Meningitis, Meningococcal
Conditions
Keywords
Neisseria meningitidis, Ciprofloxacin, Chemoprevention
Brief summary
This study evaluates the effect of antibiotic prophylaxis with ciprofloxacin, given to the contacts of meningitis cases, on the overall attack rate of meningitis during an epidemic. One third of enrolled villages will receive standard care; in one-third of villages, household contacts of meningitis cases will be offered a single dose of oral ciprofloxacin; and in one-third of villages, the entire village will be offered a single dose of oral ciprofloxacin after the notification of the first case in the village.
Detailed description
Antibiotic prophylaxis is not currently recommended for contacts of cases during a meningitis epidemic in the African Meningitis Belt. Reactive vaccination campaigns are the preferred strategy for prevention during an epidemic. A novel strain of meningococcus, Neisseria meningitidis serogroup C (NmC), began circulating in Nigeria in 2013 and caused a major epidemic with over 10 000 cases in Nigeria and Niger in 2015. There is currently a global shortage of vaccine against NmC, and a recent WHO expert panel called for the formal evaluation of antibiotic prophylaxis as another epidemic response strategy. When taken as a single dose, oral ciprofloxacin effectively eliminates nasopharyngeal carriage of meningococcus. This trial aims to investigate two different antibiotic prophylaxis strategies during an epidemic of meningococcal meningitis: ciprofloxacin prophylaxis to household members of cases and village-wide prophylaxis after the notification of a case in a village. These two strategies will be compared to villages receiving standard care.
Interventions
DRUGCiprofloxacin
Single-dose oral ciprofloxacin
Sponsors
Medecins Sans Frontieres, Netherlands
Epicentre
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
* Resident in a village included in the study area
Exclusion criteria
* Patients currently exhibiting symptoms of meningitis (to be immediately referred for further care) * Persons with a known allergy to fluoroquinolone antibiotics.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Meningitis Attack Rate | From enrollment of a village through study completion, an average of 3 months | The primary outcome aims to evaluate the impact of a chemoprevention strategy as a public health intervention during a meningitis outbreak, which is best evaluated by looking at the overall attack rates in the study area. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of participants with ciprofloxacin-resistant enterobacteriaceae in their stools | Prior to ciprofloxacin dosing (day 0) and at 7 days and 28 days post-ciprofloxacin dosing | A substudy is proposed to compare rates of acquisition of ciprofloxacin resistance among participants in the standard care arm and participants in the village prophylaxis arm. 20 participants in 10 villages in each of the two arms will be asked to provide stool samples on days 0, 7 and 28 |
| Proportion of patients who received ciprofloxacin who develop meningitis | From enrollment of a village through study completion, an average of 3 months | — |
Countries
Niger
Outcome results
None listed