Suspected Meningococcal Meningitis on an Aircraft Carrier

Military Medicine, Sep 2004 by Farr, R Wesley, Gonzalez, Michele J, Garbauskas, Heather, Zinderman, Craig E, LaMar, James E II

A close contact is defined by the Centers for Disease Control and Prevention as a household member, a daycare center contact, or anyone directly exposed to the patient's oral secretions.11 In this case, close contacts on the ship were defined as all persons who had close contact with the patient for more than 4 hours per day in the previous 7 days, all personnel living in the same berthing area, all personnel from the same work center, and all personnel who stood watches with the patient. Close friends who spent more than 4 hours per day with the patient on the ship or during a port visit to Portsmouth, England, the week before presentation, were also included as contacts.

On the basis of these criteria, 99 personnel from the ship were identified as close contacts. Current recommendations are to treat close contacts, within 24 hours after the case is identified, with a standard protocol of rifampin, ciprofloxacin, or ceftriaxone (Table I).11 Directly observed therapy with orally administered rifampin (600 mg, twice daily, for 2 days; the first dose was administered less than 6 hours after patient presentation) was administered to all 99 persons identified as close contacts in accordance with these guidelines. In retrospect, one dose of ciprofloxacin (500 mg) would have been more cost-effective than rifampin for chemoprophylaxis (Table I); however, administration of the four directly observed therapy doses of rifampln enabled the medical department to observe all of the contacts for the presence of meningococcal symptoms on four occasions. In addition, the patient reported a history of intimate contact with a local woman during the port visit to Portsmouth, England. This information was relayed to the English public health authorities within 24 hours after the patient presented. No cases of meningitis occurred among the patient's close contacts or other members of the ship's crew.

Although the case occurred while the ship was crossing the Atlantic Ocean, rapid communication with the ship's chain of command and Navy public health officials contributed to the effective management of the incident. Public health officials at Navy Environmental and Preventive Medicine Unit 2 were notified via telephone within 5 hours after the patient first presented. Navy Environmental and Preventive Medicine Unit 2 alerted the local civilian health department and the area military treatment facility. The ship's medical officer issued daily situational reports via electronic mail, to keep all concerned parties updated. The daily reports included the patient's clinical status, the number of close contacts identified and treated, and results of laboratory tests. Effective communication helped to assure medical and line commanders that control measures had been successfully implemented, minimizing the impact and preventing additional cases.

This case demonstrates that the treatment of a patient with suspected bacterial meningitis in a shipboard setting can be handled efficiently, despite limitations inherent in operational medicine. With prompt antibiotic therapy, respiratory isolation, identification and prophylactic treatment of close contacts, and open communication between health care providers and public health officials, a favorable outcome can be achieved.