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Autopsy Biosafety: Recommendations for Prevention of Meningococcal Disease
Erin G Brooks, Suzanne R Utley-Bobak1
1National Association of Medical Examiners Ad Hoc Committee for Bioterrorism and Infectious Disease.
Introduction:
As invasive meningococcal disease progresses rapidly, often affects youth, and has a fairly high mortality rate, such cases are likely to fall under medical examiner/coroner (ME/C) jurisdiction. Morgue personnel may be at risk of contracting secondary meningococcal disease. We review the current scientific literature regarding Neisseria meningitidis infection and provide recommendations for the prevention of meningococcal disease at autopsy.
Methods:
A PubMed search utilizing applicable medical subject heading terms was performed retrieving articles for review from the preceding two decades. Pertinent current guidelines from multiple national organizations were also retrieved.
Results:
Invasive meningococcal disease is transmitted by direct contact with large respiratory droplets or oral secretions. While a surgical mask would normally provide adequate protection from large droplet spread, it does not prevent inhalation of smaller aerosolized particles such as those generated at autopsy. Prosectors are advised to routinely wear N-95 respirator masks or powered respirator hoods. All published cases of secondary meningococcal disease transmission to healthcare workers invariably arose in scenarios in which face masks/respirators were not employed; none of these cases involved meningococcal disease transmission to ME/C or other morgue staff.
Discussion:
In the event that no mask-or inadequate coverage such as a surgical mask-is employed during autopsy of a decedent suspected/confirmed to have invasive meningococcal disease, antibiotic prophylaxis is advisable. Assuming appropriate personal protective equipment is utilized, chemoprophylaxis is unnecessary. Routine meningococcal vaccination is not recommended, except for ME/C with specified immunocompromising conditions or traveling to hyperendemic/endemic meningococcal regions. Acad Forensic Pathol. 2018 8(2): 328-339.
Insights
Medical examiners/coroners should use N-95 respirators during autopsies for invasive meningococcal disease. Antibiotic prophylaxis is recommended only if proper personal protective equipment is not used.
Area of Science:
- Forensic Pathology
- Infectious Disease Epidemiology
- Occupational Health
Background:
- Invasive meningococcal disease (IMD) is a rapidly progressing infection with high mortality, often requiring medical examiner/coroner (ME/C) investigation.
- Morgue personnel face potential exposure to *Neisseria meningitidis* during autopsies of individuals with IMD.
- Understanding transmission risks is crucial for preventing secondary infections among autopsy staff.
Purpose of the Study:
- To review the scientific literature on *Neisseria meningitidis* infection in the context of autopsies.
- To provide evidence-based recommendations for preventing meningococcal disease transmission during postmortem examinations.
- To guide ME/C and morgue personnel on appropriate protective measures and prophylaxis.
Main Methods:
- A comprehensive literature search was conducted using PubMed with relevant Medical Subject Headings.
- Articles published within the last two decades were reviewed for pertinent information.
- Current guidelines from national health organizations were also incorporated into the review.
Main Results:
- *Neisseria meningitidis* spreads via large respiratory droplets and oral secretions.
- Standard surgical masks do not protect against aerosolized particles generated during autopsy.
- N-95 respirators or powered air-purifying respirators are recommended for prosectors.
- No documented cases of secondary meningococcal disease transmission to ME/C staff occurred when appropriate PPE was used.
Conclusions:
- Antibiotic prophylaxis is advised if inadequate personal protective equipment (PPE) is used during autopsy of suspected/confirmed IMD cases.
- Chemoprophylaxis is unnecessary when appropriate PPE, including N-95 respirators, is utilized.
- Routine meningococcal vaccination is not generally recommended for ME/C staff, barring specific immunocompromising conditions or travel to endemic areas.
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