Effectiveness of vaccinating household contacts in addition to chemoprophylaxis after a case of meningococcal disease: a systematic review

Abstract

SUMMARYWe performed a systematic review to estimate the effectiveness of vaccination, in addition to chemoprophylaxis, in preventing meningococcal disease among household contacts. Medline, EMBASE, EMGM, and EUIBIS were used for data collection. Studies reporting on at least 100 primary cases and on subsequent cases in household settings with follow-up of more than 2 weeks after onset of disease in the primary case were reviewed. A meta-analysis was used to calculate the average attack rate in household contacts given chemoprophylaxis 14-365 days after onset of disease in the primary case. In total, 652 studies were identified, five studies and one unpublished report met the inclusion criteria. The weighted average attack rate was 1 . 1/1000 household contacts (95 % CI 0 . 7-1 . 7). This review supports vaccination of household contacts in addition to chemoprophylaxis to reduce the risk of meningococcal disease among household contacts of a case caused by a vaccine-preventable serogroup.

What is the evidence for giving chemoprophylaxis to children or students attending the same preschool, school or college as a case of meningococcal disease?

“…Indirect evidence is available suggesting that vaccination of close contacts of index cases with IMD due to a vaccine-preventable strain prevents late secondary cases [86], and thus post-exposure vaccination is strongly recommended in the ECDC guidance document [44]. Further prospective studies on the risk of subsequent cases and the transmission of diseasecausing strains in educational settings are needed.…”

Background Paper for the update of meningococcal vaccination recommendations in Germany: use of the serogroup B vaccine in persons at increased risk for meningococcal disease

“…Household contacts of persons with IMD have an approximately 100-fold increased risk of contracting IMD in the ensuing year despite post-exposure chemoprophylaxis [2]. Therefore, STIKO recommended vaccination with a Men-ACWY conjugate vaccine in 2009 for contacts of index cases due to these serogroups [3].…”

“…An increased risk of IMD was accordingly reported for persons with immune deficiencies, among these, particularly those with complement deficiencies [8,9], but also others, such as persons with asplenia [8], persons infected with HIV [10,54,55] or persons with unreplaced hypogammaglobulinemia [11]. In addition, laboratory staff at risk for contact with N. meningitis aerosols are at increased risk of IMD [4,5] and IMD incidence is increased in household contacts of IMD patients in the ensuing year despite post-exposure chemotherapy [2]. Based largely on available reviews, estimates for the risk of occurrence of IMD in the relevant risk groups are described below.…”

“…Because of these uncertainties, the NNV for vaccination of household contacts with Bexsero Ò was calculated for a range of probable VE. In a favorable scenario that might apply to older children and adults in which the MenB vaccine is administered within 4 days after diagnosis of the index case (assuming that by then the causative serogroup in the index case has been identified), the vaccine is assumed to protect with a VE of 90 % against 82 % of the strains from 14 days after vaccination and the disease risk is 108 IMD cases/100,000 household contacts [2], an estimated.…”

“…In addition, an increased risk for household contacts was observed within a one-year period after contact with an IMD index case, even after they had received chemoprophylaxis [2]. Finally, laboratory staff at risk for contact with N. meningitidis aerosols also has an increased risk of disease compared to the general population [4,5].…”