Public health considerations in the management of meningococcal disease.

We discuss chemoprophylaxis of household contacts of cases, the current status and use of meningococcal vaccine, and the role of surveillance of household contacts. Available data on secondary attack rates strongly support the need for chemoprophylaxis of household contacts of meningococcal disease cases. Until the current difficulties with side reactions to minocycline are resolved, we recommend the use of rifampin. Surveillance of household contacts alone is an untested, generally impractical, and probably ineffective method of preventing secondary cases of meningococcal disease, although it may have some effect in preventing death by encouraging prompt and appropriate treatment of cases. We recommend the use of serogroups A or C vaccine, or both, in populations experiencing an epidemic of serogroups A or C meningococcal disease. The use of serogroups A or C meningococcal polysaccharide vaccines should also be considered, along with chemoprophylaxis for household contacts of sporadic cases due to either of these organisms.