This is the current release of the guideline.

American Academy of Pediatrics (AAP) Policies are reviewed every 3 years by the authoring body, at which time a recommendation is made that the policy be retired, revised, or reaffirmed without change. Until the Board of Directors approves a revision or reaffirmation, or retires a statement, the current policy remains in effect.

Meningococcal disease

Prevention

Family Practice
Internal Medicine
Obstetrics and Gynecology
Pediatrics
Preventive Medicine

Advanced Practice Nurses
Allied Health Personnel
Health Plans
Hospitals
Managed Care Organizations
Nurses
Physician Assistants
Physicians

To provide the rationale for use of meningococcal conjugate vaccine (MCV4) in adolescents and to update recommendations for use of the meningococcal polysaccharide vaccine (MPSV4) in pediatric patients

• Pediatric patients aged 11 years and older
• Children 2 to 10 years of age at increased risk of meningococcal disease

1. Annual visits to a health care professional
2. Immunization with:
   • Tetravalent meningococcal (A,C,Y,W-135) polysaccharide vaccine (MPSV4 [Menomune-A/C/Y/W-135])
   • Tetravalent meningococcal (A,C,Y,W-135) conjugate vaccine (MCV4 [Menactra])
3. Reimmunization of individuals previously vaccinated

• Rate of meningococcal disease among vaccinated populations
• Occurrence of outbreaks of meningococcal disease
• Immunogenicity and clinical efficacy of meningococcal vaccines
• Duration of protection after meningococcal vaccination
• Adverse reactions following immunization

Hand-searches of Published Literature (Primary Sources)
Searches of Electronic Databases
Searches of Unpublished Data

Not stated

Not stated

Weighting According to a Rating Scheme (Scheme Given)

Rating System of Quality of Scientific Evidence

I. Evidence obtained from at least 1 properly designed, randomized, controlled trial

II-1. Evidence obtained from well-designed, controlled trials without randomization

II-2. Evidence obtained from well-designed cohort or case-control analytic studies, preferentially from more than 1 center or group

II-3. Evidence obtained from multiple time series with or without intervention or dramatic results in uncontrolled experiments (such as the results of the introduction of penicillin treatment in the 1940s)

III. Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees

Review

Not stated

Expert Consensus

Not stated

Not applicable

Cost of Meningococcal Vaccines

Whether universal immunization of adolescents with tetravalent A, C, Y, W-135 meningococcal vaccine would result in a net cost or a net savings to society is dependent on invasive meningococcal disease (IMD) incidence, which varies by year, the rates of death or permanent sequelae, and the cost of immunization. A recent study from the U.S. Centers for Disease Control and Prevention (CDC) suggests that universal immunization of adolescents would be cost-effective. However, variations in the epidemiology of and outcomes from IMD by region make it impossible to generate a precise estimate of cost-benefit. If, as expected, universal adolescent immunization with meningococcal conjugate vaccine (MCV4) becomes a reality in the next few years, more precise estimates should become available.

The total cost of immunizing a single adolescent with MCV4 includes direct and indirect costs. The direct costs include supplies (e.g., vaccine [MCV4 = $82.00 and meningococcal polysaccharide vaccine (MPSV4) = $86.10 per dose], syringe with needle), personnel, and administrative expenses. Public and private insurers should be responsible for payment of costs for MCV4. MCV4 is included in the Vaccines for Children program. For private insurers, avoiding financial responsibility by transferring this to intermediate risk-bearing entities (e.g., independent practice associations or other physician groups), individual physicians, or college health services will result in adolescents not being immunized in a timely fashion. Physicians incur significant administrative expenses ensuring that adolescents are immunized with recommended vaccines in a timely fashion, including explaining risk and benefits of immunization to adolescents and parents; ordering, purchasing, storing, and administering the vaccine; recording immunizations in records; and other activities. Physicians should receive reimbursement for expenses associated with each vaccine administration.

Peer Review

Not stated

None provided

The type of evidence supporting the recommendations is provided for selected recommendations (see "Major Recommendations").

Prevention of meningococcal disease and its sequelae

Adverse Reactions Following Immunization

• Among adolescents 11 to 18 years of age, safety of administering tetravalent meningococcal conjugate vaccine (MCV4) and tetravalent meningococcal polysaccharide vaccine (MPSV4) was assessed in 2 randomized controlled trials. The percentage of subjects reporting systemic adverse events was similar in both groups (see Table 4 in the original guideline document). Approximately half of the adolescents experienced at least one systemic adverse reaction, but less than 5% experienced at least one severe systemic reaction. Fever was reported by 3.4 to 5.1% of adolescents who received MCV4 and by 2.5 to 3.0% of adolescents who received MPSV4, a difference that was not significant.
• Local adverse reactions were more common among adolescents who received MCV4 than among adolescents who received MPSV4 (Table 5 of the original guideline document). Of adolescents who received MCV4, 13.1 to 16.9% reported pain that limited movement in the arm of injection, compared with 2.6 to 3.9% of adolescents who received MPSV4. These differences in frequency of local reactions could be attributable in part to different methods of administering the 2 vaccines (MCV4 is administered intramuscularly; MPSV4 is administered subcutaneously). The frequency of local adverse reactions reported after MCV4 administration was similar to that reported after tetanus and diphtheria (Td) administration, which, like MCV4, is given intramuscularly.

Immunization with meningococcal conjugate vaccine (MCV4) is contraindicated among people known to have hypersensitivity to any component of the vaccine, including diphtheria toxoid, and to dry, natural rubber latex, which is used in the vial stopper.

An implementation strategy was not provided.

Staying Healthy

Effectiveness

Not applicable: The guideline was not adapted from another source.

2005 May 25

American Academy of Pediatrics - Medical Specialty Society

American Academy of Pediatrics

Committee on Infectious Diseases

Committee on Infectious Diseases, 2003-2004: Margaret B. Rennels, MD, Chairperson; H. Cody Meissner, MD, Vice Chairperson; *Carol J. Baker, MD; Robert S. Baltimore, MD; Joseph A. Bocchini, Jr, MD; Penelope H. Dennehy, MD; Robert W. Frenck, Jr, MD; Caroline B. Hall, MD; Sarah S. Long, MD; Julia A. McMillan, MD; Keith R. Powell, MD; Lorry G. Rubin, MD; Thomas N. Saari, MD

Liaisons: Richard D. Clover, MD, American Academy of Family Physicians; Steven Cochi, MD, Centers for Disease Control and Prevention; Joanne Embree, MD, Canadian Paediatric Society; Marc Fischer, MD, Centers for Disease Control and Prevention; Bruce Gellin, MD, MPH, National Vaccine Program Office; Mamodikoe Makhene, MD, National Institutes of Health; Douglas Pratt, MD, Food and Drug Administration; Jeffrey R. Starke, MD, American Thoracic Society

Ex Officio: Larry K. Pickering, Red Book Editor

Staff: Alison Siwek, MPH

*Lead author

Not stated

This is the current release of the guideline.

American Academy of Pediatrics (AAP) Policies are reviewed every 3 years by the authoring body, at which time a recommendation is made that the policy be retired, revised, or reaffirmed without change. Until the Board of Directors approves a revision or reaffirmation, or retires a statement, the current policy remains in effect.

None available

None available

This NGC summary was completed by ECRI on July 25, 2005. The information was verified by the guideline developer on August 23, 2005. This summary was updated by ECRI on October 5, 2005 following the U.S. Food and Drug Administration (FDA) advisory on Menactra (Meningococcal Conjugate Vaccine A, C, Y, and W135). This summary was updated by ECRI on October 25, 2006 following the updated FDA advisory on Menactra (Meningococcal Conjugate Vaccine).

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions. Please contact the Permissions Editor, American Academy of Pediatrics (AAP), 141 Northwest Point Blvd, Elk Grove Village, IL 60007.