Vaccines
> Meningococcal
Meningococcal
Disease and Meningococcal
Vaccines
Fact Sheet
(April 2005)
Contents
of this page:
disease | epidemiology
| causative bacteria | mcv4
| mpsv4
additional sources of information
Related
page:
MMWR
Article: Prevention and Control of Meningococcal
Disease: Recommendations of the ACIP
Overview
With
the introduction and widespread use of Hemophilus
influenzae type b and Streptococcus pneumoniae
conjugated vaccines, invasive disease due to
these agents has been markedly reduced. The
newly licensed tetravalent meningococcal conjugated
vaccine (MCV4) should become a key addition
to existing to control of Neisseria meningitidis.
This document seeks to familiarize vaccination
providers, partners, and the public with the
epidemiology and clinical features of meningococcal
disease, with the new conjugate meningococcal
vaccine (MCV4), and the previously licensed
polysaccharide meningococcal vaccine (MPSV4).
The Advisory Committee on Immunization Practices
(ACIP) to the Centers for Disease Control and
Prevention (CDC) has recently recommended routine
vaccination of young adolescents with MCV4
at the pre-adolescent visit (11-12 years old).
Introducing a recommendation for MCV4 vaccination
in young adolescents (11-12 years old) may
strengthen the role of the pre-adolescent visit
and have a positive effect on vaccine coverage
in adolescence. ACIP recommends that young
adolescents see a health care provider at age
11-12 for a routine preventive visit, at which
time appropriate immunizations and other preventive
services should be provided. For those who
have not previously received MCV4, ACIP recommends
vaccination before high school entry (~15 years
old) as an effective strategy to reduce meningococcal
disease incidence in adolescents and young
adults. Within 3 years, the goal is routine
vaccination with MCV4 of all adolescents. ACIP
recognizes that vaccine supply may be an issue
in the first few years after licensure of MCV4.
Other adolescents who wish to decrease their
risk of meningococcal disease may elect to
receive vaccine.
College freshmen who live in dormitories are
at higher risk for meningococcal disease compared
to other people of the same age. The ACIP recommends
routine vaccination for college freshmen living
in dormitories. Because of feasibility constraints
in targeting freshmen in dormitories, colleges
may elect to target their vaccination campaigns
to all matriculating freshmen. The risk for
meningococcal disease among non-freshmen college
students is similar to that for the general
population of similar age (18-24 years). Other
college students who want to reduce their risk
for meningococcal disease may elect to receive
the vaccine.
Disease
- Invasive
meningococcal disease occurs in three common
clinical forms: meningitis (49% of cases),
blood infection (33%) and pneumonia (9%);
other forms account for the remainder (9%)
of the cases.
-
Onset can be abrupt and course of disease
rapid.
-
Case fatality rate is 10%-14%; 11%-19% of
survivors suffer serious sequelae including
deafness, neurologic deficit, or limb loss.
Epidemiology
-
Rates highest in infancy with second peak
in adolescence (see graph below) with the
peak around 18 years of age (see figure)
-
Annually, 1,400–2,800 cases of invasive
meningococcal disease occur in the US.
-
20% of cases occurs among adolescents
and young adults ages 14–24
-
16% of cases occurs among infants under
1 year of age
-
College freshmen living in dormitories are
at higher risk than general population of
similar age
-
Most cases are sporadic (97%); a minority
is associated with outbreaks (3%)
-
Disease is seasonal, with cases peaking in
December and January.
![see screen-reader version link below image](mening_fs_chart1.gif)
![see screen-reader version link below image](mening_fs_chart2.gif)
screen-reader
version of both graphs
Causative
Bacteria
- Meningococci
are carried only by humans in the nasopharynx—their
only reservoir
-
Overall 5%-10% of the population carries
the bacteria
-
Adolescents and young adults have the
highest carriage rates
-
Few carriers develop disease
- Transmission
occurs when close, face-to-face contact permits
the exchange of salivary secretions from
people who are ill or are carriers
- Worldwide,
the vast majority of disease is caused by
5 serogroups (A, B, C, Y, W-135) of the bacterium
- In
the United States, almost all cases are caused
by serogroups B, C and Y; there is currently
no licensed vaccine that protects against
Serogroup B in the U.S.
The
Vaccines
Meningococcal
Conjugate Vaccine (MCV4)
-
Licensed in the United States in January
2005 for persons 11–55 years of age
-
Covers Serogroups A, C, Y and W-135
-
Conjugate Group C vaccine is currently
licensed and routinely used in many European
countries
-
It is likely that this or a similar vaccine
will be licensed for younger age groups
in the future
-
Included in the Vaccines for Children (VFC)
Program
-
Cost to private sector per dose: $82.00
-
Given intramuscularly as a single dose
-
Need for revaccination not yet known
-
Longer duration of protection and similar
efficacy compared to MPSV4 expected in adolescents
and adults
-
Adverse reactions similar to Meningococcal
Polysaccharide Vaccine (see below)
-
Recommendations for use: in February 2005,
ACIP voted to recommend vaccination with
MCV4 in following groups:
- Adolescents
-
Young adolescents at the pre-adolescent
visit (11–12 years old)
-
Adolescents (if not previously vaccinated)
at high school entry (~15 years old)
-
Adolescents who wish to decrease
their risk may elect to receive
- Groups
that have elevated risk of meningococcal
disease
-
College freshmen living in dormitories
-
Microbiologists who are routinely
exposed to isolates of N. meningitidis
-
Military recruits
-
Persons who travel to, or reside
in countries in which N. meningitidis
is hyperendemic or epidemic, particularly
if contact with the local population
will be prolonged
-
Persons who have anatomic or functional
asplenia or terminal complement
component deficiencies
More
on MCV4
Meningococcal
Polysaccharide Vaccine (MPSV4)
-
Licensed in 1981
- Included
in the Vaccines for Children (VFC) program (no CDC contract)
-
Cost
to private sector per dose: $86.10
-
Given subcutaneously as a single dose
-
Generally not protective in children less than 2 years of age
-
Good short-term (3–5 years) protection (85%) in older children
and adults
-
Antibody levels decrease markedly after 2–3 years, especially
in children
-
People at high risk need revaccination every 3–5 years
-
Adverse reactions:
- Mostly
mild injection site pain and redness
-
Brief fever in 5 percent
-
Severe allergic and neurological reactions: each <0.1/100,000
-
Recommendations for use: MPSV4 is recommended for individuals
who are at elevated risk aged 2–10 years and over 55 years
(see MCV4 recommendations for list of groups at elevated risk)
-
If MCV4 is unavailable, MPSV4 is an acceptable alternative for
persons at elevated risk ages 11–54 years
-
MPSV4 is not recommended and should not be administered routinely
for adolescents ages 11–12 or for adolescents entering high
school. Adolescents in these age groups are recommended only to
receive MCV4
Additional
Sources of Information
National Foundation for Infectious Diseases
(NFID), The Changing Epidemiology of Meningococcal
Disease Among United States Children, Adolescents,
and Young Adults, November, 2004
www.nfid.org/pdf/meningitis/FINALChanging_Epidemiology_of_Meningococcal_Disease.pdf
Raghunathan
P, Bernhardt S, Rosenstein R. Opportunities
for control of meningococcal disease in the
United States. Annu Rev Med 2004;55:333–53
CDC.
Prevention and control of meningococcal disease:
recommendations of the Advisory Committee
on
Immunization Practices (ACIP). MMWR 2005;
In press.
CDC.
Meningococcal disease and college students:
recommendations of the Advisory Committee
on Immunization Practices (ACIP). MMWR 2000;49
(No. RR-7):11–21 www.cdc.gov/mmwr/preview/mmwrhtml/rr4907a2.htm
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