Synopsis
Identify genuine close contacts of meningococcal disease, distinguish prophylaxis from treatment, deliver rapid single-dose or alternative carriage eradication safely, and coordinate notification, vaccination and symptom action with health protection.
- Notify suspected meningococcal disease immediately; the health-protection team, not an informal contact list, defines who receives prophylaxis.
- Close contacts usually include household-like exposure, intimate kissing and direct unprotected contact with respiratory secretions around the infectious period.
- Healthcare staff need prophylaxis only after direct exposure to large-droplet secretions without appropriate protection, such as airway resuscitation.
- Give prophylaxis as soon as possible, ideally within 24 hours of identifying the index case, while later presentation still requires health-protection advice.
- Ciprofloxacin 500 mg orally once is a common adult first option when there is no resistance alert or contraindication.
- Ceftriaxone 250 mg intramuscularly once is an effective pregnancy-compatible alternative selected by health protection.
- Rifampicin 600 mg orally twice daily for 2 days is an alternative but has major interactions, stains secretions and can select resistance.
- Chemoprophylaxis does not treat symptomatic invasive disease and does not replace serogroup-specific vaccination when health protection recommends it.
Key red flags
Any invasive symptom in a contact triggers emergency treatment, not a chemoprophylaxis appointment.
Household, intimate kissing and direct unprotected airway-secretion exposure are higher-risk contacts requiring rapid health-protection assessment.
Routine proximity at work, school or hospital does not automatically meet contact criteria and indiscriminate antibiotics cause harm.
Pregnancy, severe allergy, fluoroquinolone contraindication or resistant strain changes the prophylactic agent but not the urgency.
Unprotected mouth-to-mouth resuscitation, intubation splash or intimate kissing creates a carriage exposure that health protection evaluates promptly.
Fever, headache, meningism, severe limb pain or rash represents possible disease and requires emergency clinical treatment.
Investigation priorities
Separate asymptomatic contacts from people who may already have invasive disease.
Management branches
A probable or confirmed meningococcal case creates concern among contacts.
- Notify health protection and provide secure index-case, onset, setting and exposure information for a formal contact assessment.
- Ask every potential contact about symptoms first and divert symptomatic people to emergency care without clinic delay.
- Distinguish household, intimate and direct secretion exposure from casual proximity and document the rationale for eligibility.
- Review pregnancy, allergy, renal function when relevant and major medicine interactions before selecting the approved regimen.