• American Academy of Pediatrics Committee on Infectious Diseases. Prevention and control of meningococcal disease: recommendations for use of meningococcal vaccines in pediatric patients. Pediatrics 2005 Aug;116(2):496-505. PubMed

• October 23, 2006 update, Menactra (Meningococcal Conjugate Vaccine): Updated alert to consumers and health care providers regarding reports of Guillain Barre Syndrome (GBS) following administration of Meningococcal Conjugate Vaccine A, C, Y, and W135.
• October 3, 2005, Menactra (Meningococcal Conjugate Vaccine): The U.S. Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) notified consumers and health care providers of five reports of Guillain Barre Syndrome following administration of Meningococcal Conjugate Vaccine A, C, Y, and W135 (trade name Menactra).

1. Two cohorts of adolescents should be immunized routinely with meningococcal conjugate vaccine (MCV4): 1) young adolescents at the 11- to 12-year visit; and 2) adolescents at high school entry or 15 years of age, whichever comes first (both evidence grade I). Within 3 years, the goal will be routine immunization of all adolescents with MCV4 beginning at 11 years of age.
2. Adolescents should visit a health care professional at 11 to 12 years of age, when immunization status and other preventive services can be addressed. Subsequent annual visits throughout adolescence also are recommended for all adolescents.
3. Entering college students who plan to live in dormitories should be immunized with MCV4 routinely (evidence grade II-2).
4. People at increased risk of meningococcal disease should be immunized with MCV4 if they are at least 11 years of age. These persons include:
   • Adolescents who have a terminal complement deficiency or adolescents who have anatomic or functional asplenia (evidence grade II-3)
   • Adolescents who travel to or reside in countries where Neisseria meningitidis is hyperendemic or epidemic (U.S. Centers for Disease Control and Prevention [CDC] Travelers' Health Hotline 877/FYI-TRIP or online at www.cdc.gov/travel/) (evidence grade II-3)
5. Because people with human immunodeficiency virus (HIV) infection are likely to be at higher risk of meningococcal disease, although not to the extent that they are at risk of invasive Streptococcus pneumoniae infection, they may elect to be immunized with MCV4 if they are at least 11 years of age.
6. Children 2 to 10 years of age at increased risk of meningococcal disease (see recommendations 3 and 4) should be immunized with meningococcal polysaccharide vaccine (MPSV4), because MCV4 is not yet licensed for use in these children.
7. People who wish to decrease their risk of meningococcal disease may elect to receive MCV4 if they are 11 years or older.
8. For control of meningococcal outbreaks caused by vaccine-preventable serogroups (A, C, Y, or W-135), MPSV4 or MCV4 should be used for people 11 years or older (evidence grade II-2). MCV4 is preferred, but MPSV4 is acceptable. For children 2 to 10 years of age, MPSV4 should be used.
9. Immunization with MCV4 may be indicated for adolescents previously immunized with MPSV4. These people should be considered for reimmunization 3 to 5 years after receiving MPSV4 if they remain at increased risk of meningococcal disease.
10. Public and private insurers should be responsible for payment of costs of MCV4, its administration to adolescents for whom MCV4 is recommended, and administrative costs involved in providing vaccines to high-risk people.

Evidence Grading

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

• American Academy of Pediatrics Committee on Infectious Diseases. Prevention and control of meningococcal disease: recommendations for use of meningococcal vaccines in pediatric patients. Pediatrics 2005 Aug;116(2):496-505. PubMed

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