Vaccines and Preventable Diseases:

Factsheet: Meningococcal Diseases and Meningococcal Vaccines
(August 26, 2009)

Content of this page derived from the 2005 ACIP statement.

Overview

With the introduction and widespread use of Hemophilus influenzae type b and Streptococcus pneumoniae conjugated vaccines, invasive disease due to these agents has been markedly reduced. The newly licensed tetravalent meningococcal conjugated vaccine (MCV4) has become a key addition to existing control of Neisseria meningitidis. This document seeks to familiarize vaccination providers, partners, and the public with the epidemiology and clinical features of meningococcal disease, with the new conjugate meningococcal vaccine (MCV4), and the previously licensed polysaccharide meningococcal vaccine (MPSV4).

The Advisory Committee on Immunization Practices (ACIP) to the Centers for Disease Control and Prevention (CDC) has recently recommended routine vaccination of all people 11-18 years old with MCV4 at the earliest opportunity. Children 11-12 years old should be routinely vaccinated with MCV4 at the 11-12 year old check up. Introducing a recommendation for MCV4 vaccination in young adolescents (11-12 years old) may strengthen the role of the pre-adolescent visit and have a positive effect on vaccine coverage in adolescence. ACIP recommends that young adolescents see a health care provider at age 11-12 for a routine preventive visit, at which time appropriate immunizations and other preventive services should be provided. Person aged 2-10 years and 19-55 years at increased risk for meningococcal disease are recommended to be vaccinated. These groups include:

• College freshmen living in dormitories
• Microbiologists who are routinely exposed to isolates of N. meningitidis
• Military recruits
• Persons who travel to, or reside in countries in which N. meningitidis is hyperendemic or epidemic, particularly if contact with the local population will be prolonged
• Persons who have anatomic or functional asplenia or terminal complement component deficiencies (an immune system disorder)

College freshmen who live in dormitories are at higher risk for meningococcal disease compared to other people of the same age. ACIP recommends routine vaccination for college freshmen living in dormitories. Because of feasibility constraints in targeting freshmen in dormitories, colleges may elect to target their vaccination campaigns to all matriculating freshmen. The risk for meningococcal disease among non-freshmen college students is similar to that for the general population of similar age (18-24 years). Other college students who want to reduce their risk for meningococcal disease may elect to receive the vaccine.

Disease

• Invasive meningococcal disease occurs in three common clinical forms: meningitis (50% of cases), blood infection (30%) and pneumonia (10%); other forms account for the remainder (10%) of the cases.
• Onset can be abrupt and course of disease rapid.
• Case fatality rate is 10%-14%; 11%-19% of survivors suffer serious sequelae (a condition caused by previous disease) including deafness, neurologic deficit, or limb loss.

Epidemiology

• Rates highest in infancy with second peak in adolescence (see graph below) with the peak around 18 years of age (see figure)
• Annually, 1,000–2,000 cases of invasive meningococcal disease occur in the US.
  • 20% of cases occurs among adolescents and young adults ages 14–24
  • 16% of cases occurs among infants under 1 year of age
• College freshmen living in dormitories are at higher risk than general population of similar age
• Most cases are sporadic (97%); a minority is associated with outbreaks (3%)
• Disease is seasonal, with cases peaking in December and January.  

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Causative Bacteria

• Meningococci are carried only by humans in the nasopharynx—their only reservoir
  • Overall 5%-10% of the population carries the bacteria
  • Adolescents and young adults have the highest carriage rates
  • Few carriers develop disease
• Transmission occurs when close, face-to-face contact permits the exchange of salivary secretions from people who are ill or are carriers
• Worldwide, the vast majority of disease is caused by 5 serogroups (A, B, C, Y, W-135) of the bacterium
• In the United States, almost all cases are caused by serogroups B, C and Y; there is currently no licensed vaccine that protects against serogroup B in the U.S.

The Vaccines

• Licensed in the United States in January 2005 for persons 2–55 years of age (updated March 2008)
  • Covers Serogroups A, C, Y and W-135
  • Conjugate Group C vaccine is currently licensed and routinely used in many European countries
  • It is likely that this or a similar vaccine will be licensed for younger age groups in the future
• Included in the Vaccines for Children (VFC) Program
• Cost to private sector per dose: $82.00
• Given intramuscularly as a single dose
• Persons at increased risk (persons with complement component deficiencies, asplenia, microbiologists working with N. meningitidis, or persons traveling to countries where meningococcal disease is hyperendemic) are recommended to receive the MCV4 every 5 years, children aged 2-6 years at increased risk are recommended to be revaccinated 3 years after their first MCV4, and then at 5 year intervals.
• Longer duration of protection and similar efficacy compared to MPSV4 expected in adolescents and adults
• Adverse reactions similar to Meningococcal Polysaccharide Vaccine (see below)
• Recommendations for use: in February 2005, with follow up in June 2007, ACIP voted to recommend vaccination with MCV4 in following groups:
• Adolescents aged 13-18 years receive 1 dose of MCV4
  • Young adolescents at the pre-adolescent visit (11–12 years old)
  • All persons aged 13-18 years at the earliest opportunity
• Groups that have elevated risk of meningococcal disease
  • College freshmen living in dormitories
  • Microbiologists who are routinely exposed to isolates of N. meningitidis
  • Military recruits
  • Persons who travel to, or reside in countries in which N. meningitidis is hyperendemic or epidemic, particularly if contact with the local population will be prolonged
  • Persons who have anatomic or functional asplenia or terminal complement component deficiencies (an immune system disorder)

• Licensed in 1981
• Included in the Vaccines for Children (VFC) program (no CDC contract)
• Cost to private sector per dose: $86.10
• Given subcutaneously as a single dose
• Generally not protective in children less than 2 years of age
• Good short-term (3–5 years) protection (85%) in older children and adults
• Antibody levels decrease markedly after 2–3 years, especially in children
• People at high risk need revaccination every 3–5 years
• Adverse reactions:
  • Mostly mild injection site pain and redness
  • Brief fever in 5 percent
  • Severe allergic and neurological reactions: each <0.1/100,000
• Recommendations for use: MPSV4 is recommended for individuals who are at elevated risk aged over 55 years (see MCV4 recommendations for list of groups at elevated risk)
• MPSV4 may be used in persons aged 2-55 years if there is a contraindication or precaution to receiving MCV4, such as persons with a history of guillian-barre syndrome.

Additional Sources of Information

• National Foundation for Infectious Diseases (NFID), The Changing Epidemiology of Meningococcal Disease Among United States Children, Adolescents, and Young Adults, November, 2004 [PDF - 5.35MB, 20 pages]
• Raghunathan P, Bernhardt S, Rosenstein R. Opportunities for control of meningococcal disease in the United States. Annu Rev Med 2004;55:333–53
• CDC. Notice to Readers: Revised Recommendations of the ACIP to Vaccinate All Persons Aged 11-18 Years with Meningococcal Conjugate Vaccine. MMWR 2007;56 (31):794-95
• CDC. Prevention and Control of Meningococcal Disease: Recommendations of the ACIP. MMWR 2005;54 (No. RR-7):1-21
• CDC. Meningococcal Disease and College Students: Recommendations of the ACIP. MMWR 2000;49 (No. RR-7):11–21
• CDC Meningitis website

 Return to main Meningococcal Vaccination page

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