Neisseria meningitidis

CDC

Invasive Meningococcal Disease

AAP

2005

Meningococcal Disease Five major serogroups A, B, C, Y, and W-135 Transmission via direct contact with respiratory

secretions of a nasopharyngeal carrier Most common cause of bacterial meningitis in

individuals 2-18 years Approximately 3000 cases each year Mortality rates 10-13% 10% of survivors with severe morbidity

– mental retardation– hearing loss– loss of limbs

Meningococcal Vaccines

Polysaccharide vaccine covering serogroups A, C, Y, and W-135

Single dose Revaccination if at high risk

for infection– children after 2-3 years if

<4 at time of 1st dose– consider for older children

and adults after 3-5 years

Meningococcal conjugate vaccine covering serogroups A, C, Y, and W-135

Repeat dose(s) for high risk Licensed for use in individuals

aged 9 months to 55 years (Menactra) and 2 months-55 years (Menveo)

Recommended for routine use in 11-12 year olds and repeat dose at age 16

Meningococcal Vaccine Recommendations

Also recommended for– control of serogroup C outbreaks

– individuals with immune deficiencies

– individuals with asplenia

– travelers to endemic areas

– military recruits

Incidence in College Students

Immunization Action Coalition

Vaccine Limitations

Not very effective in children less than 2 years

Does not confer 100% protection against serogroups contained in vaccine

Confers no protection from serogroup B

Short duration of protection

Confers no protection from serogroup B

Polysaccharide Conjugate

Revaccination with MCV4

Revaccinate individuals at prolonged risk of invasive disease

– Complement deficiencies– Anatomic or functional splenectomy– Prolonged exposure (microbiologists, travelers or

residents of hyperendemic or epidemic areas)

Revaccination Schedule

Revaccinate adolescents at 16 years of age

Revaccinate after 5 years if age >7 years

Revaccinate after 3 years of age 2-6 years

Continue to revaccinate at 5 year intervals if

remain in high risk group

Meningococcal Immunization for Infants MCV4 Hib-Men CY-TT

– Combination vaccine for infants– Meningococcal serotypes C and Y– Haemophilus influenzae type b – All conjugated to tetanus toxoid

MCV4 or Hib-Men CY-TT recommended for infants at high risk of invasive meningococcal disease

– Four dose series in infant immunization schedule

Vaccines for Meningococcal Serogroup B (MenB)

Meningococcal Serogroup B

Trumenba: Recombinant serogroup B fHBP protein

– (H binding protein)

Induces complement dependent antibody responses

No clinical protection confirmed 3 dose series for 10-25 year olds

Meningococcal Serogroup B

Bexsero: multicomponent; Recombinant Big increases in antibody concentrations Used in Princeton and UCSB outbreaks 2 dose series at least one month apart for

10-25 year olds

ACIP Recommendations

Either vaccine for individuals at high risk for invasive meningococcal disease starting at age 10 years

– Use same risks as for MCV4– No upper age limit

16-23 year olds may be vaccinated to provide short-term protection