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Close contact of confirmed serogroup W invasive meningococcal disease — MSRA MCQ

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ModerateInfectious DiseasesClose contact of confirmed serogroup W invasive meningococcal diseaseMSRA

A 22-year-old woman attends her GP practice after her flatmate was admitted yesterday with PCR-confirmed invasive meningococcal disease due to serogroup W. During the 7 days before the flatmate became unwell, they shared a university flat and kitchen daily, although they had separate bedrooms. The flatmate had not travelled outside the UK during the preceding month. The patient is well and has no fever, headache, rash or respiratory symptoms. She received MenACWY vaccination at age 14 years. She has no history of ciprofloxacin hypersensitivity, tendon disorder or epilepsy, is not pregnant, and takes no regular medication. UKHSA has confirmed that she is an eligible close contact and asks the practice to arrange management urgently. What is the most appropriate management today?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Give ciprofloxacin 500 mg orally as a single dose and offer MenACWY vaccine

Explanation lettering: B = shown as A · C = shown as B · E = shown as C · A = shown as E

She is a close contact because she shared a household-type setting, including a kitchen, with the index case during the 7 days before illness onset. Close contacts should receive antibiotic chemoprophylaxis urgently irrespective of prior vaccination status. In adults, the UKHSA recommended first-line regimen is ciprofloxacin 500 mg orally as a single dose. Rifampicin is an alternative, but is preferred where ciprofloxacin resistance is confirmed or likely, particularly after relevant travel by the case to the Middle East or Asia; that discriminator is absent here. Because the index case has confirmed serogroup W disease, close contacts of any age should also be offered MenACWY unless they were immunised against the relevant serogroup within the preceding 12 months. Her teenage MenACWY dose was 8 years ago, so it does not remove the indication for vaccine now. A uses an acceptable eradication agent but not the recommended first-line agent in this scenario. B wrongly omits immediate chemoprophylaxis. C omits indicated vaccination. D would be appropriate for a contact who did not meet the close-contact definition, such as a casual university acquaintance without relevant secretion exposure.

Reference: Guidance for public health management of meningococcal disease in the UK (December 2025) — https://assets.publishing.service.gov.uk/media/69c25a5bbb0dfe55b83e4c2a/UKHSA-meningo-disease-guidelines-dec2025.pdf Guidance for public health management of meningococcal disease in the UK (December 2025) — https://assets.publishing.service.gov.uk/media/69c25a5bbb0dfe55b83e4c2a/UKHSA-meningo-disease-guidelines-dec2025.pdf Guidance for public health management of meningococcal disease in the UK (December 2025) — https://assets.publishing.service.gov.uk/media/69c25a5bbb0dfe55b83e4c2a/UKHSA-meningo-disease-guidelines-dec2025.pdf