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Close contact of invasive meningococcal disease — MSRA MCQ

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HardInfectious DiseasesClose contact of invasive meningococcal diseaseMSRA

A 23-year-old woman attends urgent GP review 9 hours after her husband was admitted with PCR-confirmed meningococcal septicaemia caused by serogroup W. They live together and shared a bedroom until his admission. He developed fever and a non-blanching rash 3 days after returning from a 2-week visit to Saudi Arabia. He is being treated with intravenous ceftriaxone. The patient is well and has no fever, rash, headache or neck stiffness. She received MenACWY vaccination at age 14 years. She has no drug allergies, is not pregnant and takes no regular medicines. The health protection team has confirmed that she is an eligible close contact and that prophylaxis should be issued urgently. Which is the most appropriate management today?

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

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Correct answer: D — Prescribe rifampicin 600 mg twice daily for 2 days and offer MenACWY vaccination today

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

She is a close household contact because she shared a home and bedroom with the index case during the 7 days before illness onset. Chemoprophylaxis should therefore be given urgently, ideally within 24 hours of diagnosis. Although ciprofloxacin is normally the UK agent of choice, rifampicin is recommended first-line when the invasive case has travelled recently to the Middle East or Asia because ciprofloxacin-resistant meningococci are reported more frequently in these regions. She should also be offered MenACWY vaccine because the index infection is confirmed serogroup W and her previous MenACWY dose was 9 years ago; vaccination can be omitted only where protection against the relevant serogroup was given within the preceding 12 months. Vaccination provides longer-term protection and does not replace immediate chemoprophylaxis. B is the usual regimen for a close contact of a UK-acquired case, but recent Saudi Arabia travel changes the preferred prophylactic agent. C incorrectly delays indicated MenACWY vaccination. D omits urgent carriage eradication, which addresses the immediate risk of secondary invasive disease. E wrongly treats remote teenage vaccination as sufficient and fails to provide either indicated preventive intervention.

Reference: Guidance for public health management of meningococcal disease in the UK (23 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 (23 December 2025) — https://assets.publishing.service.gov.uk/media/69c25a5bbb0dfe55b83e4c2a/UKHSA-meningo-disease-guidelines-dec2025.pdf