Meningococcal Vaccine

Aka: Meningococcal Vaccine, Menactra, MenACWY-D, Menveo, MenACWY-CRM, MCV4, Quadrivalent Meningococcal Conjugate Vaccine

1. See Also
   1. Menomune (MPSV4)
   2. Serotype B Meningococcal Vaccine ( Trumenba, Bexero)
   3. Neisseria Meningitidis
   4. Bacterial Meningitis
2. Indications
   1. Routine Scheduled Vaccine for all teens in U.S. (Menactra)
      1. All 12 year olds
         1. First dose
      2. All 16 year olds
         1. Booster, second dose for those who received a dose prior to age 16 years
         2. Catch-up any 16 year olds if not immunized (single dose)
   2. High risk Patients (see risk factors below)
      1. See CDC guidelines (vary by population and Vaccine)
         1. https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html#note-mening
3. Indications: Risk Factors and age 55 years and younger
   1. Underlying medical condition
      1. Anatomic Asplenia or Functional Asplenia (e.g. Sickle Cell Anemia)
      2. Terminal complement deficiency
      3. Properdin deficiency
      4. Human Immunodeficiency Virus (HIV)
      5. Complement Inhibitor (eculizumab, ravulizumab)
   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 years
      1. Use Menomune (Quadrivalent Meningococcal Polysaccharide Vaccine) instead
5. Preparations
   1. Primary preparations
      1. Menactra (MenACWY-D)
         1. Approved for age over 9 months
      2. Menveo (MenACWY-CRM)
         1. Approved for age over 2 months
   2. Other preparations
      1. Menhibrix (Hib-MenCY, high risk infants only who are also due for Hib Vaccine)
6. Mechanism
   1. Tetravalent Meningococcal Conjugate Vaccine
   2. Covers strains A, C, W-135, Y (same as Menomune)
      1. Serotypes C and Y each account for a third of U.S. meningococcal cases
      2. Serotype B accounts for another third (but not included in the Vaccine, see below)
      3. Serotypes A and W are strains seen worldwide
   3. Does not cover serotype B (same as Menomune)
      1. Serotype B accounts for 50% of infant cases
      2. Serotype B accounts for <20% of teen cases
      3. Serotype B accounts for many of the college cases
      4. 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 Menomune)
   7. Storage: 35 to 46 F (2 to 8 C, same as Menomune)
7. Dosing: 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
8. 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)
9. 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. No longer associated with Guillain-Barre (despite early reports)
   4. Vaccine has no preservative (single use vial)
      1. Does not contain thimerosal (contrast with prior MenomuneVaccine)
   5. Safe in Human Immunodeficiency Virus (HIV)
      1. See Immunization in HIV
10. Adverse effects
    1. Serious adverse events are uncommon (<1.3%)
    2. Headache
    3. Fever (in up to 3% of children)
    4. Local reactions such as injection site redness (more common with Menactra than with Menomune)
    5. Syncope
11. Resources
    1. CDC Immunization Schedules (last accessed 10/28/2020)
       1. https://www.cdc.gov/vaccines/schedules/
12. References
    1. Ackerman (2015) Am Fam Physician 92(6): 460-8 [PubMed]
    2. Bilukha (2005) MMWR Recomm Rep 54(RR-7):1-21 [PubMed]
    3. Peter (2001) Pediatr Infect Dis J 20:311-2 [PubMed]
    4. Ruben (2001) Clin Infect Dis 32:170-2 [PubMed]