Recommendations on Use of Meningococcal Conjugate Vaccines Updated

From Medscape Education Clinical Briefs

News Author: Laurie Barclay, MD
Penny Murata, MD

February 3, 2011 — The Advisory Committee on Immunization Practices (ACIP) has updated its recommendations for use of meningococcal conjugate vaccines and published the new guidelines in the January 28 issue of the MMWR Morbidity and Mortality Weekly Report.

Medscape Medical News previously reported on this recommendation in October 2010.

"On October 27, 2010, the ...ACIP approved updated recommendations for the use of quadrivalent (serogroups A, C, Y, and W-135) meningococcal conjugate vaccines (Menveo, Novartis; and Menactra, Sanofi Pasteur) in adolescents and persons at high risk for meningococcal disease," the ACIP writes.

"This report summarizes two new recommendations approved by ACIP:
1) routine vaccination of adolescents, preferably at age 11 or 12 years, with a booster dose at age 16 years and
2) a 2-dose primary series administered 2 months apart for persons aged 2 through 54 years with persistent complement component deficiency (e.g., C5–C9, properidin, factor H, or factor D) and functional or anatomic asplenia, and for adolescents with human immunodeficiency virus (HIV) infection. CDC [US Centers for Disease Control and Prevention] guidance for vaccine providers regarding these updated recommendations also is included."

On the basis of immunogenicity and safety data, meningococcal conjugate vaccines were licensed in 2005.
However, postlicensure data regarding persistence of bactericidal antibody levels, US trends in meningococcal disease epidemiology, and vaccine efficacy suggested that many adolescents could lose protective immunity after 5 years.
Children immunized at ages 11 through 12 years could therefore have reduced protective immunity by ages 16 to 21 years.
Because the risk for meningococcal disease is greatest in this age range, adolescents 16 to 18 years old should receive either the first dose or a booster dose of meningococcal conjugate vaccine.

Recommendations by Risk Group

Specific recommendations for meningococcal conjugate vaccine by risk group are as follows:

* For persons 11 to 18 years old, the primary series should be 1 dose, preferably at age 11 or 12 years. The booster dose should be at age 16 years if the primary dose was at age 11 or 12 years, and at ages 16 to 18 years if the primary dose was at ages 13 to 15 years. If the primary dose was on or after age 16 years, no booster is needed.
* For HIV-infected persons 11 to 18 years old, the primary series should be 2 doses, 2 months apart. The booster dose should be at age 16 years if the primary dose was at age 11 or 12 years, and at ages 16 to 18 years if the primary dose was at ages 13 to 15 years. If the primary dose was on or after age 16 years, no booster is needed.
* For persons 2 to 55 years old with persistent complement component deficiency or functional or anatomic asplenia, the primary series should be 2 doses, 2 months apart, and the booster dose every 5 years. If a 1-dose primary series was administered, the booster dose should be given at the earliest opportunity, then at every 5 years.
* For persons 2 to 55 years old with a prolonged increased risk for exposure, the primary series should be 1 dose. The booster dose should be given after 3 years for persons 2 to 6 years old, and after 5 years for persons 7 years or older, if the person remains at increased risk.

MMWR Morb Mortal Wkly Rep. 2011;60:72-76. Full Text
Clinical Context

The ACIP previously made recommendations regarding meningococcal prevention in the May 27, 2005, issue of MMWR Recommendations and Reports and the September 25, 2009, issue of MMWR Morbidity and Mortality Weekly Report. Routine vaccination was recommended at age 11 or 12 years to protect adolescents through the period of greatest risk. The ACIP Meningococcal Vaccines Work Group reviewed data on immunogenicity in high-risk groups, antibody persistence after immunization, epidemiology, vaccine effectiveness, and cost-effectiveness. Updated recommendations for quadrivalent (serogroups A, C, Y, and W-135) meningococcal conjugate vaccine administration were approved on October 27, 2010.

This report describes the new recommendations from the ACIP regarding routine immunization schedule and schedule for immunocompromised persons.