Chapter 7: Infectious Diseases
7.3 Respiratory Tract Infections
7.3.5 Neisseria Meningitidis (Meningococcus)
220.127.116.11: Recommended Control Measures for Invasive Meningococcal Infection in Child Care
Identification of an individual with invasive meningococcal infection in the child care setting should result in the following:
- Immediate notification of the local or state health department;
- Notification of parents/guardians about child care contacts to the person with invasive meningococcal infection;
- Assistance with provision of antibiotic prophylaxis and vaccine receipt, as advised by the local or state health department, to child care contacts;
- Frequent updates and communication with parents/guardians, health care professionals, and local health authorities.
RATIONALEDue to the increased transmissibility of meningococcal infections following close personal contact with oral and respiratory tract secretions of a person with infection, institution of antibiotic prophylaxis within twenty-four hours of diagnosis of the index case is advised. Younger age and close contact with an infected person increases the attack rate of meningococcal disease among child care attendees to several hundred fold greater than the general population. As outbreaks may occur in child care settings, chemoprophylaxis with oral rifampin is the prophylaxis of choice for exposed child contacts. In some cases, intramuscular ceftriaxone may be used as an alternative if a contraindication to oral rifampin exists in the contact (1,2). In contacts over eighteen years of age, oral rifampin, ciprofloxacin, or intramuscular ceftriaxone, are effective (2,3). Rifampin is not recommended for pregnant women.
In addition to chemoprophylaxis with an oral antimicrobial agent, immunoprophylaxis with a meningococcal vaccination of age-eligible contacts in an outbreak setting, if the infection is due to a serogroup contained in the vaccine, may be recommended by the local or state health department (1,2).
COMMENTSFor facilities that care for older school-age children, meningococcal vaccine is recommended at eleven or twelve years of age with a second dose administered at sixteen years of age.
For additional information regarding meningococcal disease, consult the current edition of the Red Book from the American Academy of Pediatrics (AAP).
TYPE OF FACILITYCenter, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS18.104.22.168 Inclusion/Exclusion/Dismissal of Ill Children
American Academy of Pediatrics. Meningococcus In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018 Report of the Committee on Infectious Diseases. 31st Edition. Itasca, IL: American Academy of Pediatrics; 2018: 107-108
Centers for Disease Control and Prevention. 2007. Revised recommendations of the Advisory Committee on Immunization Practices to vaccinate all persons aged 11-18 years with meningococcal conjugate vaccine. MMWR 56:749-95. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5631a3.htm.
American Academy of Pediatrics, Committee on Infectious Diseases. 2009. Prevention and control of meningococcal disease: Recommendations for use of meningococcal vaccines in pediatric patients. Pediatrics 123:1421-22.