Investigation of Meningococcal Meningitis in a Dental Assistant, Atlanta, Georgia

BACKGROUND:  Despite the use of conjugate vaccinations and preventative antibiotic treatment, meningococcal meningitis continues to be a major cause of morbidity and mortality in the United States. An individual’s profession, living situation, and other behaviors can affect disease transmission. Recommendations for prevention of disease transmission among household and other close contacts are available, but there is little specific information on transmission of disease by healthcare workers (HCW). During May 2014, an Atlanta hospital reported confirmation of meningococcal meningitis in a patient who worked as a dental assistant to the DeKalb County Board of Health (DCBOH).  The following describes the investigation.

METHODS:  Due to the patient’s profession and close contact with patients, The Centers for Disease Control and Prevention (CDC) was consulted to discuss the span of contacts for which prophylaxis should be recommended. It was recommended to include all patients that this dental assistant worked on for two weeks prior to the onset of symptoms.  The dental office provided contact information for all individuals that the dental assistant worked with during that time.  All individuals were contacted to discuss risk and need for prophylaxis. 

RESULTS: A total of forty-five contacts were identified from the dental office. These contacts lived in seven counties across the metro Atlanta area. District Epidemiologists from these counties contacted the residents within their counties. A total of 35 (78%) received prophylactic antibiotics, 8 (18%) were unable to be contacted and 2 (4%) of individuals were identified as symptomatic and were referred for further care. No additional cases of meningococcal meningitis were identified. 

CONCLUSIONS:  Given the significant morbidity and mortality associated with meningococcal meningitis, accurate information is necessary regarding the case and contacts to determine public health measures and ensure appropriate follow up and prevention of additional disease.  This investigation highlighted the challenges in identifying and reaching out to contacts of a dental assistant who saw a large number of patients that lived in multiple public health districts. Furthermore, a dental assistant is in a unique position for disease transmission through respiratory droplets due to the type of patient contact. Guidelines for managing exposures to infected HCWs are not readily available and must be extrapolated from existing recommendations.