Meningococcal Vaccine for Clinicians

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female doctorsThe meningococcal vaccine protects against the meningococcal bacteria which can cause serious infections such as meningitis and septicemia. Although meningococcal infections are rare, they are very serious diseases that can cause death. Even with early treatment, there is a risk of serious complications.

Who is at risk for acquiring meningococcal disease?

Anybody at any age can get meningococcal disease. In fact, close to 3,000 people in the U.S. have a serious Infection with the meningococcal bacteria each year; 30% are teens and young adults. College students or anyone living in crowded living conditions are particularly at risk because the meningococcal bacteria are easily spread from one person to another, however most types of meningococcal disease can be prevented with a vaccine.

What are the symptoms?

The most common early symptoms are: high fever, headache, and stiff neck, sensitivity to light, nausea, vomiting, and rash.

How is meningococcal disease spread?

The meningococcal bacteria is usually spread by coming in contact with respiratory secretions when an infected person coughs or sneezes or by having contact with saliva. Teens who share water bottles are at risk for coming in contact with the bacteria. Meningococcal bacteria may live in the throat without causing any symptoms or may cause an infection of the blood or the fluid that surrounds the brain and spinal cord.

How is meningococcal disease treated?

Meningococcal disease is treated with antibiotics such as penicillin. Even with treatment, one in ten people will die. For those who survive, 10-20% may have permanent damage such as deafness, seizures, mental retardation, or loss of fingers and toes. The best form of protection for teens against this serious disease is to get vaccinated.

What are the types of meningococcal vaccine that are available in the United States?

There are six meningococcal vaccines that are available in the United States: 4 vaccines against Serogroup A, C, W, and Y and two vaccines against Serogroup B.MPSV4, MenACWY-D, MenACWY-CRM, Hib-MenCY-TT, and serogroup B vaccines.

4 vaccines targeted to meningococcal Serogroups A, C, W and Y, given at 11-12 with booster at 16-18 yrs:

MenACWY-D (Menactra) was approved in 2005 and is now being used to protect people who are 2-55 years old. In addition, children ages 9 months through 23 months can receive this vaccine as a two-dose series. “MenACWY-D” provides protection against serotypes A, C, W, and Y by linking these molecules to a protein (Diphtheria toxoid) to improve the immune response. Scientists believe it is better than the MPSV4 and protection against meningococcal disease appears to be longer too.

MenACWY-CRM (Menveo) was approved in 2010 and is now being used to protect people who are 2-55 years old. “MenACWY-CRM” is also a Meningococcal Conjugate Vaccine, and works similarly to MenACWY-D.

MPSV4 (Menomune) was made available in the 1970’s and is given to those over 2 years old who are at higher risk of meningococcal disease. “MPSV4” stands for Meningococcal Polysaccharide Vaccine. It protects against four serotypes of meningococcal disease: types A, C, W and Y.

Hib-MenCY-TT (MenHibrix) was approved in June 2012 for very young children ages 6 weeks to 18 months. It is a four-dose series of shots. This vaccine protects against two serotypes: C and Y.

2 vaccines targeted to meningococcal Serogroup B and given as 2 or 3 doses:

Serogroup B meningococcal vaccines Trumenba (a 3 dose vaccine, approved in October 2014) and Bexsero (a 2 dose vaccine, approved in January 2015) are for use in youth 10-25 years old to help in outbreaks of this infection and in those at risk of this infection because of persistent complement component deficiencies, persons with anatomic or functional asplenia (lack of functioning spleen), and those working in a lab studying meningococcus.

How does the vaccine work?

The vaccine is made up of parts of the meningococcal bacteria that cannot cause infection. When a person receives the vaccine, their body makes antibodies to fight the meningococcal bacteria. These antibodies then help protect the body from meningococcal disease, if the vaccinated person comes in contact with someone who has it.

Who should get the meningococcal vaccine?

Health care providers typically recommend that children between 11-12 years old get the MenACWY-D or MenACWY-CRM when they have their yearly checkup and a booster dose at age 16 through 18 years. If a youngster is older than 12 and hasn’t been vaccinated yet, most likely their health care provider will suggest getting it before they go to high school, or before they go to college or in the military service.

Other people who should get vaccinated for A, C, W, Y are those who plan to travel to places where meningococcal disease is common (such as certain regions of Africa), people who may have come in contact with meningitis, anyone who has a disorder of their immune system, anyone whose spleen has been damaged or had surgery to remove it, and people who study this disease in a lab.

If a young person has come in contact with someone who has been diagnosed with meningococcal disease, it is important that they see their health care provider so they can receive antibiotic treatment – even if they have been vaccinated.

Is a booster meningococcal vaccine for ACWY recommended?

Yes. People who receive the first dose of MenACWY-D or MenACWY-CRM at age 11-12 should have a booster dose given at ages 16-18 years. Also, people who are at increased risk for meningococcal disease should receive a second vaccination 5 years after their previous meningococcal vaccine. People considered to be at increased risk are those with disorders of their immune systems, anyone whose spleen has been damaged or had surgery to remove it, people who study this disease in a lab, or people who travel to or live in countries where meningococcal disease is common. In addition, college freshman living in dormitories who received the MPSV4 vaccine 5 or more years ago should receive a dose of either MenACWY-D or MenACWY-CRM.

Are there any side effects associated with the menigococcal vaccine?

Most people who get vaccinated will not have a side effect.

The most common side effects are:

  • Soreness where the shot was given
  • Mild swelling around the area of the shot
  • Slight fever

Serious allergic reactions are rare.

These discomforts are usually temporary but may last for a few days. In very few cases, side effects may include: fever, dizziness and/or nausea. Anaphylactic reactions requiring emergent care are rare. The risk of death is also rare. For Serogroup B vaccines, side effects have included arthritis; however, more data is needed to determine if this is vaccine related.

The U.S. Department of Health and Human Services has set up a Vaccine Adverse Event Reporting System (VAERS). For more information contact 1-800-822-7967 or vaers.hhs.gov.

Is the meningococcal vaccine effective?

Both the Meningococcal Polysaccharide vaccine (MPSV4) and the Meningococcal conjugate vaccines (MenACWY-D and MenACWY-CRM) can prevent four types of meningococcal disease, but not type B meningococcus. About 90% of people who receive either vaccine will be protected. The conjugate vaccines are preferred to the polysaccharide vaccines.

Is there any reason why a pre-teen or teen should wait or not get the meningococcal vaccine?

Most pre-teens and teens get the MenACWY-D or MenACWY-CRM without any problems. However, there are some reasons when a person should wait or not get the vaccine.

Reasons to not give the meningococcal vaccine (MenACWY-D):

  • The adolescent has had an allergic or bad reaction to the earlier vaccine.
  • The adolescent has had a serious allergic reaction to any part of the vaccine (for example, the vaccine fluid).
  • The adolescent is very ill on the day they are scheduled to receive the injections. The appointment should be rescheduled.
  • The adolescent is pregnant and at a low risk of infection. There is no data yet on pregnancy and the MenACWY-D shot, so if a pregnant teen is at risk for meningococcal disease or if they are traveling to Africa, they should get vaccinated.

What are the types of meningococcal vaccine and how are they administered?

Menactra® (MenACYW-D)

  • Menactra® comes in a single 0.5cc dose vial.
  • It is given intramuscularly (IM), preferably in the deltoid area after the skin has been cleansed with a germicide.
  • When there is a shortage of this vaccine, it is typically reserved for boarding school students, college students living in dorms, and people traveling to Africa.
  • Record the date, lot number and the manufacturer of the vaccine in the student’s health record.

Menomune® (MPSV4)

  • Menomune® comes in a vial and must be mixed with the diluent that is in the package.
  • After you inject the vial with the diluent, shake well.
  • Follow packaging instructions-using a 23 gauge 5/8 syringe, draw up 0.5cc’s of the fluid.
  • After the skin has been cleaned with a germicide such as alcohol, administer the vaccine subcutaneously (SC).
  • Record the date, lot number, and the manufacturer of the vaccine in the student’s health record.

Menveo® (MenACWY-CRM)

  • Menveo® is supplied as a liquid vaccine component that is combined through reconstitution with a lyophilized vaccine component, both in single dose vials.
  • Withdraw the entire contacts of the vial of MenCYW-135 liquid conjugate component and inject into the MenAlyophilized conjugate component vial. Gently invert or swirl the reconstituted vial until the vaccine is dissolved and then withdraw 0.5 mL of reconstituted product.
  • The reconstituted vaccine should be used immediately, but may be held at or below 77 F (25 C) for up to 8 hours.
  • It is given intramuscularly (IM), preferably in the deltoid area after the skin has been cleansed with a germicide.
  • Record the date, lot number, and manufacturer of the vaccine in the student’s health record.

Serogroup B meningococcal vaccines (Trumenba and Bexsero)

Trumenba®

  • Trumenba® comes in a 0.5ml single-dose pre-filled syringe.
  • It is given intramuscularly (IM), preferably in the deltoid area after the skin has been cleansed with germicide.
  • Never mix Trumenba® with any other vaccine in the same syringe.
  • Trumenba® should be administered in a three dose series (0.5ml each) according to a 0-, 2-, and 6 month schedule.
  • Record the date, lot number and the manufacturer of the vaccine in the patient’s health record.

Bexsero®

  • Bexsero® is a suspension that comes in a 0.5ml single-dose pre-filled syringe.
  • Shake the syringe immediately before using. The liquid should form a homogeous suspension after it is shaken. Do not use if particulate matter or discoloration is found.
  • It is given intramuscularly (IM), preferably in the deltoid area after the skin has been cleansed with a germicide.
  • Bexsero® should be administered in two doses (0.5ml each) one month apart. Record the date, lot number and the manufacturer of the vaccine in the patient’s health record.

Other considerations when administering the meningococcal vaccine:

  • Discuss the benefits and risk prior to administering the vaccine.
  • The meningococcal vaccine may be given at the same time as other vaccines.
  • As with administering other medication, vaccine recipients should stay in the office for 15-20 minutes after getting the injection to observe for potential severe reactions to the vaccine including: dyspnea, wheezing, dizziness, and/or rash accompanied with itching.
  • There have been a few cases of Guillain-Barre syndrome (GBS) reported after individuals received the MenACWY-D vaccine. Safety studies suggest that the risk of recurrent GBS is very low and in 2010 the ACIP at the CDC voted to remove the packaging precaution warning against giving MenACWY-D in persons with a history of GBS.
Meningococcal Disease is a very serious illness that can usually be prevented with a vaccine. Adolescents should be encouraged to see their health care provider regularly and keep their immunizations up to date.

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