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Meningococcal Vaccine
Aka: Meningococcal Vaccine, Menactra, Menveo, MCV4, Quadrivalent Meningococcal Conjugate Vaccine
- See Also
- Menomune (MPSV4)
- Serotype B Meningococcal Vaccine ( Trumenba, Bexero)
- Neisseria Meningitidis
- Bacterial Meningitis
- Indications
- Routine Scheduled Vaccine for all teens in U.S. (Menactra)
- All 12 year olds
- First dose
- All 16 year olds
- Catch-up any 16 year olds if not immunized
- Booster dose for those who received a dose prior to age 16 years
- High risk infants (Menactra, Menveo or Menhibrix at 6-8 weeks or 9 months)
- Asplenia
- Complement Deficiency
- Indications: Risk Factors and age 55 years and younger
- Underlying medical condition
- Functional Asplenia
- Terminal complement deficiency
- Properdin deficiency
- Human Immunodeficiency Virus (HIV)
- Close living areas
- College students in dormitories
- Military recruits
- Travel to endemic areas
- Sub-Saharan Africa
- Himalayas
- Saudi Arabia (especially Mecca)
- Contraindications
- Age over 55 years
- Use Menomune (Quadrivalent Meningococcal Polysaccharide Vaccine) instead
- Preparations
- Primary preparations
- Menactra (MenACWY-D)
- Menveo (MenACWY-CRM)
- Other preparations
- Menhibrix (Hib-MenCY, high risk infants only who are also due for Hib Vaccine)
- Mechanism
- Tetravalent Meningococcal Conjugate Vaccine
- Covers strains A, C, W-135, Y (same as Menomune)
- Serotypes C and Y each account for a third of U.S. meningococcal cases
- Serotype B accounts for another third (but not included in the Vaccine, see below)
- Serotypes A and W are strains seen worldwide
- Does not cover serotype B (same as Menomune)
- Serotype B accounts for 50% of infant cases
- Serotype B accounts for <20% of teen cases
- Serotype B accounts for many of the college cases
- Reasons for not including serotype B in Vaccine
- B has poor immunogenicity in Vaccine
- Risk of cross-reactivity with neural tissue
- Preferred in most cases over MPSV4 (higher immunogenicity)
- Conjugate Vaccine with Diphtheria protein
- Boosts T-Cell response
- Lengthens duration of immunity significantly
- Cost: $100 (similar to Menomune)
- Storage: 35 to 46 F (2 to 8 C, same as Menomune)
- Dose: Menactra
- Administer 0.5 ml IM
- General dosing protocol if under age 16 years at time of first dose
- Booster dose before entering high risk environment (e.g. college dormitory, travel to endemic area, lab workers)
- General dosing protocol if over age 16 years at time of first dose
- Single dose with no booster recommended
- Indications for a two dose series (with 2 month interval) and no further boosters
- Human Immunodeficiency Virus infection
- Indications for a two dose series (with 2 month interval) and future boosters every 5 years
- No functioning Spleen or
- Persistent complement deficiency
- Miscellaneous points
- If Menomune (MPSV4) was given previously, wait at least 3 years before giving Menactra
- Efficacy
- Menactra has a high seroconversion rate (98%-100%), similar to Menomune
- Duration: Menactra >8 years (more than double that of Menomune's 3 year duration)
- Precautions: Safety
- Approved for ages 11 to 55 years
- May also be used at 2-10 years of age due to risk factors or travel
- No longer associated with Guillain-Barre (despite early reports)
- Vaccine has no preservative (single use vial)
- Does not contain thimerosal (contrast with prior MenomuneVaccine)
- Safe in Human Immunodeficiency Virus (HIV)
- See Immunization in HIV
- Adverse effects
- Serious adverse events are uncommon (<1.3%)
- Headache
- Fever (in up to 3% of children)
- Local reactions such as injection site redness (more common with Menactra than with Menomune)
- Syncope
- References
- Ackerman (2015) Am Fam Physician 92(6): 460-8 [PubMed]
- Bilukha (2005) MMWR Recomm Rep 54(RR-7):1-21 [PubMed]
- Peter (2001) Pediatr Infect Dis J 20:311-2 [PubMed]
- Ruben (2001) Clin Infect Dis 32:170-2 [PubMed]