pediatrics
Bacterial Meningitis in Infants Over 3 Months of Age
Prevention of Bacterial Meningitis in Infants
Prevention of bacterial meningitis involves vaccination and sometimes chemoprophylaxis. A Pneumococcal Vaccine effective against 13 serotypes, including Routine vaccination with an Haemophilus influenzae Type b (Hib) Vaccine also is highly effective and begins at age 2 months. For further information, see The ACIP recommends that infants > 6 weeks who are at high risk of meningococcal disease receive a Meningococcal Vaccine . For infants not at high risk, routine Have HIV infection Have functional or anatomic asplenia (including patients with sickle cell disease) Have persistent complement component pathway deficiencies Complement inhibitor use (eg,eculizumab,ravulizumab) Are traveling to or reside in a high-risk area (eg, sub-Saharan Africa, Saudi Arabia, or during the Hajj) Exposure to an outbreak attributable to a vaccine serogroup Two serogroup B meningococcal vaccines have been approved by the ACIP for use in children ≥ 10 years of age who are at high risk of meningococcal group B disease (same categories as above); routine meningococcal B vaccination is not yet currently given. For further information, seecurrent ACIP meningococcal vaccine recommendations. Antimicrobial chemoprophylaxis is necessary for N. meningitidismeningitis: All close contacts H. influenzaemeningitis: Selected close contacts Contacts of children who have meningitis caused by other bacteria do not require chemoprophylaxis. Formeningococcal meningitis,close contacts have a risk of infection that may be 25 to 500 times higher than that of the general population. Close contacts are defined as Household members, especially children < 2 years of age Child care center contacts exposed in the 7 days before symptom onset Anyone directly exposed to the patient’s oral secretions (eg, through kissing, sharing toothbrushes or utensils, mouth-to-mouth resuscitation, endotracheal intubation, endotracheal tube management) in the 7 days before symptom onset are appropriate drugs depending on the age of the contact ( see Table: Recommended Chemoprophylaxis for High-Risk Contacts* of Children With Meningococcal or Haemophilus influenzae Type b Meningitis ). For young children, oral ForH. influenzaetype b meningitis,the risk of infection in contacts is lower than with meningococcal disease but can be substantial in young, unvaccinated infant or toddler contacts residing in the household of an index patient. Also, household contacts may be asymptomatic carriers ofH. influenzaetype b. Close contacts are defined more explicitly than for meningococcal prophylaxis because caretakers who spend time in the household but do not live there may nevertheless have become colonized withH. influenzaetype b. Thus for this organism,household contactsare defined as the following: People who live with the index patient People who have spent ≥ 4 hours with the index patient for ≥ 5 of the 7 days preceding the index patient's hospital admission Chemoprophylaxis is then recommendedfor each memberof a household, as just defined, if that householdalsohas At least 1 contact < 4 years who is incompletely immunized or unimmunized A child < 12 months who has not completed the primary Hib conjugate immunization series An immunocompromised child (regardless of previous immunization status) Complete immunization againstH. influenzaetype b is defined as having had at least 1 dose of Hib conjugate vaccine at age ≥ 15 months, or 2 doses between 12 months and 14 months, or the 2- or 3-dose primary series for children < 12 months with a booster dose at ≥ 12 months. In addition, if a preschool or child care center has had ≥ 2 cases of invasive Hib disease within 60 days among its attendees, many experts recommend chemoprophylaxis for all attendees and staff to eliminate asymptomatic nasal carriage regardless of immunization status. is acceptable for older contacts ( see Table: Recommended Chemoprophylaxis for High-Risk Contacts* of Children With Meningococcal or Haemophilus influenzae Type b Meningitis ). Drug and Indication Drug and Indication Age Age Dosage Dosage Duration Duration Rifampin† (forNeisseria meningitidis) < 1 month 5 mg/kg IV or orally every 12 hours 2 days ≥ 1 month 10 mg/kg IV or orally every 12 hours (maximum 600 mg orally every 12 hours) 2 days Rifampin† (forH. influenzae) < 1 month 10 mg/kg IV or orally once a day 4 days ≥ 1 month 20 mg/kg IV or orally once a day (maximum 600 mg orally once a day) 4 days Ceftriaxone(for either pathogen) < 15 years 125 mg IM Single dose ≥ 15 years 250 mg IM Single dose Ciprofloxacin‡ (for either pathogen) > 1 month 20 mg/kg orally (maximum 500 mg) Single dose * See Chemoprophylaxis for meningitis for definitions of high-risk close contacts. †Rifampinis not recommended for pregnant women. ‡Ciprofloxacinis not routinely recommended for children < 18 years; however, it may be used for certain children > 1 month if risks and benefits have been assessed. If fluoroquinolone-resistant strains of meningococci have been identified in a community,ciprofloxacinshould not be used for chemoprophylaxis. 