Vaccines For Adults Increasing Opportunities For Health
Historically, vaccines were deemed to be only for children. However, vaccines for adults are becoming increasingly common and necessary. Most adults think only of the tetanus booster recommended every 10 years and even then, many adults only get the vaccine if they injure themselves. In 2005, the Tdap vaccine was licensed as an improved version of the typical tetanus booster, Td. The newer version also contains a component to protect against pertussis . All adults, especially those who are going to be around young infants, should get the Tdap vaccine. Adults often unwittingly pass pertussis to young infants for whom the disease can be fatal. In 2012, the CDC recommended that pregnant women get a dose of Tdap during each pregnancy between 27 and 36 weeks gestation. In 2019, the CDC recommended that Tdap or Td vaccine could be used for booster dosing every 10 years.
Influenza vaccines, available since the 1940s, are now recommended for most adults. Vaccines like MMR and chickenpox are recommended for adults who have not had the diseases, and vaccines including hepatitis A, hepatitis B, pneumococcus, and meningococcus are recommended for sub-groups of the adult population. The HPV vaccine became available in 2006. In 2018, the license was expanded to include people up to 45 years of age.
The first formal adult immunization schedule was published in 2002 and is updated annually.
Available Vaccines And Vaccination Campaigns
Five serogroupsgroups of bacteria that contain a common antigen that can generate an immune responseare collectively responsible for nearly all invasive meningococcal disease: groups A, B, C, Y, and W-135. Four of these are covered by quadrivalent meningococcal vaccines used in the United States.
There are two main types of meningococcal vaccines. A meningococcal polysaccharide vaccine has been available since the 1970s. However, like the polysaccharide vaccine against pneumococcal disease, it is most effective in adults and does not consistently generate immunity in young children.
The first conjugate meningococcal vaccine in the United States, MCV4 , was licensed in 2005, with a second, MenACWY-CRM , licensed in 2010. These are the preferred vaccines for individuals between two years and 55 years of age Menactra is approved for ages two to 55, and Menveo for ages 11 to 55.
Vaccines for group B meningococcal disease were licensed in the United States in 2014 and 2015. MenB-FHbp is a two-dose vaccine.
Common And Local Adverse Events
Conjugate meningococcal vaccines
Men-C-ACYW vaccines
Injection site reactions occur in up to 59% of vaccinees. Fever is reported in up to 5% of recipients and systemic reactions, such as headache and malaise, are reported in up to 60% of recipients.
Men-C-C vaccines
Mild reactions, including injection site reactions , occur in up to 50% of vaccine recipients. Irritability occurs in up to 80% of infants and fever in up to 9% when other vaccines were administered. Headaches and malaise occur in up to 10% of older children and adults. These reactions last no more than a few days.
Serogroup B Meningococcal vaccines
4CMenB vaccine
Solicited local and systemic reactions have been commonly reported in clinical trials and include injection site tenderness, induration, sleepiness and irritability. Higher rates of fever have been observed with simultaneous administration of 4CMenB vaccine and routine infant vaccines therefore, routine prophylactic administration of acetaminophen or separating 4CMenB vaccination from routine vaccination schedule has been proposed for preventing fever in infants and children up to three years of age.
MenB-fHBP vaccine
Solicited local and systemic reactions have been commonly reported in clinical trials and include injection site tenderness, induration and irritability.
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The Meningococcal A Polysaccharide Vaccine
After the trial in Yako in 1967, many doses of the prototype vaccine developed by the Institut Mérieux were sent to different African countries to test different features of the vaccine, such as the effect on germ carriers and the effect of the vaccine on the morbidity rate, but until 1969 no subsequent attempt was made to evaluate the efficacy of the vaccine.
Although Sudan refused, an agreement was reached with Mali another one of the four countries targeted at the round table to conduct a trial in December 1969. For this experiment, following discussions as the round table, the Institut Mérieux had prepared 40 000 doses of vaccine batch V1 S004 and an equal quantity of placebo. However, the Malian vaccine trial never took place. The Dakar pilot trial was inconclusive and the meningococcal A polysaccharide vaccine batch V1 S004 showed no immunogenicity. Following this disappointment, the WHO had wanted to quickly arrange another pilot trial in Dakar with a new batch of vaccine, but Rey was no longer available. Furthermore, a yellow fever epidemic broke out in Mali in early December, and the countrys health authorities were no longer interested in a meningococcal vaccine trial. With the vaccines immunogenicity problem, the impossibility of carrying out a new pilot trial and the need to find another country in which to perform a full vaccine trial, the protagonists had to think again.
What Happens After The Immunization
Your child might have a fever, soreness, and some swelling and redness at the injection area. Check with your doctor to see if you can give either acetaminophen or ibuprofen for pain or fever and to find out the right dose.
A warm, damp cloth or a heating pad on the injection site may help reduce soreness, as can moving or using the arm.
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Effectiveness Of The Menacwy Vaccine
The type of meningococcal vaccine that most young adults get is generally called the MenACWY vaccine, which protects against four strains of the Neisseria meningitidis bacteria.
Since the CDC recommended vaccination for adolescents in 2005, cases of meningococcal disease fell by 90%. Similar declines werent seen in groups that didnt have this vaccine recommendation.
Other studies also noted a large drop in meningococcal disease since the vaccine was introduced. One 2020 paper in JAMA Pediatrics analyzed the national rates of meningococcal disease between 2000 and 2005 and compared it to 2011 to 2017 .
The annual incidence rates of three strains of meningococcal disease were already dropping in the pre-vaccine period by about 14.6% among adolescents 16 to 22 years old. But that drop accelerated after vaccine introduction. Between 2011 and 2017, the incidence of meningitis due to these strains dropped by 35.6% per year.
This suggests that MenACWY vaccination is related to the drop in meningococcal disease among adolescents, though vaccination alone cant explain this decline. But other studies have replicated these results in other populations.
A study compared meningococcal disease cases and deaths in the Republic of Korea Armed Forces between 2008 and 2013 and 2013 to 2016 . Data showed the MenACWY vaccine is 88% effective in protecting against meningococcal disease.
Countries Where Both Meningococcal Quadrivalent Polysaccharide And Quadrivalent Polysaccharide
There are two meningococcal vaccines available in the United States, MC-4 and MPS-4 and The Advisory Committee on Immunization Practices has published recommendations on their use.128 These vaccines as well as monovalent group C conjugate vaccines are also available in Canada. Selected properties of these vaccines are shown in Table 19-4. MPS-4 vaccine can be given both to adults and to children 2 years of age and over, whereas as of July 2006, MC-4 was recommended in the U.S. only for 1155-year-olds. However, in Canada MC-4 vaccine is also licensed for use in children 210 years of age. Routine MPS-4 vaccination of civilian populations is not recommended, primarily because of limited effectiveness in young children, the age group at greatest risk of acquiring disease, and minimal if any effect on decreasing N. meningitidis nasopharyngeal carriage in the population.
MC-4 vaccine elicits serum bactericidal antibodies of superior quality and persistence than those elicited by MPS-4 vaccine and there also is the potential for vaccination to decrease meningococcal carriage. Therefore, once MC-4 vaccine was licensed in the U.S. for persons 11 to 55 years, there was the potential to introduce routine meningococcal vaccination into the general population. The ACIP recommended routine immunization of adolescents at 11-12 years of age or, if not given at that age, before starting high school128. College freshmen living in dormitories also should receive vaccine.
Revaccination
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What Are The Symptoms Of Meningococcal Disease
Signs and symptoms of meningococcal disease include sudden onset of fever, stiff neck, headache, nausea, vomiting, sensitivity to light and/or mental confusion. A rash may also be present. Changes in behavior such as confusion, sleepiness, and unresponsiveness are important symptoms of illness. Anyone who has these symptoms should be seen by a healthcare provider immediately. In fatal cases, death can occur in as little as a few hours, even with appropriate medical treatment. Less common presentations include pneumonia and arthritis.
Measles Mumps And Rubella
Measles, Mumps, and Rubella are viral infections that have each caused widespread, deadly disease outbreaks. Throughout the 1960s, individual vaccines were developed for each of them, but a decade later, they were combined into one.
Measles was the first of the three to receive its own vaccine in 1963, followed by mumps in 1967, and rubella in 1969. Two years later, in 1971, Maurice Hilleman of the Merck Institute of Therapeutic Research developed a combined vaccination that would provide immunity for all three viruses.
Hilleman was credited with creating the first measles and mumps vaccine, and began researching ways to incorporate a system of immunity for each virus. Using his previous research and a rubella vaccine developed by Stanley Plotkin in 1969, he created the first successful MMR vaccine in just two years.
According to the CDC, “One dose of MMR vaccine is 93% effective against measles, 78% effective against mumps, and 97% effective against rubella.”
“Two doses of MMR vaccine are 97% effective against measles and 88% effective against mumps.”
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Vaccines For Adolescents: A New Generation Of Vaccines
Adolescents, like adults, were recommended to get tetanus boosters every 10 years most requiring their first booster dose around age 11. Other than this, however, most adolescents did not require additional vaccines unless they missed one in childhood. By 2005, vaccines specifically recommended for adolescents were only recommended for sub-groups based on where they lived or medical conditions that they had. However, a new group of vaccines became available in the latter part of the decade.
- New vaccines: Tdap, 2005, meningococcal conjugate , HPV , meningococcal serogroup B vaccine
- Additional recommendations for existing vaccines: HPV , intranasal influenza vaccine
- New versions of existing vaccines: HPV
- Discontinuation of vaccine: intranasal influenza vaccine
2000
Pneumococcus
Global Public Health Response Elimination Of Meningococcal A Meningitis Epidemics In The African Meningitis Belt
In the African meningitis belt, meningococcus serogroup A accounted for 8085% of meningitis epidemics before the introduction of a meningococcal A conjugate vaccine through mass preventive campaigns and into routine immunization programmes . As of April 2021, 24 of the 26 countries in the meningitis belt have conducted mass preventive campaigns targeting 1-29 year olds , and half of them have introduced this vaccine into their national routine immunization schedules. Among vaccinated populations, incidence of serogroup A meningitis has declined by more than 99% – no serogroup A case has been confirmed since 2017. Continuing introduction into routine immunization programmes and maintaining high coverage is critical to avoid the resurgence of epidemics.
Cases of meningitis and outbreaks due to other meningococcal serogroups, apart from serogroup B, continue to strike. The roll out of multivalent meningococcal conjugate vaccines is a public health priority to eliminate bacterial meningitis epidemics in the African Meningitis Belt.
Pneumococcus
The pneumococcus has over 97 serotypes, 23 causing most disease.
Haemophilus influenzae
Haemophilus influenzae has 6 serotypes, serotype b causing most meningitis.
- Conjugate vaccines protect specifically against Haemophilus influenzae serotype b . They are highly effective in preventing Hib disease and are recommended for routine use in infant vaccine schedules.
Group B streptococcus
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Meningococcal Acw & Y Vaccine Menactra Or Nimenrix
Menactra is a meningococcal conjugate vaccine to protect against meningococcal groups A, C, W and Y. Menactra is approved for use for those aged 9 months to 55 years.
From 1 December 2019, people aged 13-25 years living in boarding school hostels, tertiary education halls of residence, military barracks, or prisons, can receive a single dose of meningococcal ACWY vaccine free of charge. The catch-up programme is only available until 30 November 2021. For more details see Section 13.5 of the Immunisation Handbook 2020.
The vaccine is funded for children and adults with a medical condition that increases their risk of invasive meningococcal disease AND is listed on the Pharmaceutical Schedule.
Menactra is also available as a purchased vaccine through your family doctor. The cost is approximately $150 per dose. For children aged 9 – 23 months, two doses are given at least three months apart. For individuals aged 2 – 55 years, one dose is given.
Guidelines For Other Locations
Country-specific guidelines have been developed for other regions of the world . Guidance for Australia and Canada are shown in Table 2 . Overall, vaccine strategies against meningococcal disease vary worldwide and should be based on local epidemiologic trends derived from ongoing surveillance data. Since Neisseria are capable of undergoing capsular switching and serogroup/ST replacement can occur over time, continued reassessment of trends and serogroups is advocated to ensure optimal vaccine programs. The importance of surveillance in serogroup trends is exemplified by the global spread of serogroup W causing severe cases of invasive disease .
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Who Guidance For High
Populations significantly affected by meningococcal disease should be prioritized for vaccination with the choice of vaccine dependent on locally prevalent N. meningitidis serogroups. The World Health Organization recommends that countries with high or intermediate endemicity conduct large-scale meningococcal vaccine programs. Additionally, countries with frequent epidemics of invasive disease should also initiate vaccination programs. Mass vaccination campaigns should consider immunizing young persons , with a preference for the use of a conjugate vaccine given its potential for population protection . Reduced carriage rates and population protection have been demonstrated after conjugate vaccine campaigns in both the UK and Africa . Surveillance of disease rates and serogroups are advocated after such campaigns to evaluate the need for repeat vaccine campaigns and use within the routine immunization programs.
What Is Meningococcal Disease
Meningococcal disease is caused by infection with bacteria called Neisseria meningitidis. These bacteria can infect the tissue that surrounds the brain and spinal cord and cause meningitis, or they may infect the blood or other body organs. Onset of illness may be very sudden, and 10-15% die despite receiving antibiotic treatment. Of those who survive, 10-20% may lose limbs, become hearing impaired or deaf, have problems with their nervous system, including long-term neurologic problems, or have seizures or strokes.
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A Meningococcal Capsular Group A Conjugate Vaccine For Africa
For the past two decades, the only meningococcal vaccines available in sub-Saharan Africa were a bivalent group A and C and a trivalent group A, C, and W135 polysaccharide vaccine . These vaccines are poorly immunogenic in infants, the age group at greatest risk of acquiring disease, and have only a transient effect, if any, on colonization and spread of infection. For these reasons, meningococcal vaccination in Africa was largely done in response to epidemics, which was a logistically challenging strategy. Although an emergency response plan had been developed in collaboration with the WHO and the CDC,436 implementation was often delayed because of limitations of surveillance or logistics. One study estimated that even under optimal circumstances, fewer than 60% of outbreak-related cases were prevented by implementing vaccination after an epidemic was recognized.436 An improved meningococcal vaccine, therefore, was needed.
In , 2016
What Are The Risks Of Gbs With The Mcv4 Vaccine
Between 2005 and 2012, more than 18 million doses of MCV4 were distributed. It’s uncertain how many of those have actually been given. In that same time period, there have been 99 confirmed cases of GBS, a serious nervous system disorder, reported within six weeks of the vaccine being taken. There is not enough data at this time to tell whether or not the vaccine was a factor. But analysis of the data suggests that the incidence of GBS is no higher for people receiving the vaccine than the incidence of GBS in the general population.
Still, the timing of the onset of symptoms has raised concern. The CDC is continuing to study the issue and has recommended that people be told about the study when they are considering the vaccine. The current opinion is that even if there is a slight increase in the risk of GBS, it’s significantly outweighed by the risk of meningococcal disease without the vaccine.
Talk to your doctor if you have any further concerns about the vaccine and GBS.
Show Sources
Pediatrics, published online Feb. 1, 2011. CDC web site: “Meningitis Questions & Answers,” “Meningococcal Vaccines: What You Need to Know,” “Meningococcal Vaccination,” “Vaccines and Preventable Diseases: Meningococcal: Who Needs to Be Vaccinated?” “Meningococcal vaccine side-effects,” “GBS and Menactra Meningococcal Vaccine.”
VaccineInformation.org: “Meningococcal Disease Vaccine.”
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Meningitis B Vaccine Added To Uk Child Immunisation Scheme
Government reaches deal with GlaxoSmithKline on price of Bexsero, which was recommended by vaccination advisers a year ago
All babies in the UK will soon have a potentially life-saving vaccine against meningitis B under a landmark deal, the health secretary has announced.
Jeremy Hunt said Britain would become the first country in the world with a nationwide meningitis B vaccination programme, after the government reached an agreement with the drugmaker GlaxoSmithKline .
The decision follows recent controversy over the Bexsero MenB vaccine after it emerged that it was still not available to children despite being recommended by health advisers a year ago.
The drug will now be added to the national childhood immunisation scheme, meaning babies will receive the first vaccine at two months old, followed by two further doses.
Hunt said: I am very proud that we will be the first country in the world to have a nationwide MenB vaccination programme, helping to protect our children from a devastating disease.
MenB can be severely disabling or fatal, especially in babies and young children. Losing a child is every parents worst nightmare so I am delighted that we have reached an agreement with GSK to supply the vaccine.
Discussions between the department and the drug company over the price of the vaccine began in August last year, following the advice from the Joint Committee on Vaccination and Immunisation .