neurologic disorders
Acute Bacterial Meningitis
Prevention of Acute Bacterial Meningitis
Use of vaccines forH. influenzaetype B and, to a lesser extent, forN. meningitidisandS. pneumoniaehas reduced the incidence of bacterial meningitis. Keeping patients in respiratory isolation (using droplet precautions) for the first 24 hours of therapy can help prevent meningitis from spreading. Gloves, masks, and gowns are used. Vaccination can prevent certain types of bacterial meningitis. Pneumococcal Vaccine None Haemophilus influenzae Type b (Hib) Vaccine is highly effective and begins at age 2 months. Meningococcal Vaccine None Children who are 2 to 10 years if they have an immunodeficiency or functional asplenia All children at age 11 to 12 years with a booster dose at age 16 Older children, college students living in dormitories, and military recruits who have not had the vaccine previously Travelers to or residents of endemic areas Laboratory personnel who routinely handle meningococcal specimens During a meningitis epidemic, the population at risk (eg, college students, a small town) must be identified, and its size must be determined before proceeding to mass vaccination. The effort is expensive and requires public education and support, but it saves lives and reduces morbidity. The meningococcal vaccine does not protect against serotype B meningococcal meningitis; this information should kept in mind when a vaccinated patient presents with symptoms of meningitis. Anyone who has prolonged face-to-face contact with a patient who has meningitis (eg, household or day care contacts, medical personnel and other people who are exposed to the patient's oral secretions) should be given postexposure chemoprophylaxis. Formeningococcal meningitis,chemoprophylaxis consists of one of the following: Rifampin600 mg (for children>1 month, 10 mg/kg; for children<1 month, 5 mg/kg) orally every 12 hours for 4 doses Ceftriaxone250 mg (for children<15 years, 125 mg) IM for 1 dose For adults, a fluoroquinolone (ciprofloxacinorlevofloxacin500 mg orofloxacin400 mg) orally for 1 dose Formeningitis due to H. influenzae type b,chemoprophylaxis isrifampin20 mg/kg orally once a day (maximum: 600 mg/day) for 4 days. There is no consensus on whether children<2 years require prophylaxis for exposure at day care. Chemoprophylaxis is not usually needed for contacts of patients with other types of bacterial meningitis. 