source of transmission. additionally, basic hygiene measures, such as handwashing and not sharing drinking cups, can reduce the incidence of infection by limiting exposure. when a case is confirmed, all close contacts with the infected person can be offered antibiotics to reduce the likelihood of the infection spreading to other people. however, rifampin-resistant strains have been reported and the indiscriminate use of antibiotics contributes to this problem. chemoprophylaxis is commonly used to those close contacts who are at highest risk of carrying the pathogenic strains. since vaccine duration is unknown, mass select vaccinations may be the most cost-effective means for controlling the transmission of the meningococcal disease, rather than mass routine vaccination schedules. chronic medical conditions persons with component deficiencies in the final common complement pathway (c3, c5-c9) are more susceptible to n. meningitidis infection than complement-satisfactory persons, and it was estimated that the risk of infection is 7000 times higher in such individuals. in addition, complement component-deficient populations frequently experience frequent meningococcal disease since their immune response to natural infection may be less complete than that of complement non-deficient persons. inherited properdin deficiency also is related, with an increased risk of contracting meningococcal disease. persons with functional or anatomic asplenia may not efficiently clear encapsulated neisseria meningitidis from the bloodstream persons with other conditions associated with immunosuppression also may be at increased risk of developing meningococcal disease. antibiotics an updated 2013 cochrane review investigated the effectiveness of different antibiotics for prophylaxis against meningococcal disease and eradication of n. meningitidis particularly in people at risk of being carriers. the systematic review included 24 studies with 6,885 participants. during follow up no cases of meningococcal disease were reported and thus true antibiotic preventative measures could not be directly assessed. however, the data suggested that rifampin, ceftriaxone, ciprofloxacin and penicillin were equally effective for the eradication of n. meningitidis in potential carriers, although rifampin was associated with resistance to the antibiotic following treatment. eighteen studies provided data on side effects and reported they were minimal but included nausea, abdominal pain, dizziness and pain at injection site. disease outbreak control meningitis a, c, y and w-135 vaccines can be used for large-scale vaccination programs when an outbreak of meningococcal disease occurs in africa and other regions of the world. whenever sporadic or cluster cases or outbreaks of meningococcal disease occur in the us, chemoprophylaxis is the principal means of preventing secondary cases in household and other close contacts of individuals with invasive disease. meningitis a, c, y and w-135 vaccines rarely may be used as an adjunct to chemoprophylaxis,1 but only in situations where there is an ongoing risk of exposure (e.g., when cluster cases or outbreaks occur) and when a serogroup contained in the vaccine is involved. it is important that clinicians promptly report all cases of suspected or confirmed meningococcal disease to local public health authorities and that the serogroup of the meningococcal strain involved be identified. the effectiveness of mass vaccination programs depends on early and accurate recognition of outbreaks. when a suspected outbreak of meningococcal disease occurs, public health authorities will then determine whether mass vaccinations (with or without mass chemoprophylaxis) is indicated and delineate the target population to be vaccinated based on risk assessment. treatment charlotte cleverley-bisman, who had all four limbs partially amputated aged seven months due to meningococcal disease. when meningococcal disease is suspected, treatment must be started immediately and should not be delayed while waiting for investigations. treatment in primary care usually involves prompt intramuscular administration of benzylpenicillin, and then an urgent transfer to hospital (hopefully, an academic level i medical center, or at least a hospital with round the clock neurological care, ideally with neurological intensive and critical care units) for further care. once in the hospital, the antibiotics of choice are usually iv broad spectrum 3rd generation cephalosporins, e.g., cefotaxime or ceftriaxone. benzylpenicillin and chloramphenicol are also effective. supportive measures include iv fluids, oxygen, inotropic support, e.g., dopamine or dobutamine and management of raised intracranial pressure. steroid therapy may help in some adult patients, but is unlikely to affect long term outcomes. there is some debate on which antibiotic is most effective at treating the illness. a systematic review compared two antibiotics. there was one trial: an open label (not blinded) non-inferiority trial of 510 people comparing two different types of antibiotics; ceftriaxone (in which there were 14 deaths out of 247), and chloramphenicol (12 deaths out of 256). there were no reported side effects. both antibiotics were considered equally effective. antibiotic choice should be based on local antibiotic resistance information. prognosis complications complications following meningococcal disease can be divided into early and late groups. early complications include: raised intracranial pressure, disseminated intravascular coagulation, seizures, circulatory collapse and organ failure. later complications are: deafness, blindness, lasting neurological deficits, reduced iq, and gangrene leading to amputations. epidemiology africa