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Meningococcal ACWY Disease

Ask the Experts: Diseases & Vaccines

Meningococcal ACWY Disease

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Disease Issues
Please tell us about meningococcal disease.
Meningococcal disease is a bacterial infection caused by Neisseria meningitidis. Meningococcal disease usually presents clinically as meningitis (about 50% of cases), bacteremia (38% of cases), or bacteremic pneumonia (9% of cases). N. meningitidis colonizes mucosal surfaces of the nasopharynx and is transmitted through direct contact with large-droplet respiratory tract secretions from patients or asymptomatic carriers. Meningococcal disease can be severe. The overall case-fatality ratio is 10%–15%, and 20% of survivors have long-term sequelae such as neurologic disability, limb or digit loss, and hearing loss.
N. meningitidis is classified into at least 13 serogroups based on characteristics of the polysaccharide capsule. Most invasive disease (such as meningitis and sepsis) is caused by serogroups A, B, C, W, and Y. The relative importance of serogroups depends on geographic location and other factors such as age. Serogroups B, C, and Y are the most frequent causes of disease in the U.S., each accounting for about one third of reported cases. Serogroup A is common in Sub-Saharan Africa but is rare in the U.S.
Nasopharyngeal carriage rates are highest in adolescents and young adults who serve as reservoirs for transmission of N. meningitidis.
How common is meningococcal disease?
The incidence of meningococcal disease has declined since a peak of reported disease in the late 1990s. Even before routine use of a meningococcal conjugate vaccine (MenACWY) in adolescents was recommended in 2005, the overall annual incidence of meningococcal disease had decreased 64%, from 1.1 cases per 100,000 population in 1996 to 0.4 cases per 100,000 population in 2005. Since 2005, declines have occurred among all age groups and in all vaccine-contained serogroups. In addition, incidence of disease caused by serogroup B, a serogroup not included in MenACWY, declined for reasons that are not known.
During 2005–2011, an estimated 800–1,200 cases of meningococcal disease occurred annually in the United States, representing an incidence of 0.3 cases per 100,000 population. A total of 372 cases was reported in 2015. Of those with known serogroup (N=152) 52% were serogroups A, C, Y or W-135 (primarily serogroups C and Y) and 48% were serogroup B.
What are the risk factors for meningococcal disease?
For all meningococcal serogroups risk factors include age, functional or anatomic asplenia, persistent complement component deficiency (an immune system disorder) including that caused by eculizumab (Soliris, Alexion Pharmaceuticals) used for treatment of atypical hemolytic uremic syndrome or paroxysmal nocturnal hemoglobinuria (the drug binds to C5 and inhibits the terminal complement pathway), and occupation as a microbiologist in a laboratory that works with meningococcal isolates.
Certain groups are at increased risk for meningococcal serogroups A, C, W, and Y but not serogroup B. These risk factors include HIV infection, travel to places where meningococcal disease is common (such as certain countries in Africa and in Saudi Arabia), and college students living in a dormitory. Other risk factors for serogroups A, C, W. and Y include having a previous viral infection, living in a crowded household, having an underlying chronic illness, and being exposed to cigarette smoke (either directly or second-hand).
Vaccine Recommendations
What meningococcal vaccines are available in the United States?
Two types of meningococcal vaccines are available in the United States that protect against meningococcal serogroups A, C, W, and Y: 1) meningococcal polysaccharide vaccine (MPSV4; Menomune, Sanofi Pasteur), which is made up of polysaccharide (sugar molecules) from the surface of the meningococcal bacteria; and 2) meningococcal conjugate vaccines (MenACWY; Menactra, Sanofi Pasteur; Menveo, GlaxoSmithKline) in which the polysaccharide is chemically bonded ("conjugated") to a protein to produce a better immune response to the polysaccharide. MenACWY is more effective in young children than the original polysaccharide vaccine. Menhibrix (GSK), licensed in 2012, contained conjugated polysaccharides of N. meningitidis serogroups C and Y and Haemophilus influenzae type b and was approved by the U.S. Food and Drug Administration for use in children age 6 weeks through 18 months. The manufacturer discontinued distribution of Menhibrix in the U.S. in 2016.
Since late 2014, vaccines have become available that offer protection from meningococcal serogroup B disease. These vaccines are composed of proteins found on the surface of the bacteria.
MPSV4 and MenACWY provide no protection against serogroup B disease, and meningococcal serogroup B vaccines (MenB) provide no protection against serogroup A, C, W, or Y disease. For protection against all 5 serogroups of meningococcus, it is necessary to receive MenACWY or MPSV4 and MenB. No currently available meningococcal vaccine contains live meningococcal bacteria.
Trade Name Type of Vaccine Serogroups Included Year Licensed Approved Ages
Menomune Polysaccharide A, C, W, Y 1981 2 years and older
Menactra Conjugate A, C, W, Y 2005 9 months–55 years*
Menveo Conjugate A, C, W, Y 2010 2 months–55 years*
Trumenba Protein B 2014 10–25 years+
Bexsero Protein B 2015 10–25 years+
*May be given to people age 56 years or older (consult ACIP recommendations at www.cdc.gov/mmwr/pdf/rr/rr6202.pdf).
+May be given to people age 26 years or older (consult ACIP recommendations at www.cdc.gov/mmwr/pdf/wk/mm6422.pdf).
Where can I find the most current meningococcal vaccine recommendations?
The most current comprehensive recommendations from the Advisory Committee on Immunization Practices (ACIP) for meningococcal polysaccharide and conjugate vaccines, which include serogroups A, C, W, and Y, were published in March 2013. This document is available on the MMWR website at www.cdc.gov/mmwr/pdf/rr/rr6202.pdf. Recommendations for use of MenACWY among people with HIV infection were published in November 2016 and are available at www.cdc.gov/mmwr/volumes/65/wr/pdfs/mm6543.pdf, pages 1189–94. Recommendations for use of MenB among persons at increased risk were published in June 2015 and are available at www.cdc.gov/mmwr/pdf/wk/mm6422.pdf, pages 608–12. MenB recommendations for healthy adolescents and young adults were published in October 2015 and are available at www.cdc.gov/mmwr/pdf/wk/mm6441.pdf, pages 1171–6.
Who is recommended to be vaccinated against meningococcal ACWY disease?
MenACWY is recommended for these groups:
All children and teens, ages 11 through 18 years
  People age 2 months and older with functional or anatomic asplenia
  People age 2 months and older who have persistent complement component deficiency (an immune system disorder, including people taking eculizumab [Soliris])
  People age 2 months and older with HIV infection
  People younger than 22 years of age if they are or will be a first-year college student living in a residential hall
  People age 2 months and older who are at risk during an outbreak caused by a vaccine serogroup
  People age 2 months and older who reside in or travel to certain countries in sub-Saharan Africa as well as to other countries for which meningococcal vaccine is recommended (e.g., travel to Mecca, Saudi Arabia, for the annual Hajj)
  Microbiologists who work with meningococcus bacteria in a laboratory
What is the schedule for MenACWY vaccine?
All adolescents should receive a dose of MenACWY at 11 or 12 years of age. A second (booster) dose is recommended at 16 years of age. Adolescents who receive their first dose at age 13 through 15 years should receive a booster dose at age 16 through 18 years. The minimum interval between MenACWY doses is 8 weeks. Adolescents who receive a first dose after their 16th birthday do not need a booster dose unless they become at increased risk for meningococcal disease. Colleges may not consider a second dose given even a few days before age 16 years as valid, so keep that in mind when scheduling patients.
Should college students be vaccinated against meningococcal ACWY disease?
MenACWY is recommended for previously unvaccinated first-year college students who are age 21 years and younger and who are or will be living in a residence hall. Some colleges and universities require incoming freshmen and others to be vaccinated with MenACWY. Some may require that a dose of MenACWY have been given after age 16 years.
Several healthy adult college students from Asia (ages 24 years and older) presented to our clinic. They will be living in a residence hall. None have a record of having received MenACWY. Should the receive a dose of MenACWY now?
ACIP does not routinely recommend MenACWY for college students age 22 years and older. It is recommended for previously unvaccinated first-year college students who are age 21 years and younger who are or will be living in a residence hall. However, some colleges and universities may require incoming freshmen and others to be vaccinated with MenACWY, and some may also require that a dose have been given after 16 years of age.
We run immunization clinics at the local jail, which has a living arrangement comparable to a college residential hall. In this setting, would you recommend vaccinating incarcerated individuals who are younger than age 22, as is recommended for people living in a college dormitory?
ACIP does not identify incarceration as an indication for meningococcal vaccination. Providers are always free to use their clinical judgment in situations not addressed by ACIP.
Can you provide a comprehensive overview of the MenACWY recommendations, including those for vaccinating younger children and older adults who have risk factors?
IAC has prepared a document that provides a summary of the ACIP recommendations for use of MenACWY for people of all ages, including recommendations published by ACIP in MMWR in March 2013 and November 2016. The document is available at www.immunize.org/catg.d/p2018.pdf.
Menveo (MenACWY-CRM) is approved by the FDA for use in children as young as 2 months of age. What is the ACIP recommendation for use of this vaccine?
MenACWY-CRM is approved for people age 2 months through 55 years. For children beginning the vaccination series at age 2 months the schedule is 4 doses at age 2, 4, 6, and 12 to15 months. Fewer doses are recommended for children beginning the vaccination series at age 7 months or older (see the IAC document at www.immunize.org/catg.d/p2018.pdf for details.
ACIP recommends the use of MenACWY-CRM in high-risk children 2 through 23 months of age (children with persistent complement deficiency including children taking eculizumab [Soliris], functional or anatomic asplenia, HIV infection, who travel to or reside in regions where meningitis is epidemic or hyperendemic, or who are at risk during a community outbreak attributable to a vaccine serogroup). These recommendations were published in MMWR in June 2014 and are available at www.cdc.gov/mmwr/pdf/wk/mm6324.pdf, pages 527–30. Menactra (MenACWY-D) can be given to children 9 months and older at increased risk of meningococcal disease.
I have a 3-month-old patient whose family will be doing mission work in sub-Saharan Africa. They are leaving as soon as the child is 6 months old. We gave her the first dose of Menveo brand MenACWY vaccine today. I know the usual Menveo schedule for an infant is 2, 4, 6, and 12 months. If we maintain usual spacing, she will only get 1 more dose before she leaves. Can we compress the schedule so she can get 2 more doses prior to travel?
The meningococcal ACIP recommendations don't clearly state a minimum interval for MenACWY in this situation. However, the minimum interval for a pediatric MenACWY schedule would presumably be 4 weeks like for other pediatric vaccines on a 2-4-6 schedule. You should try to give a third dose before travel begins.
If a healthy child received meningococcal polysaccharide (MPSV4, Menomune; Sanofi) or MenACWY prior to international travel at age 9 years, will two additional doses of MenACWY be needed?
Yes. Doses of quadrivalent meningococcal vaccine (either MPSV4 or MenACWY) given before 10 years of age should not be counted as part of the series. If a child received a dose of either MPSV4 or MenACWY before age 10 years, they should receive a dose of MenACWY at 11 or 12 years and a booster dose at age 16.
If someone received MPSV4 or MenACWY vaccine at age 10 years and a dose of MenACWY before the 16th birthday, will they still need a booster dose at age 16?
Yes, they should receive a booster dose. A booster dose of MenACWY is recommended at 16 through 18 years even if 2 (or more) doses of meningococcal vaccine were received before age 16 years. People age 19 through 21 years who are entering college or are first year students living in a residence hall, and who have not received a dose of MenACWY on or after age 16 years, should also be vaccinated.
If someone received MPSV4 or MenACWY at age 9 years, will two additional doses of MenACWY be needed?
Yes. Doses of quadrivalent meningococcal vaccine (either MPSV4 or MenACWY) given before 10 years of age should not be counted as part of the routine 2-dose series. If a child received a dose of either MPSV4 or MenACWY before age 10 years, they should receive a dose of MenACWY at 11 or 12 years and a booster dose at age 16 years.
ACIP recommends that adolescents who receive the first dose of MenACWY at age 13 through 15 years receive a one-time booster dose at age 16 through 18 years. Given how hard it is to get teens into a medical office, is it okay to give the doses close together if the opportunity arises or should we try to space it out as far as possible (age 18)?
If the first dose is given at age 13 through 15 years, you can give the booster dose as early as age 16 years, with a minimum interval of 8 weeks from the previous dose. So even if the patient was vaccinated at age 15 years 11 months, you should wait at least 8 weeks and then give the booster at age 16 years 1 month (or later).
The ACIP recommendations for meningococcal vaccine published in March 2013 advise using MenACWY in certain adults older than age 55 years. Please provide details of this recommendation.
Both MenACWY vaccines (Menactra and Menveo) are approved for adults through age 55 years. Previously, ACIP recommended only the quadrivalent meningococcal polysaccharide vaccine (MPSV4) for use in adults age 56 years and older. The most recent recommendations recommend the use of either MenACWY vaccine in adults age 56 years and older who were vaccinated previously with MenACWY and now need revaccination or are recommended to receive multiple doses (for example, adults with asplenia or microbiologists working with N. meningitidis). The use of these vaccines in people age 56 and older is off-label but recommended by ACIP. It is also acceptable to use MenACWY if MPSV4 is not available. These recommendations are available at www.cdc.gov/mmwr/pdf/rr/rr6202.pdf, page 15.
Sanofi is discontinuing the production of Menomune (MPSV4) this year. I administer a lot of travel vaccine doses. Should I now give MenACWY (Menactra or Menveo) off-label to travelers age 56 years and older?
In its 2013 meningococcal recommendations, ACIP recommended off-label use of MenACWY vaccine (not MPSV4) for people age 56 years or older who were vaccinated previously with MenACWY and are recommended for revaccination or for whom multiple doses are anticipated (for example, people with asplenia and microbiologists). The situation of unavailability of MPSV4 is not addressed, but the use of MenACWY vaccine is appropriate when MPSV4 is not available.
Are the two MenACWY vaccines interchangeable?
MenACWY-D (Menactra) is not approved for children younger than 9 months so only MenACWY-CRM (Menveo) should be used for children age 2 through 8 months. For persons age 9 months and older the vaccines are interchangeable.
We anticipate that parents will be seeking serology to prove immunity to meningococcal disease in lieu of vaccination required for school attendance. Would a positive meningococcal titer (serology) in a person who has not had meningococcal disease nor vaccination be accepted as evidence of immunity for school requirements?
According to the meningococcal subject matter experts at CDC, the only test for which there is a correlate of immunity is a serum bactericidal assay (SBA). This test is mostly used for research and is not likely to be commercially available. An IgG EIA that might be available at a commercial laboratory is not useful for determining immunity. So there is no practical serologic test for determining immunity to meningococcus. Serologic testing is not recommended except perhaps in a research setting.
For People with Risk Factors Back to top
Which people age 2 years and older are recommended to receive a 2-dose primary series of MenACWY?
For people who are age 2 years or older, a 2-dose series of MenACWY, spaced 8–12 weeks apart, is recommended if they have functional or anatomic asplenia, persistent complement component deficiency (including C3, C5-C9, properdin, factor H, and factor D and people taking eculizumab [Soliris]), and people with HIV infection. People with these high-risk medical conditions also need booster doses of MenACWY (see Booster Doses section below).
Which children should be vaccinated before the routine recommended age (11–12 years)?
ACIP does not recommend routine meningococcal vaccination for all children younger than 11 years. ACIP recommends vaccination only for high-risk children. ACIP defines high-risk children age 2 months and older as (1) those with persistent complement component deficiency (including children taking eculizumab [Soliris]), (2) those with functional or anatomic asplenia, (3) those traveling to or residing in an area of the world where meningococcal disease is hyperendemic or epidemic (such as sub-Saharan Africa and Saudi Arabia) or (4) are at risk during a community outbreak attributable to a vaccine serogroups. MenACWY-CRM (Menveo) is approved for children age 2 months and older. MenACWY-D (Menactra) is approved for children age 9 months and older.
For children with functional or anatomic asplenia, MenACWY-D should not be administered until at least 4 weeks after the pneumococcal conjugate vaccine (PCV13, Prevnar13, Pfizer) vaccination series is completed. Children at increased risk for meningococcal disease should receive booster doses as long as they remain at increased risk (see Booster Doses section below).
Why delay meningococcal vaccination for infants with functional or anatomic asplenia until the pneumococcal conjugate vaccine series is completed?
In addition to being at increased risk for meningococcal disease, children with functional or anatomic asplenia are also at increased risk invasive disease caused by Streptococcus pneumoniae. Data show that the MenACWY-D may interfere with the immunologic response to PCV13 if these two vaccines are given too close together. So ACIP recommends that MenACWY-D not be administered until at least 4 weeks after completion of the age-appropriate PCV13 series. MenACWY-CRM (Menveo) does not affect the immune response to pneumococcal vaccine so can be given at any time before or after PCV13.
In its 2016 recommendations for use of meningococcal conjugate vaccines in HIV-infected persons, ACIP states not to use MenACWY-D (Menactra, Sanofi) in children younger than age 2 years. However, in Table 3 of these recommendations (page 1192), MenACWY-D is listed as an option for children 9 through 23 months of age. This seems to be a discrepancy. Please clarify.
CDC meningococcal experts prefer MenACWY-D not be used before two years of age in children at increased risk of meningococcal disease (such as those with HIV infection or asplenia) because of possible interference with the response to pneumococcal conjugate (PCV13) vaccine. However, they recognize that vaccine supply or other constraints may require its use before age two years and provided permissive language with important guidance in the Table 3 footnote. These recommendations are published in MMWR, Nov 4, 2016, at www.cdc.gov/mmwr/volumes/65/wr/pdfs/mm6543a3.pdf, pages 1189–94.
Can we vaccinate a 2-year-old boy with functional or anatomic asplenia against meningococcal disease if he has not completed a series of PCV13?
Possibly. If you are going to give him Menactra brand MenACWY, you need to wait at least 4 weeks after he completes the PCV13 series before giving him the Menactra. There is no similar space consideration if Menveo brand MenACWY is used; it may be given simultaneously with PCV13 or at any interval before or after receipt of PCV13.
Adults who are asplenic need PCV13 and MenACWY. Does the recommendation to separate PCV13 and MenACWY-D (Menactra) apply to adults as well as children?
Studies that showed possible interference when PCV7 and Menactra were given simultaneously were done in children. This was then extrapolated to use of PCV13 and MenACWY-D in children. This interference was not noted with MenACWY-CRM (Menveo).
At this time, there are no data to support a similar recommendation for adults. However, to be prudent, if MenACWY-D is being used, you should space it 4 weeks after PCV13 if possible. MenACWY-CRM can be administered at any time before, simultaneous with, or after PCV13.
Do any of the bacterial vaccines that are recommended for people with functional or anatomic asplenia need to be given before splenectomy? Do the doses count if they are given during the 2 weeks prior to surgery?
PCV13, Haemophilus influenzae type b vaccine, MenACWY, and meningococcal B vaccine should be given 14 days before splenectomy, if possible. Doses given during the 14 days before surgery can be counted as valid. If the doses cannot be given prior to the splenectomy, they should be given as soon as the patient's condition has stabilized after surgery. Pneumococcal polysaccharide vaccine should be administered 8 weeks after the dose of PCV13 for people 2 years of age and older.
I have a pediatric patient who has functional asplenia. I gave her a dose of MenACWY-D (Menactra) 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 second dose of the primary series (assuming 8 weeks have passed since the first primary series dose). Because she has a high-risk medical condition she will need periodic booster doses. If she is younger than age 7 years when she receives the second dose of her primary series, she should receive her first booster dose 3 years after completing the primary series. She should then receive a booster dose every five years thereafter. If she is age 7 years or older when she receives the second primary dose she should receive her first booster dose 5 years after the completing the primary series and every five years thereafter.
If someone is older than 55 years and had their spleen removed, are they recommended for MPSV4 or MenACWY?
MenACWY vaccines are licensed for persons through age 55 years. For persons older than 55 years with a high-risk medical condition (such as asplenia), ACIP recommends off-label use of MenACWY. Asplenic persons should receive a primary series of two doses of MenACWY separated by 8–12 weeks, followed by a dose every five years thereafter. These recommendations are available at www.cdc.gov/mmwr/pdf/rr/rr6202.pdf, page 15.
We have a 68-year-old who has been asplenic since 2009. She had one dose of MPSV4 in 2009, but no subsequent dose. She is now due for a booster. Should she receive 2 doses of MenACWY, 2 months apart, to catch up, or just one dose?
This situation is not addressed in the most recent ACIP guidelines for meningococcal conjugate vaccine. It is the CDC meningococcal subject matter expert’s opinion that this patient should receive 2 doses of MenACWY separated by at least 8 weeks, followed by a booster dose of MenACWY every 5 years thereafter. The concern is that having had only MPSV4 previously, she may not have an adequate booster response to a single dose of MenACWY.
I have a patient with paroxysmal nocturnal hemoglobinuria who is being treated with Soliris (eculizumab). Should he receive meningococcal vaccine?
Eculizumab binds to C5 and inhibits the terminal complement pathway. Persons with persistent complement component deficiency are at increased risk for meningococcal disease. This person should receive a series of both MenACWY (2 doses separated by 8–12 weeks) and a 2- or 3-dose series (depending on brand) of meningococcal serogroup B vaccine.
We have a 10-year-old getting renal dialysis. The nephrologist will be starting her on a monoclonal antibody that interferes with C5 complement. If we administer MenACWY and pneumococcal polysaccharide vaccine (PPSV23) now, and then give her PCV13 in 8 weeks, will the PCV13 interfere with the efficacy of the PPSV23 or the MenACWY?
Recommendations to separate MenACWY and PCV13 only apply to persons with functional or anatomic asplenia. So the best schedule is to give MenACWY (either brand) simultaneously with PCV13, and then PPSV23 in eight weeks. ACIP recommends giving PCV13 before PPSV23 in order to maximize the immune response from PCV13. PPSV23 may blunt the immune response to PCV13 if PCV13 is given after PPSV23, although in children there is a smaller effect than in adults. A 10 year-old with persistent complement component deficiency should also receive a 2- or 3-dose series (depending on brand) of meningococcal B vaccine.
Are people who are HIV-positive at increased risk for meningococcal disease?
A growing body of evidence supports an increased risk for meningococcal disease in HIV-infected people. ACIP recommends that all HIV-infected people 2 months of age and older should routinely receive an age-appropriate MenACWY series (see www.cdc.gov/mmwr/volumes/65/wr/pdfs/mm6543.pdf, pages 1189–94). Children younger than age 2 years should be vaccinated using a multidose schedule (see the IAC document "Meningococcal Vaccine Recommendations by Age and Risk Factor for Serogroups A, C, W, or Y Protection" available at www.immunize.org/catg.d/p2018.pdf for details).
People age 2 years and older with HIV infection who have not been previously vaccinated should receive a 2-dose primary series of MenACWY (doses separated by 8–12 weeks). People with HIV infection who have previously received one dose of MenACWY should receive a second dose at the earliest opportunity (at least 8 weeks after the previous dose) and then receive booster doses at the appropriate intervals (see Booster Doses below). ACIP does not recommend routine meningococcal serogroup B vaccination of people with HIV infection.
I have an HIV-positive 64-year-old patient who received MenACWY last week. Was this the correct vaccine for this patient or should he have gotten MPSV4 due to his age? Also, should this patient get another dose in 2 months?
MenACWY was the correct vaccine in this situation. The 2013 ACIP recommendations on meningococcal vaccination recommend the use of meningococcal conjugate vaccine in adults age 56 years and older who 1) were vaccinated previously with MenACWY and now need revaccination, or 2) are recommended to receive multiple doses. A person with HIV infection should receive 2 doses of MenACWY separated by 8–12 weeks. Both MenACWY vaccines are licensed for use in people through age 55 years, which means that the use of these vaccines in people age 56 and older is off-label but recommended by ACIP.
I have an otherwise healthy 26-year-old patient with HIV infection who received one dose of MenACWY three years ago. Should he receive one or two doses now? Will he need booster doses later?
It is not necessary to restart the MenACWY series. Give the person one dose of MenACWY vaccine now. This dose represents a delayed second dose in the primary series (a 2-dose primary series recommended for people with HIV infection). The patient will also need booster doses every 5 years.
I have a 24-month-old patient with HIV infection and I want to use MenACWY-D (Menactra) because this is the only vaccine we have available in our clinic. However, this child received DTaP vaccine yesterday at another clinic. Can I administer MenACWY-D?
ACIP recommends that you wait 4 weeks from the dose of DTaP to administer the dose of MenACWY-D. This is because data suggest a reduced response to the MenACWY-D if given within a month after DTaP. If MenACWY-D is to be administered to a child at increased risk for meningococcal disease, including children who have HIV infection, MenACWY-D should be given either before or at the same visit as DTaP. Menveo brand MenACWY vaccine can be given at any time before or after DTaP.
I have a 24-month-old patient with a complement component deficiency who received a dose of DTaP at 23 months of age and then received a dose of MenACWY-D (Menactra) two weeks later. Do I need to repeat the dose of MenACWY-D?
No. Even though ACIP recommends that MenACWY-D should be given no less than 4 weeks after a dose of DTaP, there is no evidence to support repeating the dose of MenACWY-D. A child with a complement component deficiency should still receive a second dose of MenACWY vaccine 8 weeks after the first dose.
Does the recommendation about a 4-week separation of DTaP and MenACWY-D also apply to children with functional or anatomic asplenia?
Yes. The recommendation about spacing of DTaP and MenACWY-D applies to all children younger than 7 years with a high-risk condition for meningococcal disease, including travelers.
A 32-year-old patient with ulcerative colitis is taking high-dose immunosuppressive medications (6-mercaptopurine). Should he receive meningococcal vaccine?
There is no specific indication for meningococcal vaccine in this patient. He is older than 21 years, and the risk–based recommendations are restricted to specific forms of altered immunocompetence (persistent complement component deficiency, functional or anatomic asplenia, use of eculizumab and HIV infection) and are not inclusive of other forms of altered immunocompetence.
The 2013 ACIP meningococcal ACWY recommendations (www.cdc.gov/mmwr/pdf/rr/rr6202.pdf) list household crowding and both active and passive smoking as risk factors for meningococcal disease. Should I recommend MenACWY vaccine for a nonsmoker living in a crowded household of smokers?
Although second-hand smoke and other environmental conditions have been identified as risk factors for meningococcal disease, ACIP does not include them as indications for MenACWY vaccination. Providers are always free to use their clinical judgment in situations not addressed by ACIP.
Booster Doses Back to top
Should all adolescents receive a routine booster dose of MenACWY?
ACIP recommends adolescents age 11 or 12 years be routinely vaccinated with MenACWY 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 age 16 through 18 years, which are the years before the peak in incidence of meningococcal disease among adolescents occurs. Teens who receive their first dose of MenACWY at or after age 16 years do not need a booster dose, as long as they have no risk factors.
Why does ACIP recommend a routine booster dose of MenACWY for adolescents at age 16 years?
In 2005, ACIP recommended routine MenACWY vaccination for all adolescents at age 11 or 12 years to protect them from meningococcal disease as older teens. The peak age for meningococcal disease is 16 through 21 years. In 2005, ACIP reasoned that higher MenACWY vaccination rates could be achieved if administering the dose was coupled with giving the Td booster dose at the 11 or 12-year-old visit (the Td dose for 11 or 12-year-olds was replaced by Tdap in 2006). Subsequent studies indicated that the protection provided by MenACWY wanes within 5 years following vaccination. For this reason, in 2010, ACIP recommended an MenACWY booster dose to provide continuing protection during the age of increased meningococcal incidence (see www.cdc.gov/mmwr/pdf/wk/mm6003.pdf).
Which previously vaccinated college students need a booster dose of MenACWY?
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.
If someone received MPSV4 or MenACWY at age 9 years, will two additional doses of MenACWY be needed?
Yes. Doses of quadrivalent meningococcal vaccine (either MPSV4 or MenACWY) given before 10 years of age should not be counted as part of the series. If a child received a dose of either MPSV4 or MenACWY before age 10 years, they should receive a dose of MenACWY at 11 or 12 years and a booster dose at age 16 years.
Which people with risk factors should receive booster doses of MenACWY?
ACIP recommends routine booster doses of MenACWY for people at highest risk for meningococcal infection (see www.cdc.gov/mmwr/pdf/wk/mm5837.pdf). This group includes people (1) with persistent complement component deficiency including people taking eculizumab (Soliris), (2) with anatomic or functional asplenia, (3) with HIV infection, (4) who have frequent prolonged exposure (such as microbiologists routinely working with Neisseria meningitidis, and travelers to or residents of areas with high rates of meningococcal disease [such as the African meningitis belt]).
Children at continued high risk who received the last dose of the primary series of MenACWY before age 7 years should receive the next dose 3 years after the most recent dose. People at continued high risk who received the last dose of the primary series at age 7 years or older should receive the next dose 5 years after the most recent dose. MenACWY is licensed through age 55 years; however, ACIP recommends off-label use of MenACWY for adults 56 and older who were vaccinated previously with MenACWY and are recommended for revaccination, or for whom multiple doses are anticipated.
Should people with continued high risk of meningococcal disease receive additional doses of meningococcal vaccine beyond the 3- or 5-year booster?
Yes, people should receive additional booster doses (every 5 years) if they continue to be at highest risk for meningococcal infection.
If a child with a high-risk condition receives MenACWY at age 9 years (and a second primary dose 8 weeks later), should they receive a booster dose at age 14 years (5 years after the primary series), or should they receive a dose at age 16 years as recommended in the routine schedule?
The MenACWY booster dose should be given at 14 years (5 years after the primary series) and every 5 years thereafter. The every 5-year booster dose schedule for persons with high-risk conditions takes precedence over the routine second dose schedule.
What do you do if an adult patient is in a high-risk situation for meningococcal disease (for example travel to sub-Saharan Africa) and doesn't know whether they received MenACWY or MPSV4 in the past. Should we vaccinate them?
If the person cannot provide written documentation of the previous vaccination you should assume they are unvaccinated and vaccinate accordingly.
Administering Vaccine Back to top
By what route should meningococcal vaccines be administered?
All meningococcal conjugate vaccines should be administered by the intramuscular route. MPSV4 should be given by the subcutaneous route. Meningococcal serogroup B vaccine is given by the intramuscular route.
We mistakenly gave a patient the diluent for Menveo brand MenACWY-CRM without adding it to the powdered vaccine. Since vaccine antigen is present in the diluent as well as in the powder, what should we do now?
Menveo's liquid vaccine component (the diluent) contains the C, W-135, and Y serogroups, and the lyophilized vaccine component (the 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 N. 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-135 "diluent" only) is certain not 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 MenACWY. There is no minimum interval between the incorrect dose and the repeat dose.
Can MenACWY and MenB vaccines be given at the same visit?
Yes. MenACWY and MenB vaccines can be given at the same visit or at any time before or after the other.
Vaccine Safety Back to top
What adverse events are expected after receiving MenACWY?
In clinical trials the most common adverse events within 7 days of receiving MenACWY were injection site pain, swelling or redness (44%–59% of recipients). One percent or less of recipients considered the pain to be severe. Other reported symptoms included malaise (11%–22%), and headache (29%–36%). In general adverse events were less frequent following MPSV4 than following MenACWY.
Is MenACWY included in the National Vaccine Injury Compensation Program?
Yes. The National Vaccine Injury Compensation Program includes payment for injuries determined to have occurred following vaccination with a vaccine routinely recommended for children in the United States. The recipient can be of any age, but the vaccine must be routinely recommended for children and teens through age 18 years. MenACWY is routinely recommended for children so it is included in the program. More information about the program and the covered vaccines is at www.hrsa.gov/vaccinecompensation/coveredvaccines/index.html.
Contraindications and Precautions Back to top
What are the contraindications and precautions for MenACWY?
As with all vaccines, a severe allergic reaction (for example, anaphylaxis) to a vaccine component or to a prior dose is a contraindication to further doses of that vaccine. A moderate or severe acute illness is a precaution; vaccination should be deferred until the person's condition has improved. Because MenACWY and MPSV4 are inactivated vaccines, they can be administered to persons who are immunosuppressed as a result of disease or medications; however, response to the vaccine might be less than optimal.
Can a pregnant woman receive MenACWY vaccine?
Yes. No safety concerns associated with vaccination have been identified in mother vaccinated during pregnancy or their infants.
I understand that a prior history of Guillain-Barrè syndrome (GBS) is no longer a precaution for giving meningococcal conjugate vaccine. Please tell me more about this.
A history of GBS had previously been a precaution for Menactra brand MenACWY. 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 2010 to remove the precaution for use of Menactra in people with a history of GBS. This precaution did not apply to other meningococcal vaccines.
Vaccine Storage and Handling Back to top
What are the storage requirements for MenACWY and MPSV4?
Store at MenACWY at refrigerator temperature, 2° to 8°C (36° to 46°F). The vaccines must not be frozen. Vaccine that has been frozen or exposed to freezing temperature should not be used. Do not use after the expiration date.
The manufacturer recommends that reconstituted vaccine from a multidose vial of MPSV4 be discarded within 35 days after reconstitution. Vaccine from single dose vials should be used immediately after reconstitution.
 
This page was updated on June 7, 2017.
This page was reviewed on January 12, 2017.
 
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