Vaccine Preventable Diseases

Meningococcal

ACIP Recs | Disease | Vaccine | References | VIS ACWY | VIS MenB | WHO modules | Archives

Adolescents
• All adolescents 11-18 years of age without contraindications should receive two doses of meningococcal conjugate vaccine (abbreviations: MCV4, MenACWY; trade names: Menactra®, Menveo®), routinely given at 11 or 12 years of age and a booster at 16 years of age.
• 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.

All Age Groups
• Vaccination to prevent meningococcal disease is also recommended for all persons starting at 9 months of age who are at increased risk for meningococcal disease (such as travelers to hyperendemic or epidemic countries; those with asplenia; or those with persistent complement component deficiency).
• Serogroup B meningococcal vaccine (trade names: Trumenba®, Bexsero®) is recommended for all persons starting at 10 years of age who are at increased risk for serogroup B meningococcal disease (such as those with persistent complement component deficiencies; those with anatomic or functional asplenia; microbiologists routinely exposed to N. meningitides; and anyone identified to be at increased risk during an outbreak of serogroup B meningococcal disease). Adolescents and young adults aged 16–23 years may also receive this vaccine, even if they are not at increased risk [2,3].

For More Information
• ACIP recommendations: https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/mening.html
• Immunization schedules: http://www.cdc.gov/vaccines/schedules/index.html

Disease

Neisseria meningitidis, or meningococcus, is an aerobic gram-negative diplococcus. Meningococci colonize the nasopharynx, and in less than 1% of colonized persons the organism invades the bloodstream. Most strains are not pathogenic; five serogroups cause almost all invasive disease (A, B, C, W, and Y). Serogroup prevalence depends heavily on geographic location as well as other factors including age. In the United States, groups B, C, and Y are primarily responsible for meningococcal disease. Rates of meningococcal disease in the US have been declining for the last few decades, so that in 2016, there were 375 reported cases in the entire US.

N. meningitides can cause bacteremia, meningococcemia, meningitis, pneumonia, and/or septic arthritis. The average incubation period is 3-4 days for meningococcemia. Disease usually presents with an abrupt onset of fever, hypotension, and rash with or without meningeal symptoms. The most common presentation of invasive disease is meningitis, usually accompanied by fever, headache and stiff neck. Fatality rates range from 10%-15% (and up to 40% in meningococcemia) for meningococcal meningitis. Less common presentations include pneumonia (5-15%), arthritis (2%), otitis media (1%) and epiglottitis (<1%) [3].

There are several meningococcal conjugate vaccines (MCVs) licensed in the United States. The MCV4 vaccines MenACWY-D (Menactra®) and MenACWY-CRM (Menveo®) protect against serogroups A, C, W and Y [3], and the single-component vaccines MenB-FHbp (Trumenba®) and MenB-4C (Bexsero®) protect against serogroup B [1].

Both MenACWY-D and MenACWY-CRM are administered via intramuscular injection and contain no preservatives or adjuvants. MenACWY-D is approved for use in persons 9 months through 55 years of age, and MenACWY-CRM is approved for use in persons 2-55 years of age [3]. MenB-FHbp and MenB-4C are approved for use in persons 10-25 years of age [1]. Hib-MenCY-TT is approved for use as a 4-dose series at 2, 4, 6, and 12-18 months of age.

Quadrivalent meningococcal polysaccharide vaccine which was a plain polysaccharide vaccine not conjugated to protein, MPSV4 (Menomune®), is no longer recommended for routine use [3].

The Hib-MenCY-TT combination vaccine MenHibrix® was discontinued in the United States in 2016 [4].

Vaccine Effectiveness: Meningococcal serogroups A and C polysaccharide vaccines have demonstrated estimated clinical efficacies of at least 85% among children and adults during outbreaks. Meningococcal conjugate vaccines were shown to achieve a seroresponse comparable to the MPSV4 and are able to elicit better immunologic memory [3].

Vaccine Safety: The most common adverse events reported for MenACWY-D are fever (17%), headache (16%), injection-site erythema (15%), dizziness (13.4%), and syncope (10%); the most common reported for MenACWY-CRM are injection site reactions (20%), injection site erythema (14%), and syncope (9%) [3]. Because syncope has been reported among adolescents receiving vaccinations, adolescent recipients should always receive the vaccine while sitting and not in view of others awaiting vaccination, and be observed for up to 15 minutes immediately after vaccination [5-8]. Serious adverse events* are rare. Hib-MenCY-TT had rates of adverse events comparable to Hib-TT vaccine [3].

The most common adverse reactions reported for both MenB-FHbp and MenB-4C included pain at the injection site (≥83%), fatigue (≥35%), headache (≥33%), and myalgia (≥30%) [1].

Contraindications and Precautions: Severe allergic reaction (e.g. anaphylaxis) to a previous dose or vaccine component is a contraindication to further vaccination with meningococcal vaccines. Current moderate to severe acute illness is a precaution to any vaccination [3].

Considerations in Pregnancy: Meningococcal vaccines are not routinely recommended during pregnancy. However, pregnancy should not preclude indicated MenACWY vaccination. MenB vaccination should be deferred in pregnant and lactating women unless the woman is at increased risk.

No randomized, controlled clinical trials have been conducted to evaluate use of MenACWY or MenB vaccines in pregnant or lactating women. However, pregnancy should not preclude indicated MenACWY vaccination. MenB vaccination should be deferred in pregnant and lactating women unless the woman is at increased risk, and, after consultation with her health care provider, the benefits of vaccination are considered to outweigh the potential risks [1, 9].

During January 1, 2005–June 30, 2010, a total of 80 reports were submitted to VAERS regarding pregnant women or infants born to women who received MenACWY-D during pregnancy. No concerning patterns of adverse events after MenACWY-D in pregnancy were identified [10].

* A serious adverse event is defined by the Food and Drug Administration (FDA) as resulting “in any of the following outcomes: Death, a life-threatening adverse event, inpatient hospitalization or prolongation of existing hospitalization, a persistent or significant incapacity or substantial disruption of the ability to conduct normal life functions, or a congenital anomaly/birth defect. Important medical events that may not result in death, be life-threatening, or require hospitalization may be considered serious when, based upon appropriate medical judgment, they may jeopardize the patient or subject and may require medical or surgical intervention to prevent one of the outcomes listed in this definition.” This definition is found in Title 21, §312.32 of the Electronic Code of Federal Regulations.

References

1. MacNeil JR, Rubin L, Folaranmi T, Ortega-Sanchez IR, Patel M, Martin SW. Use of Serogroup B Meningococcal Vaccines in Adolescents and Young Adults: Recommendations of the Advisory Committee on Immunization Practices, 2015. MMWR Morb Mortal Wkly Rep. 2015;64(41):1171-6.
2. Patton ME, Stephens D, Moore K, MacNeil JR. Updated Recommendations for Use of MenB-FHbp Serogroup B Meningococcal Vaccine - Advisory Committee on Immunization Practices, 2016. MMWR Morb Mortal Wkly Rep. 2017;66(19):509-13.
3. Epidemiology and Prevention of Vaccine-Preventable Diseases. In: Hamborsky J KA, Wolfe S ed. 13 ed. Washington D.C.: Centers for Disease Control and Prevention; 2015.
4. GlaxoSmithKline 2016; Menhibrix Discontinuation Notice.
5. Kroger AT, Duchin J, Vazquez M. General Best Practice Guidelines for Immunization. Best Practices Guidance of the Advisory Committee on Immunizaition Practices (ACIP). 2017. Last accessed May 2018.
6. Syncope after vaccination--United States, January 2005-July 2007. MMWR Morb Mortal Wkly Rep. 2008;57(17):457-60.
7. Braun MM, Patriarca PA, Ellenberg SS. Syncope after immunization. Arch Pediatr Adolesc Med. 1997;151(3):255-9.
8. Bernard DM, Cooper Robbins SC, McCaffery KJ, Scott CM, Skinner SR. The domino effect: adolescent girls' response to human papillomavirus vaccination. Med J Aust. 2011;194(6):297-300.
9. MacNeil JR, Rubin LG, Patton M, Ortega-Sanchez IR, Martin SW. Recommendations for Use of Meningococcal Conjugate Vaccines in HIV-Infected Persons - Advisory Committee on Immunization Practices, 2016. MMWR Morb Mortal Wkly Rep. 2016;65(43):1189-94.
10. Cohn AC, MacNeil JR, Clark TA, Ortega-Sanchez IR, Briere EZ, Meissner HC, et al. Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2013;62(Rr-2):1-28.