Meningococcal Vaccine

1. See Also
   1. Menomune (MPSV4)
   2. Neisseria Meningitidis
   3. Bacterial Meningitis
2. Indications: Routine Scheduled Vaccine for all teens in U.S. (Menactra)
   1. All 12 year olds
   2. All 16 year olds
      1. Catch-up any 16 year olds if not immunized
      2. Booster dose for those who received a dose prior to age 16 years
3. Indications: Risk Factors and age 55 years and younger
   1. Underlying medical condition
      1. Functional Asplenia
      2. Terminal complement deficiency
      3. Properdin deficiency
      4. Human Immunodeficiency Virus (HIV)
   2. Close living areas
      1. College students in dormitories
      2. Military recruits
   3. Travel to endemic areas
      1. Sub-Saharan Africa
      2. Himalayas
      3. Saudi Arabia (especially Mecca)
4. Contraindications
   1. Age over 55 (use Menomune, the Quadrivalent Meningococcal Polysaccharide Vaccine instead)
5. Mechanism: Menactra (MCV4)
   1. Tetravalent Meningococcal Conjugate Vaccine
   2. Covers strains A, C, W-135, Y (same as Menomune)
   3. Does not cover serotype B (same as Menomune)
      1. B accounts for 50% of infant cases
      2. B accounts for <20% of teen cases
      3. Reasons for not including serotype B in Vaccine
         1. B has poor immunogenicity in Vaccine
         2. Risk of cross-reactivity with neural tissue
   4. Preferred in most cases over MPSV4 (higher immunogenicity)
   5. Conjugate Vaccine with Diphtheria protein
      1. Boosts T-Cell response
      2. Lengthens duration of immunity significantly
   6. Cost: $100 (similar to Menactra)
   7. Storage: 35 to 46 F (2 to 8 C), Same as Menactra
6. Dose: Menactra
   1. Administer 0.5 ml IM
   2. General dosing protocol if under age 16 years at time of first dose
      1. Booster dose before entering high risk environment (e.g. college dormitory, travel to endemic area, lab workers)
   3. General dosing protocol if over age 16 years at time of first dose
      1. Single dose with no booster recommended
   4. Indications for a two dose series (with 2 month interval) and no further boosters
      1. Human Immunodeficiency Virus infection
   5. Indications for a two dose series (with 2 month interval) and future boosters every 5 years
      1. No functioning Spleen or
      2. Persistent complement deficiency
   6. Miscellaneous points
      1. If Menomune (MPSV4) was given previously, wait at least 3 years before giving Menactra
7. Efficacy
   1. Menactra has a high seroconversion rate (98%-100%), similar to Menomune
   2. Duration: Menactra >8 years (more than double that of Menomune's 3 year duration)
8. Precautions: Safety
   1. Approved for ages 11 to 55 years
   2. May also be used at 2-10 years of age due to risk factors or travel
   3. Vaccine has no preservative (single use vial)
      1. Does not contain thimerosal (contrast with Menomune)
   4. Safe in Human Immunodeficiency Virus (HIV)
      1. See Immunization in HIV
9. Adverse effects
   1. Serious adverse events are uncommon (<1.3%)
   2. Headache
   3. Fever (in up to 3% of children)
   4. Local reactions (more common with Menactra than with Menomune)
10. References
    1. Bilukha (2005) MMWR Recomm Rep 54(RR-7):1-21
    2. Peter (2001) Pediatr Infect Dis J 20:311-2
    3. Ruben (2001) Clin Infect Dis 32:170-2