| 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? |
|
| MCV4 is preferred for all persons ages 2
through 55 years, although MPSV4 is an acceptable alternative. 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). Either
MCV4 or MPSV4 may be used to control meningococcal outbreaks caused by
serogroups A, C, W-135, and Y, although MCV4 is preferred over MPSV4 if
the targeted populations is in the 2-55 year age group. |
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| Who should
receive meningococcal polysaccharide (MPSV4) vaccine? |
|
| MPSV4 vaccine should be used for
high-risk persons ages 2-10 years as well as ages 56 years and older
(i.e., who are not in the currently licensed age group for MCV4). Either
MCV4 or MPSV4 may be used to control meningococcal outbreaks caused by
serogroups A, C, W-135, and Y, although MCV4 is preferred over MPSV4
if the targeted populations is in the 11-55 year age group. |
|
| What is the difference between the
two meningococcal vaccines, MPSV4 and MCV4? |
|
| The conjugate vaccine (MCV4), licensed
in 2005, is believed to have several advantages over the polysaccharide
vaccine (MPSV), 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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| Will MCV4 provide protection against
all serogroups? |
|
| 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. More data will likely become available within the
next few years to guide recommendations on revaccination for persons who
were previously vaccinated with MCV4. |
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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? |
|
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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| Reviewed on 5/08 |
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