Special Considerations For Concomitant Use Of Menactra And Dtap
Children can receive Menactra® before or concomitantly with diphtheria and tetanus toxoids and acellular pertussis vaccines. This timing avoids interference with the immunologic response to the meningococcal vaccine antigens that occurs when administering Menactra® after DTaP. Alternatively, children can receive Menveo® or MenQuadfi®, regardless of timing of DTaP vaccination.
Vaccines For Meningococcal Disease
There are a number of vaccines available which protect against different types of meningococcal disease. There is no one vaccine that can protect against all of the types of meningococcal disease. Different vaccines are required to protect against the most common types of meningococcal disease one to protect against meningococcal group A,C,W & Y disease, and another vaccine to protect against meningococcal group B disease. There is also a separate vaccine available to protect against meningococcal group C disease.
Simultaneous Administration With Other Vaccines
Men-C-C and 4CMenB vaccine may be administered concomitantly with routine childhood vaccines, and Men-C-ACYW vaccine may be administered concomitantly with adolescent and adult age appropriate vaccines. MenB-fHBP can be given concomitantly with quadrivalent human papillomavirus vaccine meningococcal serogroup A, C, Y, W conjugate vaccine and tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine adsorbed. The concomitant administration of MenB-fHBP has not been studied with other vaccines.
Men-C-ACYW-CRM can be administered with routine paediatric vaccines however, further studies are needed with regard to concomitant administration with pneumococcal 13-valent conjugate vaccine. Co-administration of Men-C-ACYW-CRM and combined tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine may result in a lower immune response to the pertussis antigens than when Tdap vaccine is given alone however, the clinical significance of this is unknown. Tdap vaccine given one month after Men-C-ACYW-CRM induces the strongest immunologic response to pertussis antigens.
If vaccines are to be administered concomitantly with another vaccine, a separate injection site and a different syringe must be used for each injection.
Refer to Timing of Vaccine Administration in Part 1 for additional general information.
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What Are The Side Effects From The Meningococcal Vaccines
With any vaccine, there is the potential of a severe allergic reaction within a few minutes to a few hours after the shot. But the likelihood that the meningococcal vaccines would cause a severe reaction is extremely slight.
About one out of every two people who get the shot experience mild reactions such as redness or a mild pain where the shot was given. Those usually go away in one to two days. A small percentage of people develop a mild fever.
There have been reports that a few people have been diagnosed with Guillain-Barre syndrome after receiving MCV4. But experts say it occurs so rarely that it’s not possible to tell if it’s related to the vaccine or coincidental.
Meningococcal B Vaccine Bexsero
Bexsero is broadly protective against meningococcal group B disease. Bexsero can be used to protect babies, children, adolescents and adults. Infants younger than twelve months of age need three doses to be fully protected. Older children, adolescents, and adults need two doses to be protected.
From 1 July 2021, Bexsero vaccine will be provided free of charge to close contacts of meningococcal cases of any meningococcal group , or people who are at higher risk of contracting meningococcal B disease because they:
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are pre- or post-splenectomy
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are pre- or post-solid organ transplant
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are post-bone marrow transplant
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are pre- or post-immunosuppression that will be/is longer than 28 days.
For others wishing to be protected against meningococcal B disease, Bexsero is available through your family doctor. The cost is approximately $150 per dose.
Bexsero is different to the MeNZB vaccine used in New Zealand between 2004 and 2011. The MeNZB vaccine was designed to target a specific type of meningococcal group B bacterium that only caused disease here in New Zealand. MeNZB was not meant for long term use. The vaccine was withdrawn once the rate of disease was significantly reduced. However, the active component of the MeNZB vaccine has contributed to the successful development of Bexsero.
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Meningitis B Is A Killer
Meningococcal group B bacteria are a serious cause of life-threatening infections worldwide, including meningitis and .
They’re also the leading infectious killer of babies and young children in the UK.
There are 12 known groups of meningococcal bacteria, and group B is responsible for about 9 in every 10 meningococcal infections in the UK.
Meningitis and sepsis caused by meningococcal group B bacteria can affect people of any age but are most common in babies and young children.
While most young children recover from MenB, around 1 in 20 die from the infection.
Many of those who survive have a permanent disability, such as brain damage, epilepsy, hearing loss, or the loss of limbs .
Why Get Immunised Against Meningococcal Disease
Meningococcal disease is a very serious infection that can cause severe scarring, loss of limbs, brain damage and death.
Vaccination is a safe and effective way to protect yourself from meningococcal disease.
Meningococcal disease is most commonly caused by types A, B, C, W and Y. Vaccines can protect against all these types, but different vaccines protect against different types. No single vaccine protects against all types.
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Diphtheria Tetanus And Pertussis Vaccination
Routine vaccination
- 5-dose series at 2, 4, 6, 1518 months, 46 years
- Prospectively: Dose 4 may be administered as early as age 12 months if at least 6 months have elapsed since dose 3.
- Retrospectively: A 4th dose that was inadvertently administered as early as age 12 months may be counted if at least 4 months have elapsed since dose 3.
Catch-up vaccination
- Dose 5 is not necessary if dose 4 was administered at age 4 years or older and at least 6 months after dose 3.
- For other catch-up guidance, see Table 2.
Special situations
- Wound management in children less than age 7 years with history of 3 or more doses of tetanus-toxoid-containing vaccine: For all wounds except clean and minor wounds, administer DTaP if more than 5 years since last dose of tetanus-toxoid-containing vaccine. For detailed information, see www.cdc.gov/mmwr/volumes/67/rr/rr6702a1.htm.
Where And When Can I Get The Vaccine
Talk to your doctor or local public health clinic to find out where and when your child should get vaccinated.
- The cost of Men-C-C is covered everywhere in Canada.
- Many provinces currently cover the cost of MCV-4 vaccine.
- Currently, no provinces or territories cover the cost of Men-B vaccine for all children. Some provide it for children at high risk of getting meningococcal disease.
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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.
Variations From The Vaccine Data Sheets
The MenACWY-D data sheet states that the vaccine is indicated for use in individuals aged 9 months to 55 years. The Ministry of Health recommends that this vaccine can be used in adults aged over 55 years.
The data sheet states that MenACWY-D should be given as a single dose for individuals aged 2 years and older. The Ministry of Health recommends that two doses are given to individuals at high risk of meningococcal disease , with booster doses every five years. If the first MenACWY-D dose was given before age 7 years, give a booster after three years then five-yearly.
A history of GBS is listed as a precaution in the MenACWY-D data sheet. However, there is no evidence of an association between meningococcal conjugate vaccines and GBS . The Ministry of Health advises that, if indicated, MenACWY-D may be administered to individuals with a history of GBS.
The MenC data sheet states that the first dose of vaccine is not be given earlier than age 8 weeks. However, the Ministry of Health recommends that MenC may be given from age 6 weeks to infants at high risk of meningococcal disease .
The 4CMenB data sheet states that the vaccine is indicated from age 2 months or older. However, the Ministry of Health recommends that 4CMenB can be given from age 6 weeks to infants at high risk of meningococcal disease .
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Schedule For Children Who Are More Likely To Get Meningitis
Younger kids will need a vaccine if they’re at a greater risk of getting meningitis because they:
- Have complement component deficiency, a rare immune system disease
- Have spleen damage or had their spleen removed
- Live in an area that had a meningitis outbreak
- Take drugs that affect their immune system
- Travel to a country where meningitis is common
For these cases, doctors strongly recommend MenACWY for kids ages 2 months to 10 years. The number of doses and boosters your child needs depends on their health, age, and how long they stay at risk for the disease. For example, a child with spleen damage will be at risk longer than someone who travels for a week to a country where meningitis is common. Check with your doctor to find out what your child needs.
Doctors also recommend that kids ages 10 and older with these risks get the standard doses of MenB.
Can The Meningococcal Vaccine Cause Meningococcal Disease
The short answer is no. There are actually four meningococcal vaccines licensed in the U.S. None of the vaccines contains live bacteria.
The vaccines contain antigens — substances that trigger the body’s immune system and cause it to make antibodies. These antibodies then protect the body by attacking and killing the bacteria if it should invade your system.
The first vaccine — meningococcal polysaccharide vaccine or MPSV4 — was approved in 1978. It’s made with the antigens contained in the outer polysaccharide or sugar capsule that surrounds the bacterium.
The meningococcal conjugate vaccine or MCV4 was approved in 2005. It uses antigens taken from the polysaccharide capsule and then bound to a separate protein that targets the body’s immune cells. This makes it easier for the body’s immune system to see and recognize the antigens.
One type of MCV4, Menveo, is licensed for use in people ages 2 to 55. Another version, Menactra, is approved for those 9 months to 55 years old. MPSV4 is the only vaccine licensed for use in people over 55 as well as people 2 to 55. Both vaccines protect against four types of meningococcal disease.
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Side Effects Of The Menb Vaccine
Babies given the MenB vaccine alongside their other routine vaccinations at 8 and 16 weeks are likely to develop a high temperature within 24 hours of vaccination.
It’s important to give your baby liquid paracetamol following vaccination to reduce this risk. Your nurse will advise you about using children’s paracetamol at your vaccination appointment.
Other common side effects of the MenB vaccine include:
- pain, swelling or redness where the injection was given
- diarrhoea or being sick
- crying and irritability
The liquid paracetamol will also help with these symptoms.
An allergic reaction is a rare side effect of the MenB vaccine. This may be a rash or itching that affects part or all of the body.
Very rarely, a baby may have a severe allergic reaction after having the MenB vaccine.
Childhood Program: 6 Weeks To 12 Months
- Children commencing the vaccine schedule between 6 weeks and 12 months of age require 3 doses in total .
- Bexsero should be routinely administered at 6 weeks, 4 and 12 months of age. This aligns with the usual schedule points for the National Immunisation Program vaccines.
- Children who were born from 1 October 2017 are eligible under the ongoing Childhood Program which commenced on the 1 October 2018. These children can receive funded Bexsero vaccine for missed doses if they did not receive them at the recommended schedule points. Those commencing the vaccine schedule at 12 months of age or older require 2 doses in total with a minimum interval of 8 weeks between doses.
- Bexsero can be safely administered with other NIP vaccines.
Fever in young children aged less than 2 years is a common and expected adverse event following Bexsero administration. Paracetamol is recommended with every dose of Bexsero for those aged less than 2 years.
The first dose of paracetamol is recommended within 30-minutes prior to, or as soon as practicable, after vaccination. This is followed by two more doses of paracetamol given 6 hours apart, even if the child does not have a fever. Doses of paracetamol should be administered as per the manufacturers guidelines. Refer to the Managing possible fever after meningococcal B vaccine administration .
From 1 July 2020 the Commonwealth Government included the meningococcal B vaccine on to the National Immunisation Program for:
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Is It Possible To Get The Vaccine And Still Get Meningitis
Because the vaccines do not protect against all causes of meningitis, it is still possible that someone could receive the vaccine and still get meningitis from a different strain not protected by the vaccine. But the risk of contracting meningococcal meningitis is significantly lower after the vaccine.
There are other causes of meningitis that are preventable. Vaccines like the Hib vaccine and the pneumococcal vaccine are also very effective at protecting against other causes of meningitis and should be included as part of a routine childhood vaccination schedule. Check with your doctor and your children’s doctor to make sure that you and your family are protected against meningitis, as well as other serious illnesses.
Who Should Not Get The Meningococcal Vaccine Or Should Wait To Get It
- Your child should not get the vaccine if he or she has had an allergic reaction to the vaccine or any component of the vaccine, such as thimerosal . Tell your child’s healthcare provider if your child has any severe allergies.
- Your child should wait to get the vaccine if he or she is sick or has a fever.
- If your older child is pregnant, ask her healthcare provider before she gets the vaccine. The provider will tell you if she should wait to get the vaccine until after she delivers or stops breastfeeding. He or she can talk to you and your child about the possible risks from the vaccine. She may still need to get the vaccine if her risk for meningitis is high.
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What Is The Meningococcal Vaccine
The meningococcal vaccine is an injection given to protect your child from certain types of meningococcal disease. Meningococcal disease is an infection caused by meningococci bacteria. The infection may cause serious disease, such as meningitis. Meningitis causes swelling of the fluid and lining that covers your child’s brain and spinal cord. Meningococcal disease is spread from person to person through the air. The vaccine begins to protect your child 1 to 2 weeks after he or she gets it. The vaccine may protect him or her for 3 to 5 years.
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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Persons With Chronic Diseases
Asplenia
Two doses of Men-C-ACYW vaccine are recommended for persons with anatomic or functional asplenia, including sickle cell disease. When elective splenectomy is planned, all recommended vaccines should ideally be completed at least 2 weeks before surgery if only one dose can be given before surgery, the second dose should be given 8 weeks after the first dose, with a minimum interval of 4 weeks. In the case of an emergency splenectomy, two doses of vaccine should ideally be given beginning 2 weeks after surgery but can be given earlier, before discharge, if the person might not return for vaccination after discharge. Persons one year of age and older with asplenia who have not received Men-C-ACYW vaccine should receive two doses administered 8 weeks apart, with a minimum interval of 4 weeks. In addition, 4CMenB or MenB-fHBP vaccine should be offered. Periodic booster doses with Men-C-ACYW vaccine are also recommended.
Refer to Table 1 for vaccination recommendations of high risk individuals due to underlying conditions. Refer to Booster doses and re-immunization for additional information and Immunization of Persons with Chronic Diseases in Part 3 for additional general information.