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| General information - meningococcal |
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| Who is
recommended to be vaccinated against meningococcal disease? |
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Groups for whom the CDC's Advisory
Committee on Immunization Practices (ACIP) has recommended routine
vaccination against meningococcal disease include
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All
previously unvaccinated adolescents ages 11 through 18 years, |
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All
previously unvaccinated college freshmen who will be living in
dormitories, |
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All
persons ages 2 years and older with anatomic or functional
asplenia, or terminal complement component deficiencies, |
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All
persons ages 2 years and older anticipating travel to Mecca,
Saudi Arabia, for the annual Hajj |
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Any
person working as a microbiologist with routine exposure to
isolates of N. meningitidis, |
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Military recruits, and |
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Any
other person wishing to decrease their risk for meningococcal
disease |
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Who should receive
meningococcal conjugate vaccine (MCV4 or Menactra) and who should be
given the polysaccharide (MPSV4 or Menomune) vaccine? |
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| MCV4 is preferred for all persons ages 2
through 55 years. MPSV4 should only be used if there is a permanent
contraindication or precaution to MCV4. Only MPSV4 vaccine can be used
for high-risk persons ages 56 years and older (i.e., who are not in the
currently licensed age group for MCV4). MCV4 or MPSV4 may be used to
control meningococcal outbreaks caused by serogroups A, C, W-135, and Y,
depending on the age group that is targeted for vaccination. |
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| What is the difference between the
two meningococcal vaccines, MPSV4 and MCV4? |
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| The conjugate vaccine (MCV4), licensed
in 2005, is believed to have several advantages over the polysaccharide
vaccine (MPSV4), such as reduction in bacterial carriage
in the nose and throat, longer duration of immunity, and better immunologic memory
with no need for booster doses. These advantages may result in better herd immunity.
In addition, the ages for which each vaccine is licensed differ; MCV4 is licensed
for persons ages 2-55 years and MPSV4 is licensed for persons ages 2 years and
older. |
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How can children younger than age two
years be protected from meningococcal disease? |
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Under special circumstances (e.g., where
short-term protection against serogroup A meningococcal disease is
needed), MPSV4 may be given to children ages 3 through 23 months. These
children should get two doses, three months apart. |
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If a student received MCV4
(Menactra; sanofi pasteur) before their eleventh birthday, does it need
to be repeated at age 11? |
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| No. On October 17, 2007, FDA expanded
the age indications for Menactra for use in children as young as age 2
years (i.e., it is now licensed for use in people ages 2 through 55
years). Right now only a 1-time dose of Menactra is recommended. ACIP
will make recommendations for revaccination with Menactra as more data
on duration of protection become available. |
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| I understand a second dose of
meningococcal conjugate vaccine (MCV4) is now recommended for certain
people. Please tell me more about this. |
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| When meningococcal conjugate vaccine (Menactra;
sanofi pasteur) was licensed in January 2005, data were lacking on
long-term efficacy and the need for additional vaccination. Since that
time, studies indicate that antibody level declines over time. ACIP
voted on June 24, 2009, to recommend a routine second dose of MCV4 for
people at highest risk for meningococcal infection. This group includes
people (1) with persistent complement component deficiencies, (2) with
anatomic or functional asplenia, or (3) who have frequent prolonged
exposure (e.g., microbiologists routinely working with Neisseria
meningitidis, travelers to or residents of areas with high rates of
meningococcal disease [African meningitis belt]). Children at continued
high risk who received the first dose of MCV4 at ages 2 through 6 years
should receive the second dose no sooner than 3 years after the first
dose. People at continued high risk who received the first dose of
meningococcal vaccine at age 7 years or older should receive the second
dose no sooner than 5 years after the first dose. Because MCV4 is
licensed only for people through age 55, adults 56 and older should
instead receive meningococcal polysaccharide vaccine (MPSV4; Menomune;
sanofi), as should people ages 2 through 55 years who have a precaution
or contraindication to MCV4. Students living in on-campus housing are
not included in the at-risk group to receive second doses of MCV4
vaccine. |
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| Should persons with continued high
risk of meningococcal disease receive additional doses of meningococcal
vaccine beyond the 3- or 5-year booster described above? |
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| Yes, all persons who remain at highest
risk for meningococcal infection should receive additional doses if they
continue to be at highest risk for meningococcal infection, as described
in the answer to the previous question. If the person is age 55 years or
younger, they should receive MCV4; if they are age 56 years or older,
they should receive MPSV4. |
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| Will MCV4 provide protection against
all serogroups? |
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| No. The conjugate vaccine, like the polysaccharide
vaccine, contains antigen for serogroups A, C, Y, and W-135. Serogroups
C and Y account for about two-thirds
of invasive meningococcal disease in the United States. Serogroups A and W-135
are rare in this country. Serogroup B, which accounts for about a third of invasive
disease, is not included in the vaccine. Work is underway to develop a vaccine
for serogroup B. |
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| By what route should MCV4 and MPSV4
be administered? |
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| MCV4 should be administered IM. MPSV4
should be given SC. |
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| Why are college students at increased
risk for meningococcal disease? |
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| A study in Maryland (JAMA 1999; 281:1906-10)
found that the risk of meningococcal disease in college students
was similar to that for persons of the same age in
the general population (1.4-1.7 cases per 100,000 population). However, in that
study, the risk among students who lived in on-campus housing was about 3 times
higher (about 3 per 100,000 population) than students who lived off campus (about
1 per 100,000 population), and about twice as high as the general population
of the same age. |
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| We have boarding school students in
our practice who received MPSV4 vaccine (Menomune) in the past. Should
we give them a dose of MCV4 (Menactra) before they go to college? |
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| ACIP currently recommends revaccination
with MCV4 only if it has been at least 5 years since the MPSV4 dose
and if the student is still in a high-risk category
(e.g., freshman living in a dorm). |
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| Should a child or teen who received
MCV4 (Menactra) at age 12 years receive a second dose if they will be a
freshman in a college dorm? |
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| No, at this time only 1 dose of Menactra
(MCV4) is recommended for students whose only risk factor is living in
on-campus housing. |
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| What has been learned about a possible
relationship between receipt of MCV4 and Guillain-Barr syndrome
(GBS) that was reported in the summer of 2005? |
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In October 2005, FDA and CDC issued alerts
to healthcare providers of a possible association between GBS and
MCV4. Healthcare providers or other persons with
knowledge of possible cases of GBS (or other clinically significant adverse events)
occurring after vaccination with MCV4 were requested to report them to the Vaccine
Adverse Event Reporting System (VAERS).
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Because of the ongoing known risk for
serious meningococcal disease, CDC recommended continuation of current
vaccination strategies, including routine vaccination of all previously
unvaccinated children ages 11-18 years and for college freshmen who will
live in dormitories. In October 2006, an update was published
in MMWR following an examination of additional reports of GBS to VAERS,
the Vaccine Safety Datalink (VSD), and the Healthcare Cost and Utilization
Act (used to estimate background incidence rate of GBS). The report
concluded that "Because of the ongoing risk for meningococcal disease
and the limitations of the data indicating a small risk for GBS after
MCV4 vaccination, the additional cases reported here do not affect
or change current CDC recommendations." CDC also indicated that a larger
study over the next several years would be necessary to provide a more
definitive assessment. |
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| What do you do if an adult patient is
in a high-risk situation for meningococcal disease (e.g., traveling to
Sub-Saharan Africa) and doesn't know whether they received MCV4 or MPSV4
(Menomune; sanofi pasteur) in the past. Should we vaccinate them? |
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| Yes. The ACIP recommendation is to
vaccinate when vaccination is indicated and when you don't have adequate
documentation. |
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| Reviewed on 11/09 |
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