In the described exposure to a patient with gram-negative diplococci, which individuals require prophylaxis after exposure?

• A. EMTs, ED staff on duty, ICU personnel, and the radiography technician
• B. EMT who suctioned the patient, the person who intubated the patient, and the patient’s girlfriend
• C. ICU and ED staff, students in the patient’s dormitory, and the patient’s family
• D. No special prophylaxis needed

Answer: (B)

Transmission of Neisseria meningitidis occurs mainly through respiratory droplets and direct contact with oral secretions. Prophylaxis is indicated for close contacts who were exposed to the patient’s secretions or who share living space, to eradicate carriage and prevent secondary cases. In this exposure scenario, those who had direct exposure to the patient’s airway secretions during procedures (the EMT who suctioned the patient and the person who intubated) are at risk, and a household contact (the patient’s girlfriend) also needs prophylaxis due to close, prolonged contact. The other groups described did not have direct exposure to secretions or close, prolonged contact, so routine prophylaxis isn’t indicated for them. Prophylaxis is typically given with rifampin, ciprofloxacin, or ceftriaxone, ideally within 24 hours and within seven days of exposure.