting [ 26 ].…”

Public health management of invasive meningococcal disease in Baden-Wuerttemberg, Germany, 2012: adherence to guidance and estimation of resources required as determined in a survey of local health authorities

“…Household contacts of persons with IMD have a higher risk of acquiring the disease [ 8 , 9 ]. This also holds for close contacts in preschool settings, albeit to a lesser extent [ 10 ]. For household settings, the European Centre for Disease Prevention and Control (ECDC) estimated the number of contacts needed to be treated (NNT) with PEP to prevent one case at 284 (95% confidence interval (CI): 156–1515) [ 7 ].…”