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Neisseria meningitidis, or meningococcus, can be acquired from an infected patient if a mask is not worn [59–61]. All health care workers should understand that preventing transmission of meningococcus requires adherence to droplet precautions and that it is not an airborne‐transmitted disease. The illness has a high case‐fatality rate (10%) [61].

Patients are considered infectious for one week before the onset of symptoms and for 24 hours after effective treatment begins. PEP should be administered when close, unprotected (no mask) contact occurs, such as while performing unprotected mouth‐to‐mouth resuscitation on an infected patient, or if splash/splatter of secretions into mucous membranes occurs, as with suctioning, intubation, vomiting, coughing, or endotracheal tube management. Simple proximity to the patient does not qualify as close contact, unless the EMS clinician was less than 3 feet from the patient for more than 8 hours [61]. Because many patients having symptoms consistent with N. meningitidis infection are actually infected with other viruses or organisms, PEP should be given only after substantial exposure (as defined above) to a patient with culture‐ or Gram stain‐proven meningococcus. There is time to determine if N. meningitidis is present before empirically administering prophylaxis to many EMS personnel unnecessarily. PEP for meningococcus should start within 24 hours but may begin up to 10 days after exposure. PEP options include ceftriaxone, ciprofloxacin, or rifampin. Exposed workers may return to duty 24 hours after PEP begins.

The EMS medical director plays an important role in ensuring that prehospital personnel are treated quickly and appropriately when a true exposure to N. meningitidis has occurred. Often, one of the following situations occurs:

1 A crew transports a patient suspected of having meningitis to an emergency department and calls the infection control officer with concerns about exposure.

2 Hospital infection control personnel attempt to contact exposed prehospital personnel involved with treatment/transport of an inpatient now diagnosed with meningococcus.

Usually, the infection control officer is directly involved, but the medical director can assist hospital infection control, occupational health service, and emergency department personnel by including prehospital clinicians in the pool of exposed workers. The designated infection control officer should gather specific information, confirming which (if any) prehospital personnel were close enough to the patient to warrant having them report for evaluation and possible PEP administration.

Routine vaccination is not recommended for any specific health care worker group, including fire and EMS personnel. However, certain groups of people, who may also be EMS clinicians, are appropriate to consider for vaccination if they have not already received it. They include 19‐ to 55‐year‐olds living in college dormitories or other congregate settings, military recruits, microbiologists routinely exposed to isolates of N. meningitides, travelers to or residents of countries in which N. meningitidis meningitis is hyperendemic or epidemic, individuals with terminal complement‐component deficiencies, and individuals with anatomic or functional asplenia.