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Recommendations for Use of Meningococcal Vaccines in High-Risk Infants and Children
April 2013
Technically Speaking
Monthly Column by Deborah Wexler, MD
Technically Speaking is a monthly column written by IAC’s Executive Director Deborah Wexler, MD. The column is featured in The Children’s Hospital of Philadelphia Vaccine Education Center’s (VEC’s) monthly e-newsletter for healthcare professionals. Technically Speaking columns cover practical topics in immunization delivery such as needle length, vaccine administration, cold chain, and immunization schedules.
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TECHNICALLY SPEAKING
Recommendations for Use of Meningococcal Vaccines in High-Risk Infants and Children
Published April 2013
Information presented in this article may have changed since the original publication date. For the most current immunization recommendations from the Advisory Committee on Immunization Practices, visit www.immunize.org/acip/acip_vax.asp.
The recommendations and available products for meningococcal vaccination of high-risk infants and children have evolved since 2007 when ACIP first recommended vaccination of children age 2 to 10 years who are at increased risk for meningococcal disease. Published on March 22, 2013, the current recommendations summarize and compile all previous meningococcal recommendations. The current recommendations are complex; for example, in the recommendations for vaccinating people in certain risk groups, the number of recommended vaccine doses and products varies, and includes some off-label use. This column offers an overview of the meningococcal recommendations for vaccinating high-risk infants and children, and provides links to some valuable resources that will help healthcare professionals make appropriate vaccination decisions.
It is important to understand the differences between vaccines available for meningococcal immunization. The nomenclature for meningococcal vaccines is based on both the number of serotypes included in the vaccine and whether the vaccine is conjugate or polysaccharide. Menomune® (Sanofi Pasteur), the only polysaccharide meningococcal vaccine, is known as MPSV4, with the 4 denoting the number of serotypes in the vaccine. Two different licensed quadrivalent meningococcal conjugate vaccines — Menactra® (MCV4-D, Sanofi Pasteur) and Menveo® (MCV4-CRM, Novartis) — are known as MCV4. All three vaccines (the polysaccharide and both conjugates) include the same 4 serotypes (A, C, W and Y). Licensed in June 2012, MenHibrix® (Hib-MenCY; GSK) is indicated to prevent invasive disease caused by Neisseria meningitidis serogroups C and Y and Haemophilus influenzae type b (Hib). MenHibrix® protects only against meningococcal serogroups C and Y; it does not protect against serogroups A and W. In general, ACIP recommends routine meningococcal vaccination of children age 2 months and older who are at increased risk for meningococcal disease, including:
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Children age 2 months and older with certain medical conditions, such as anatomical or functional asplenia or complement component deficiency; and
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Children age 9 months and older who travel to or reside in countries in which meningococcal disease is hyperendemic or epidemic, particularly if contact with the local population will be prolonged.
The recommended product, dosing schedule and interval for booster dose(s) vary based on many factors. For example, a 12-month-old infant traveling to Saudi Arabia should get two doses of MCV4-D, three months apart, but an infant with asplenia should get Hib-MenCY at ages 2, 4, 6, and 12—15 months. Due to these complexities, providers who use these vaccines should consider printing the following resources for reference when needed. These resources also include information about routine meningococcal vaccination of adolescents and recommendations for vaccinating high-risk adults.
