Meningococcal Disease Epidemiology In Brazil And Impact Of Menc Vaccination
In Brazil, infant MenC vaccination was introduced in 2010.
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We evaluated nationwide surveillance data across 20052018 to assess vaccine impact.
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Incidence and mortality of MenC disease declined substantially in children < 5 years.
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Disease due to other serogroups e.g., B and W remains a concern.
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Recent infant MenC vaccine uptake has declined .
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Adolescent vaccine uptake remains low .
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
What Are The Possible Side Effects Of Meningococcal Vaccines
Some of the most common side effects are swelling, redness, and pain at the site of the injection, along with headache, fever, or tiredness. Serious problems, such as allergic reactions, are rare.
The meningococcal vaccines contains only a small piece of the germ, so it can’t cause meningococcal disease.
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Quadrivalent Meningococcal Conjugate Vaccines
In 2005, the first quadrivalent meningococcal conjugate vaccine conjugated to diphtheria toxin was licensed by the US Food and Drug Administration. A second MenACWY vaccine conjugated to CRM-197 was licensed in 2010 and Nemenrix by GSK was licensed in 2012. In pre-licensure clinical studies, all these vaccines were found to be safe and immunogenic. In the United States these vaccines are licensed for the age 254 years, with studies evaluating a multiple dose series in infants and toddlers ongoing.
Where Can I Find These Vaccines
Your doctor is usually the best place to receive recommended vaccines for you or your child. These vaccines are part of the routine childhood immunization schedule. Therefore, vaccines for children and teens are regularly available at
- Pediatric and family practice offices
- Community health clinics
If your doctor does not have these vaccines for adults, ask for a referral.
Vaccines may also be available at
- Pharmacies
- Health departments
- Other community locations, such as schools and religious centers
You can also contact your state health department to learn more about where to get vaccines in your community.
When receiving any vaccine, ask the provider to record the vaccine in the state or local vaccine registry, if available. This helps providers at future visits know what vaccines you or your child have already received.
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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.
Controlled Temperature Chain Increases Reach Of Meningitis A Vaccine
The MenAfriVac vaccine, which was developed to meet the specific needs of the meningitis belt, can be kept at temperatures of up to 40°C for a maximum of four days as part of a controlled temperature chain . This can help improve coverage and save money otherwise spent on maintaining the challenging cold chain until the last mile.
Our funding has so far helped five countries Côte dIvoire, Mauritania, South Sudan, Democratic Republic of Congo and Togo use CTC in their meningitis A campaigns.
The CTC approach could have major economic benefits. According to a WHO study1, administering the MenAfriVac vaccine without having to keep it cold could reduce costs by 50%.
1 Lydon et al, Bull of the WHO 2014.
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Are Both Meningococcal Vaccines Equally Effective
The MCV4, MPSV4 and MenB vaccines are about 85-90% effective in preventing meningococcal disease. There are actually several types of N meningitidis — the bacterium that causes meningococcal disease, five of which are common in the U.S. These vaccines together protect against all five of these strains.
MCV4 has not been available long enough to compare the long-term effectiveness of the two vaccines. But most experts think that MCV4 provides better, longer-lasting protection.
Contraindications And Precautions Of Meningococcal Vaccine
The main contraindication for meningococcal vaccines is
For children with functional or anatomic asplenia, MenACWY and pneumococcal conjugate vaccine is caused by some of the > 90 serotypes of Streptococcus pneumoniae . Vaccines are directed against many of… read more ) should not be given during the same visit but should be separated by 4 weeks.
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Cost Effectiveness Of Men C Conjugate Vaccine
Six countries reported economic evaluations before the introduction of MCC vaccines , The Netherlands, UK, Portugal, and Switzerland). All of them recommended that one dose in the second year of life was more cost-effective than a three-dose infant schedule. Further development of the dynamic model was undertaken after vaccine introduction to predict the impact of the meningococcal vaccination program and its cost effectiveness in the UK. Various factors feed into this dynamic model, including the high transmissibility of the disease, the role of carriage/colonization and possibility of recurrent colonization with different serotypes, interaction between related bacteria, and the differing risks of colonization and disease at different ages. The model accurately reflected the trends of meningococcal disease in the UK when it was applied retrospectively to the actual experience in the UK from 1998 to 2004. It was also able to predict the significant herd protection that has been seen with the use of this vaccine. The UK model was also used to investigate the impact of vaccine schedules in the UK and Spain.
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.
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Meningococcal Vaccine: Canadian Immunization Guide
For health professionals
Latest partial content update :
: The chapter has been updated to align with the National Advisory Committee on Immunization Statement : The Use of Bivalent Factor H Binding Protein Meningococcal Serogroup B Vaccine for the Prevention of Meningococcal B Disease.
Updates include:
MenB-fHBP vaccine may be considered as an option for use in individuals 10 years of age and older in situations when a serogroup B meningococcal vaccine should be offered:
MenB-fHBP vaccine may be considered as an option for individuals 1025 years of age who are not at higher risk of meningococcal disease than the general population, but who wish to reduce their risk of invasive serogroup B meningococcal disease.
Last complete chapter revision: May 2015
Inclusion And Exclusion Criteria
Studies of primary impact and effectiveness of currently available meningococcal vaccines were included, published from January 1999 March 2017, in any language. The review focused on the meningococcal polysaccharide, polysaccharide-protein conjugate, and protein sub unit vaccines, and considered any serogroup except for serogroup A. The outcomes of interest were clinically-compatible and/or laboratory-confirmed meningococcal cases and deaths due to meningococcal disease.
The following study types were excluded: case series, case reports, and randomized controlled trials and economic, cost-benefit, and modelling studies. Additionally, studies performed in Africa related to meningococcal A vaccine were excluded for not being relevant to Latin American and the Caribbean, as were those studies specifically targeting patients with sickle cell disease, HIV-infection, or conditions known to affect immune response. Others excluded were: studies that considered only the disease of selected serogroups without denominators, adverse events, or immunogenicity studies of nasopharyngeal carriage studies considering only laboratory data studies with all-cause mortality and hospitalization as primary outcomes and studies that assessed only nosocomial infections.
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Guidance On Reporting Adverse Events Following Immunization
To ensure the ongoing safety of vaccines in Canada, reporting of AEFIs by vaccine providers and other clinicians is critical, and in some jurisdictions, reporting is mandatory under the law.
Vaccine providers are asked to report AEFIs, through local public health officials, and to check for specific AEFI reporting requirements in their province or territory. In general, any serious or unexpected adverse event felt to be temporally related to vaccination should be reported.
For additional information about AEFI reporting, please refer to Adverse events following immunization. For general vaccine safety information, refer to Vaccine safety and pharmacovigilance in Part 2.
How Is Meningococcal Disease Spread And Who Is Most At Risk
Meningococcal disease is not as contagious as other illnesses, such as a cold or the flu. But it is spread by contact with infected respiratory and throat secretions. That can happen with coughing, kissing, or sneezing.
Because the risk increases with close or prolonged contact with an infected person, family members in the same household and caregivers are at an increased risk. For the same reason, so are college students who live in dormitories.
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Dose And Administration Of Meningococcal Vaccine
The dose is 0.5 mL IM for MenACWY and 0.5 mL subcutaneous for MPSV4.
Two doses of MenACWY, given 8 weeks apart and followed by a booster every 5 years, are required for adults who have anatomic or functional asplenia, HIV infection, or persistent complement component deficiencies or who take eculizumab or ravulizumab. Adolescents with HIV infection are routinely vaccinated with a 2-dose primary series, given 8 weeks apart.
A single dose of MenACWY meningococcal vaccine is given to microbiologists who are routinely exposed to isolates of N. meningitidis, military recruits, people at risk during an outbreak attributable to a vaccine serogroup, and those who travel to or live in endemic areas. If risk continues , a booster dose is given every 5 years.
Based on a shared clinical decision-making discussion, adolescents and young adults aged 16 to 23 years who are not at increased risk of meningococcal disease are given two doses of MenB-4C at least 1 month apart or a 2-dose series of MenB-FHbp given at 0 and 6 months . The same MenB must be used for all doses.
People 10 years of age with certain high-risk conditions , and people identified to be at increased risk because of a meningococcal disease outbreak caused by serogroup B are given a 2-dose series of MenB-4C 1 month apart or a 3-dose series of MenB-FHbp at 0, 1 to 2, and 6 months .
Persons New To Canada
Health care providers who see persons newly arrived in Canada should review the immunization status and update immunization for these individuals. Review of meningococcal vaccination status is particularly important for persons from areas of the world where sickle cell disease is present as persons with sickle cell disease are at risk of serious meningococcal infections. In many countries outside of Canada, conjugate meningococcal vaccines are in limited use. Information on vaccination schedules in other countries can be found on the World Health Organization website. Refer to Immunization of Persons New to Canada in Part 3 for additional general information.
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Types Of Meningococcal Vaccines
The first category of vaccine is called the meningococcal conjugate vaccines or MenACWY vaccines. This vaccine protects against four strains of bacteria that fall into serogroups A, C, W, and Y.
Serogroups are closely related groups of bacteria that all present the same calling cards to the immune system. The MenACWY vaccine protects against meningitis-causing bacteria that present with the A, C, W, or Y calling cards.
Three types of MenACWY vaccines are currently available:
- Menactra
- Menveo
- MenQuadfi
The second category of meningococcal vaccines protects against bacteria that fall into serogroup B. These are called MenB vaccines and are sold under the brand names Bexsero and Trumenba.
The MenB vaccine is fairly new. The FDA approved Trumenba in 2014. Bexsero was approved in 2015. MenB vaccine is not currently part of the U.S. standard childhood vaccine immunization schedule. But in other countries, like the United Kingdom, Bexsero is routinely given during infancy.
Who Shouldn’t Get Vaccinated
According to the CDC, some people should speak to their healthcare provider before receiving a meningococcal vaccine. Specifically, people who have had life-threatening allergic reactions to meningococcal vaccines or their ingredients should not receive it.
Growing evidence suggests that it is safe for pregnant people to receive a MenACWY vaccine. The CDC notes that pregnancy shouldn’t preclude a person from seeking a MenACWY vaccine and that they should contact a healthcare provider for more information.
As for MenB vaccines, the CDC notes that there have been no randomized controlled trials evaluating this vaccine’s safety for pregnant or lactating people. The agency suggests that vaccination can wait until after this period. But if the person is at increased risk of meningococcal disease, a vaccine should still be considered.
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Who Should Get Which Meningococcal Vaccine And When
Although MCV4 is the preferred vaccine for most people, if it is not available when it’s time for the vaccination, MPSV4 can be used.
Routine immunization with the meningococcal vaccine MCV4 is recommended for children ages 11 or 12, with a booster to be given between ages 16 and 18. Vaccinations are also recommended for the following groups:
- College freshmen living in a dorm
- Military recruits
- Someone who has a damaged spleen
- Someone whose spleen has been removed
- Someone with terminal complement component deficiency
- Microbiologists who are routinely exposed to meningococcal bacteria
- Someone traveling to or residing in a country where the disease is common
- Someone who has been exposed to meningitis
Preteens who are 11 and 12 usually have the shot at their 11- or 12-year-old checkup. An appointment should be made to get the shot for teenagers who did not have it when they were 11 or 12.
The vaccine may be given to pregnant women. However, since MCV4 and MenB are newer vaccines, there is limited data about their effect on pregnant women. They should only be used if clearly needed.
Anyone who is allergic to any component used in the vaccine should not get the vaccine. It’s important to tell your doctor about all your allergies.
People with mild illness such as a cold or congestion can usually get the vaccine. But people who are moderately or severely ill at the time of vaccine administration should wait until they recover.
Why Are Meningococcal Vaccines Recommended
Meningococcal disease is caused by a type of bacteria. It can lead to an infection of the bloodstream or meningitis, or both, and can be life-threatening if not quickly treated. The MenACWY vaccine is very effective at protecting against four strains of the bacteria, while the MenB vaccine protects against a fifth strain.
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When Should My Child Get The Vaccine
- Your child should be immunized with Men-C-C at 12 months of age. Your child may get earlier doses, started anytime between 2 and 12 months of age, depending on your province or territorys immunization program.
- Teens should get a dose of MCV-4 or Men-C-C, usually at about 12 years of age.
- Children at higher risk for meningococcal disease should receive MCV-4 and Men-B vaccine starting as early as 2 months of age. If you are unsure, talk to your doctor.