Which individuals should receive antibiotic prophylaxis after exposure to meningococcal disease?

• A. All household members
• B. Close contacts only
• C. Healthcare workers with exposure
• D. Individuals living in the same city

Answer: (B)

Exposure to meningococcal disease is most likely to lead to illness in people who have had close, direct contact with the patient’s respiratory secretions or prolonged contact. To prevent secondary cases, antibiotic prophylaxis is given to those at highest risk—the close contacts. This group includes household members, intimate partners, and anyone with direct exposure to the patient’s oral secretions. Casual contacts (like classmates or coworkers who didn’t have direct exposure) are not routinely treated.

Prophylaxis works by eradicating nasopharyngeal carriage of Neisseria meningitidis, using agents such as rifampin, ciprofloxacin, or ceftriaxone, and should be administered as soon as possible after exposure, ideally within 24 hours and no later than about a week.