An epidemic of
meningococcal disease after an
influenza outbreak in a community of 49 boys (14-18 years) and 8 adults in a boarding-school is reported. The first patient died with all symptoms of the
Waterhouse-Friderichsen syndrome. Several hours later, two other boys developed severe
septicemia with
meningitis and
meningitis respectively. N. meningitidis group B susceptible to
penicillin and
rifampin was isolated. Within the next 8 hours,
chemoprophylaxis with
rifampin (600 mg twice daily) was started and maintained for 4 days for the whole community. Throat cultures had not been obtained before prophylaxis. Ten other symptomatic boys were admitted to the hospital and treated by
penicillin infusion. The results of blood and cerebrospinal fluid cultures were negative, and treatment was therefore discontinued. Five days after the death of the first boy, another boy died with full-blown
Waterhouse-Friderichsen syndrome while on
chemoprophylaxis. The neisseriae isolated from this patient were
rifampin-resistant. Serological investigations in all patients admitted to hospital revealed the existence of concomitant epidemic
infection with
influenza A and B in this school. We assume that the
viral infection made way for the outbreak of the
meningococcal disease and for the high rate of secondary
meningococcal infection.
Chemoprophylaxis with
rifampin should not be continued for longer than 2 to 3 days, otherwise the risk of occurrence of
rifampin resistant strains of N. meningitidis increases. Hitherto such strains have rarely been isolated in clinically manifest disease.