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| Who
is recommended to be vaccinated against meningococcal disease? |
 |
Groups for whom the CDC's Advisory Committee on Immunization Practices (ACIP) has recommended
routine vaccination against meningococcal disease include
| - |
All
adolescents ages 11-12 years |
| - |
All
previously unvaccinated adolescents ages 13 through 18
years, |
| - |
All
previously unvaccinated first-year college students ages 19
through 21 years who are or will be living in a residence
hall, |
| - |
All
people ages 2 years and older with anatomic or functional
asplenia, or persistent complement component deficiencies, |
| - |
All
people ages 2 years and older who travel to or reside in
countries where meningococcal disease is hyperendemic or
epidemic (e.g., travel to Mecca, Saudi Arabia, for the
annual Hajj), |
| - |
Any
person working as a microbiologist with routine exposure to
isolates of N. meningitidis, |
| - |
Military recruits, and |
| - |
Any
other adult wishing to decrease their risk for meningococcal
disease. |
|
|
| Can
you provide a comprehensive overview of the meningococcal conjugate
vaccine recommendations, including those for vaccinating younger
children and older adults who have risk factors? |
|
The following table provides a summary
of the ACIP recommendations for use of meningococcal vaccine for
people of all ages. It reflects the changes issued by ACIP in October
2010, which were published in early 2011, and also those issued by
ACIP in June 2011, and published in October of 2011 (see
www.cdc.gov/mmwr/pdf/wk/mm6040.pdf).
Meningococcal vaccination recommendations by age group
and/or risk
This table summarizes the recommendations of CDC's Advisory Committee on Immunization Practices for
the use of meningococcal vaccines. |
|
Targeted group by age
and/or risk factor |
Primary series |
If and when to give
booster |
| People ages 11
through 18 years |
Give 1 dose of MCV4,
preferably at age 11 or 12 years1 |
Give booster at age 16
years if primary dose given at age 12 years or younger |
| Give booster at ages
16 through 18 years if primary dose given at ages 13 through 15
years2 |
| People ages 19 through 21 years who are in college and living in residence halls |
| Give 1 dose of MCV41 |
Give booster if previous dose given at age younger than 16 years |
| Certain travelers, people present during outbreaks caused by a vaccine serogroup,3 and other people with prolonged increased risk for exposure (e.g., travelers to or residents of countries where meningococcal disease is hyperendemic or epidemic and microbiologists routinely working with
Neisseria meningitidis) |
| - for age 9 through 23 months |
Give 2 doses of MCV4-D
(Menactra by sanofi), 3 months apart4 |
If risk continues, give initial booster after 3 years followed by boosters every 5 years |
| - for ages 2 through
55 years |
Give 1 dose of MCV41 |
Boost every 5 years with MCV45,6 |
| - for ages 56 years
and older |
Give 1 dose of MPSV |
Boost every 5 years with MPSV6 |
| People with persistent complement component deficiencies,7 or functional or anatomic asplenia |
| - for age 9 through 23 months with persistent complement component deficiencies only
(does not include children with functional or anatomic asplenia) |
Give 2 doses of MCV4-D (Menactra by sanofi), 3 months apart |
Give booster after 3 years followed by boosters every 5 years thereafter |
| - for ages 2 through 55 years |
Give 2 doses of MCV4, 2 months apart8 |
Boost every 5 years with MCV45,9 |
| - for age 56 years and older |
Give 1 dose of MPSV |
Boost every 5 years with MPSV9 |
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Footnotes: |
|
1. |
If
the person is HIV-positive, give 2 doses, 2 months apart. |
|
2. |
The
minimum interval between doses of MCV4 is 8 weeks. |
|
3. |
Seek advice of local public health authorities to determine
if vaccination is recommended. |
|
4. |
If
child age 9 through 23 months will enter endemic area in
less than 3 months, give doses as soon as two months apart. |
|
5. |
If
primary dose(s) given when younger than age 7 years, give
initial booster after 3 years, followed by boosters every 5
years. |
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6. |
Boosters are recommended if the person remains at increased
risk. |
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7. |
Persistent complement component deficiencies include C5-C9,
properdin, factor H, and factor D. |
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8. |
Children with functional or anatomic asplenia should
complete a series of PCV13 vaccine before vaccination with
MCV4; if MCV4-D is to be given, vaccinate at least 4 wks
following last dose of PCV13. |
|
9. |
If
the person received a 1-dose primary series, give booster at
the earliest opportunity, then boost every 5 years. |
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| Which
previously unvaccinated college students are recommended to receive
MCV4 and how many doses should they be given? |
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| Previously unvaccinated first-year
college students ages 19 through 21 years who are or will be living in
a residence hall should receive 1 dose of MCV4. Routine vaccination is
not recommended for adults age 22 and older who do not have risk
factors. If an adult patient requests vaccination against
meningococcal disease, ACIP states that you can vaccinate them. |
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| Which
previously vaccinated college students need booster doses? |
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| A booster dose should be given to
first-year college students age 21 years and younger who are or will
be living in a residence hall if the previous dose was given before
the age of 16 years. |
|
| Will
the meningococcal vaccine provide protection against all serogroups? |
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| No. Both the conjugate vaccine and the
polysaccharide vaccine contain 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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| What is the appropriate way to
differentiate between the different meningococcal vaccines? |
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| The nomenclature for meningococcal
vaccines is based on both the serotypes included in the vaccine as
well as the vaccine type (i.e., conjugate or polysaccharide). There is
only one polysaccharide vaccine (Menomune [sanofi pasteur]) and it is
known as MPSV4 (the 4 denotes the number of serotypes in the vaccine).
There are two different licensed quadrivalent meningococcal conjugate
vaccines (MCV4) – Menactra (sanofi) which is known in technical
circles as MCV4-D, and Menveo (Novartis), known as MCV4-CRM, – and
they each include the same 4 serotypes (A, C, W, and Y). |
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| With three licensed meningococcal
vaccines, how do I decide which one to use? |
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| Quadrivalent meningococcal conjugate
vaccine (MCV4) is the preferred product for people age younger than 55
years. MCV4-D (Menactra [sanofi]) is licensed for ages 9 months
through 55 years and MCV4-CRM (Menveo [Novartis]) is licensed for ages
2 through 55 years. These conjugate vaccines are believed to have
several advantages over meningococcal polysaccharide vaccine (MPSV4;
Menomune [sanofi]), such as reduction in bacterial carriage in the
nose and throat, longer duration of immunity, and better immunologic
memory. MPSV4 should be used for adults age 56 and older. |
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| For which patients is MPSV4 the
preferential vaccine? |
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| MPSV4 is the only meningococcal
vaccine licensed for adults age 56 years and older. MPSV4 can also be
used in people ages 2 through 55 years who have a contraindication or
precaution to MCV4. |
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| Are the two meningococcal
quadrivalent conjugate vaccines (MCV4) interchangeable? |
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| Yes. Healthcare providers should use
every opportunity to provide the booster dose when indicated for
persons ages 2 through 55 years, regardless of the vaccine brand used
for the previous dose or doses. |
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| We recently vaccinated an asplenic
65-year-old man against Neisseria meningitidis; unfortunately, we gave
him MCV4, which isn't licensed for people older than 55. Should we now
give him a dose of meningococcal polysaccharide vaccine (MPSV4 [Menomune])? |
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| No. Though giving MCV4 to a
65-year-old is off-label and a vaccine administration error, there is
no need to repeat the dose. The error should be documented in the
medical record, and the patient should be informed. Make sure your
clinic staff are trained so this error is not repeated. MCV4 is not
approved by FDA for people 56 years and older. People this age should
receive meningococcal polysaccharide vaccine (MPSV4). |
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| Now that MCV4-D (Menactra; sanofi)
is licensed for use in children as young as age 9 months, can you tell
me which children should be vaccinated before their second birthday? |
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In April 2011, FDA expanded Menactra
licensing to include children ages 9 through 23 months. At its June
2011 meeting, ACIP recommended that (1) high-risk children age 9
through 23 months receive a 2-dose series of Menactra, with a 3-month
interval between doses and (2) these doses routinely be given at ages
9 and 12 months. The final recommendations were published in October
2011 (see
www.cdc.gov/mmwr/pdf/wk/mm6040.pdf)
|
ACIP defines high-risk children age 9
through 23 months as (1) those with complement component deficiencies,
(2) those in a community or institution where a meningococcal disease
outbreak is occurring, or (3) those traveling to an area of the world
where meningococcal disease is epidemic. Children who need protection
prior to international travel can receive the second dose as early as
2 months after the first dose. Age 2 years remains the minimum age for
vaccinating children with asplenia or sickle cell disease with MCV4.
Children who remain at increased risk for meningococcal disease should
receive a booster dose 3 years after the primary 2-dose series. |
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| Which people age 2 years and older
are recommended to receive a 2-dose primary series of MCV4? |
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| For people who are age 2 through 55
years, a 2-dose series of MCV4, spaced 2 months apart, is recommended
if they have functional or anatomic asplenia, or persistent complement
component deficiency, including C5-C9, properdin, factor H, and factor
D. In addition, people in this age group who are HIV-positive who are
vaccinated should receive a 2-dose series of MCV4, spaced 2 months
apart. |
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| Since we know that children with
functional or anatomic asplenia are at high risk for contracting
Neisseria meningitidis, why aren't they included in the latest
recommendations to vaccinate certain high-risk children against
meningococcal disease beginning at age 9 months? |
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| Though what you say is true, these
children are also at higher risk of Streptococcus pneumoniae.
Data show that the MCV4-D vaccine (Menactra; sanofi pasteur) may
interfere with the immunologic response to PCV13 if these two vaccines
are given too close together. Therefore, ACIP recommends that MCV4
vaccination be delayed until age 2 years to ensure that these children
get age-appropriate vaccination with PCV13, and to improve the
likelihood that these children are not vaccinated simultaneously with
PCV13 and MCV4. |
|
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Can we vaccinate a
2-year-old boy with functional or anatomic asplenia who has not
completed a series of PCV13? |
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| You should first be certain that he is
up to date with PCV13 vaccine before you vaccinate him with MCV4. If
you are going to give him MCV4-D (Menactra; sanofi pasteur), you need
to wait at least 4 weeks after he completes the PCV13 series before
giving him the MCV4-D. There is no similar space consideration if
MCV4-CRM (Menveo; Novartis) is used; it may be given simultaneously
with PCV13 or at any interval since receipt of PCV13. |
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| I have a pediatric patient who has
functional asplenia. I gave her a dose of MCV4 when she was 3 years
old. Do I need to give her a booster at some time? |
|
| Because she has functional asplenia,
she is due for the 2nd dose of the primary series (assuming 8 weeks
has passed since the first primary series dose). Then, because
asplenia places her at highest risk for meningococcal disease, give
her additional boosters every 5 years thereafter. |
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| Are
people who are HIV positive in a risk group for meningococcal disease? |
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Being HIV-positive does not put a
person into a risk group that necessitates meningococcal vaccination.
However, the updated ACIP recommendations for use of MCV4 vaccines
state that people "with HIV who are vaccinated should receive a 2-dose
primary series administered 2 months apart." Accordingly, the
following HIV-positive people should receive 2 initial doses of MCV4
(instead of 1), spaced 2 months apart:
| - |
HIV-positive adolescents ages 11 through 18 who, like other
adolescents, are recommended for routine MCV4 vaccination |
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HIV-positive people ages 2 through 55 years who are at
prolonged increased risk for exposure to meningococcal
disease (e.g., travelers to or residents of countries where
meningococcal disease is hyperendemic or epidemic and
microbiologists who routinely work with Neisseria
meningitidis) |
| - |
Any HIV-positive adult who
chooses to be vaccinated |
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| I've heard the updated
recommendations for the use of meningococcal conjugate vaccines in
adolescents now include a booster dose. Would you please tell me more? |
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| ACIP recommends people age 11 or 12
years be routinely vaccinated with quadrivalent meningococcal
conjugate vaccine (MCV4) and receive a booster dose at age 16 years.
Adolescents who receive the first dose at age 13 through 15 years
should receive a one-time booster dose, preferably at ages 16 through
18 years, which are the years before the peak in incidence of
meningococcal disease occurs. Teens who receive their first dose of
meningococcal conjugate vaccine at or after age 16 years do not need a
booster dose, as long as they have no risk factors. |
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| Why did ACIP vote to recommend a
routine booster dose of MCV4 for adolescents age 16 years and older? |
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| In October 2005, ACIP recommended
routine MCV4 vaccination for all adolescents at ages 11–12 years to
protect them from meningococcal disease as older teens. The peak age
for meningococcal disease is 16–21 years. In 2005, ACIP reasoned that
higher MCV4 vaccination rates could be achieved if administering the
dose was coupled with giving the Td booster dose at the 11–12-year-old
visit. (The Td dose for 11–12-year-olds was replaced by Tdap in 2006.)
Current data now indicate that the protection provided by MCV4 wanes
within 5 years following vaccination. For this reason, in October
2010, ACIP recommended an MCV4 vaccine booster dose to provide
continuing protection during the peak years of vulnerability (see
www.cdc.gov/mmwr/pdf/wk/mm6003.pdf). |
|
| If someone received meningococcal
polysaccharide vaccine (MPSV4) at age 5 years (e.g., for pending
foreign travel) and a dose of MCV4 at age 11–12 years, will they still
need a booster dose of MCV4 vaccine starting at age 16 years? |
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| Yes. Any meningococcal vaccination
given prior to the tenth birthday (either with MCV4 or MPSV4) does NOT
count toward routinely recommended doses. |
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| If someone received MPSV4 (or MCV4)
at age 10 years and another dose at age 11–12 years, will they still
need a booster dose at age 16 years? |
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| No, as long as the first dose was
given at age 10 years or older, the second dose was MCV4 (not MPSV4),
there was an interval of at least 8 weeks between the two doses, and
they are not in a risk group that necessitates ongoing boosters (e.g.,
due to asplenia). In this scenario, however, the healthcare provider
may offer a booster dose if the person is younger than age 22 years
and about to enter a college or university setting. |
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| Which people with risk factors
should receive subsequent boosters of meningococcal conjugate vaccine
(MCV4)? |
|
| 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.
Consequently, ACIP recommended routine boosters of MCV4 for people at
highest risk for meningococcal infection in 2009 (see
www.cdc.gov/mmwr/pdf/wk/mm5837.pdf). 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. |
|
| Should people with continued high
risk of meningococcal disease receive additional doses of
meningococcal vaccine beyond the 3- or 5-year booster described above? |
|
| Yes, all people 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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| Why are college students at
increased risk for meningococcal disease? |
|
| A study in Maryland (JAMA 1999;
281:1906-10) found that the risk of meningococcal disease in college
students was similar to that for people of the same age in the general
population (1.4-1.7 cases per 100,000 persons). However, in that
study, the risk among students who lived in on-campus housing (i.e.,
dormitory) 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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| A 19-year-old student who received
1 dose of MCV4 at age 12 years will be attending a community college
this fall. Does she need a booster dose of MCV4? |
|
| Yes, but only if she will be living in
residential housing. Adults ages 19 through 21 years who meet these
criteria and who received the previous dose of MCV4 before age 16
years, need a booster dose. |
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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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| 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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| We mistakenly gave a patient the
diluent for Menveo (Novartis) meningococcal conjugate vaccine without
adding it to the powdered vaccine. Since vaccine is present in the
diluent as well as in the powder, what should we do now? |
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| Menveo's liquid vaccine component
(i.e., diluent) contains the C, Y, and W-135 serogroups, and the
lyophilized vaccine component (i.e., freeze-dried powder) contains
serogroup A. Because the patient received only the diluent, he or she
is not protected against invasive meningococcal disease caused by
Neisseria meningitidis serogroup A.
Invasive disease with N. meningitidis
serogroup A is very rare in the United States, but is more common in
some other countries, particularly the African meningitis belt. If the
recipient (of the C-Y-W135 "diluent" only) does not plan to travel
outside the United States then the dose does not need to be repeated.
However, if the recipient plans to travel outside the United States
the dose should be repeated with either correctly reconstituted Menveo,
or with a dose of Menactra brand MCV4. There is no minimum interval
between the incorrect dose and the repeat dose. |
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I understand that a prior
history of Guillain-Barrè syndrome (GBS) is no longer a
precaution for giving meningococcal conjugate vaccine (MCV4). Please
tell me more about this. |
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| A history of GBS had previously been a
precaution for Menactra (sanofi pasteur) MCV4 vaccine. Findings from
two studies that examined more than 2 million doses of Menactra given
since 2005 showed no evidence of an increased risk of GBS.
Consequently, ACIP recommended in June 2010 to remove the precaution
for use of Menactra in people with a history of GBS. This precaution
did not apply to Menveo (Novartis) or Menomune (sanofi pasteur). |
|
| Reviewed on 4/12 |
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