Wednesday, January 25, 2012

Clarifying Meningococcal Booster Dose Recommendations

From CDC Expert Commentary Amanda Cohn, MD 01/17/2012 Hi, I am Dr. Amanda Cohn, a pediatrician and epidemiologist. Thanks for tuning in to this CDC Expert Video Commentary on Medscape. In January 2011, recommendations were made by the Advisory Committee on Immunization practices (ACIP) for adolescents to receive a booster dose of meningococcal conjugate vaccine. Today I am going to explain the rationale behind this recommendation and answer frequently asked questions about implementation. First, some background. When this vaccine was first recommended for adolescents in 2005, the expectation was that protection would last for 10 years. However, currently available data suggest that immunity wanes much earlier than 10 years. In fact, only about half of adolescents are still protected 5 years after administration of the initial dose. Based on that information, a single dose for all 11- to 18-year-olds, recommended to be given at age 11-12 years, may not offer continued protection through the period when risk for meningococcal infection is highest, 16-21 years of age. Therefore, ACIP voted to recommend a booster dose of meningococcal conjugate vaccine for adolescents. This booster dose is recommended to be given at 16 years of age, following the routine first dose at age 11-12 years. Unfortunately, not all adolescents receive these doses on time, so here are some key points about when to give the booster dose. For adolescents who receive the first dose at age 13-15 years, a 1-time booster dose should be administered, preferably between the ages of 16 and 18 years. There is no need to wait 5 years from the first dose before administering the booster. Rather, give the booster dose any time after the child's 16th birthday. Eight weeks is the minimum interval between doses. If the teen is younger than 16 years of age, but the clinician believes this is a situation where there may not be another opportunity to provide the booster dose, the second dose can be given prior to 16 years of age. The booster dose is not recommended for adolescents who receive their first dose of meningococcal conjugate vaccine after their 16th birthday. What about college requirements? Meningococcal vaccination is required to attend many colleges, but which kids going off to college still need the booster dose? You may have a patient going off to college who requires vaccination. Many colleges will consider any dose given within 5 years prior to matriculation as valid. However, the recommendation for providers is to still follow the new guidelines: Administer a dose (a booster dose or the first dose if the adolescent is unvaccinated) after the 16th birthday and prior to college. Ideally, we want kids to get the booster dose before they reach the age when they are at greatest risk. All college freshmen living in a dormitory are recommended to be fully vaccinated. The booster dose may still be given to college students not living in dorms but is not routinely recommended. Which vaccine should be used? Only the meningococcal conjugate vaccine is recommended for adolescents. However, if the first dose of meningococcal vaccine was administered as polysaccharide vaccine, it is still counted as valid in the adolescent schedule. The booster dose of meningococcal vaccine for adolescents should always be a conjugate vaccine. The 2 licensed products, Menactra® and Menveo®, are interchangeable. If polysaccharide vaccine is inadvertently administered as the booster dose, revaccination with conjugate vaccine is recommended 8 weeks later. We want to protect as many kids as possible from this rare but often devastating disease. For more information on meningococcal disease and vaccine recommendations, visit Thanks for tuning in today.

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