Risk of secondary meningococcal disease in health-care workers

Guidelines on chemoprophylaxis vary between countries and reflect uncertainty about the risk of meningococcal disease in healthcare workers. In a retrospective survey of risk in healthcare workers in England and Wales, three pairs of primary cases and healthcare workers with secondary infections were identified between 1982 and 1996. Secondary infections were probably caused by exposure to primary cases' respiratory droplets around the time of admission. We estimated an attack rate of 0.8 per 100 000 healthcare workers at risk, a risk 25 times that in the general population (p=0.0003). The excess risk is small and inappropriate use of prophylactic antibiotics should be avoided.