Meningococcemia (cont.)

Case-fatality rates for meningococcemia are as high as 19% in industrialized countries but probably average 8%. Patients who present earlier with milder symptoms and normal immune systems are still at risk, but mortality rates are lower. In developing countries, mortality rates reach 70%. Patients with severe infection may require amputation of limbs due to ischemia or low blood pressure. Other complications may include nerve, muscle and heart problems, and arthritis and rarely, major adrenal hemorrhage (termed Waterhouse-Friderichsen syndrome).

Meningococcemia can be prevented in several ways. People who have come into close contact with an infected patient should strongly consider taking antibiotics to reduce the risk of disease. These antibiotics are usually given in pill form, although sometimes a shot is needed if the organism is resistant to common oral antibiotics. Close contact usually means household contacts, day-care or child-care contacts, or those who have been exposed to potentially infected saliva in the week before the patient got sick. Routine patient care does not warrant prophylaxis in health-care workers, unless the worker has had very close contact with respiratory secretions such as when giving mouth-to-mouth resuscitation or inserting a breathing tube. Prophylaxis should be given as soon as possible after the exposure but certainly within two weeks of the event. The antibiotics eliminate carriage of the bacteria and may also be used in the final step of treatment for infected patients.

For caretakers and health-care workers, frequent hand washing is recommended to minimize the transfer of infected secretions to the mouth or nose. In the hospital, patients with meningococcemia are placed in private rooms and staff will wear surgical masks when approaching the patient.

There is an effective and safe vaccine to protect against most serogroups of meningococcus that cause meningococcemia. Unfortunately, no effective vaccine exists for serogroup B. For the other major disease-causing serogroups (A, C, Y, W135), there are two vaccines available in the United States: the meningococcal polysaccharide vaccine (Menomune, MPSV4) and the meningococcal conjugate vaccine (Menactra, Menveo, MCV4). The choice of vaccine depends on the age of the patient.

The vaccine is recommended starting at 11 years of age. A booster dose is given at 16 years of age. Older teens who have never been vaccinated need only a single dose. The vaccine may be required for admission to college, and students should have received the vaccine less than five years before starting college. Others for whom vaccination is recommended include military recruits, college students living in dormatories, individuals with missing or damaged spleens, people with certain immune deficiencies in the complement system, those traveling to areas where the disease is common, and scientists who perform research on the bacteria.

Source: MedicineNet.com
http://www.medicinenet.com/meningococcemia/article.htm