Meningococcemia primary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]

Primary Prevention

• Current vaccines have polysaccharides of groups A, C, Y, and W-135. No vaccine available presently for group B disease since the polysaccharide is not sufficiently immunogenic to produce a reliable antibody response in humans to be effective.
• There is a vaccine for the bacteria that cause meningococcal disease.
• Available vaccines do not cover all serogroups (“strains”) of Neisseria meningitidis bacteria.
• Meningococcal vaccines are not 100% effective. This means that even if you have been vaccinated, there is still a chance you can develop a meningococcal infection.

Who Needs to be Vaccinated ?

• First-year college student living in a residence hall
• Military recruit
• Damaged spleen or your spleen has been removed
• Terminal complement deficiency
• Microbiologist who is routinely exposed to Neisseria meningitidis (the causal pathogen)
• People traveling or residing in countries in which the disease is common.

Vaccine

There are two kinds of meningococcal vaccine in the U.S.:

• Meningococcal conjugate vaccine (MCV4) is the preferred vaccine for people 55 years of age and younger.
• Meningococcal polysaccharide vaccine (MPSV4) has been available since the 1970s. It is the only meningococcal vaccine licensed for people older than 55.

Meningococcal Polysaccharide Vaccine (MPSV4)

• Both vaccines can prevent 4 types of meningococcal disease, including 2 of the 3 types most common in the United States and a type that causes epidemics in Africa.
• There are other types of meningococcal disease; the vaccines do not protect against these.The first meningococcal polysaccharide vaccine was licensed in the United States in 1974.
• The current quadrivalent A, C, Y, W-135 polysaccharide vaccine (Menomune, sanofi pasteur) was licensed in 1978.
• Each dose consists of 50 mcg of each of the four purified bacterial capsular polysaccharides. The vaccine contains lactose as a stabilizer.
• MPSV4 is administered by subcutaneous injection. The vaccine is available in single-dose and 10-dose vials. Fifty-dose vials are no longer available.
• Diluent for the single-dose vial is sterile water without preservative.
• Diluent for the 10-dose vial is sterile water with thimerosal added as a preservative. After reconstitution the vaccine is a clear colorless liquid.
• No vaccine is available in the United States for serogroup B.

Meningococcal Conjugate Vaccine (MCV4)

• Two meningococcal conjugate vaccines are licensed in the United States.
• Menactra (sanofi pasteur) was licensed in 2005.
• The vaccine contains N. meningiditis serogroups A, C, Y and W-135 capsular polysaccharide antigens conjugated to diphtheria toxoid protein.
• Each 0.5-mL dose of vaccine is formulated in sodium phosphate buffered isotonic sodium chloride solution to contain 4 mcg each of meningococcal A, C, Y, and W-135 polysaccharides conjugated to approximately 48 mcg of diphtheria toxoid protein carrier.
• Menactra is approved for use in persons 9 months through 55 years of age.
• It is administered by intramuscular injection. Menactra is supplied as a liquid in a single-dose vial and does not contain a preservative or an adjuvant.Menveo (Novartis) was licensed in the United States in 2010.
• Menveo consists of two components: 10 µg of lyophilized meningococcal serogroup A capsular polysaccharide conjugated to CRM (MenA) and 5 µg each of capsular polysaccharide of serogroup C, Y, and W135 conjugated to CRM-197 in 0.5 mL of phosphate buffered saline, which is used to reconstitute the lyophilized MenA component before injection.
• Menveo is approved for use in persons 2 through 55 years of age. It is administered by intramuscular injection. It does not contain a preservative or an adjuvant

Schedule

• Two doses of MCV4 are recommended for adolescents 11 through 18 years of age: the first dose at 11 or 12 years of age, with a booster dose at age 16.
• Adolescents in this age group with HIV infection should get three doses: 2 doses 2 months apart at 11 or 12 years, plus a booster at age 16.
• If the first dose (or series) is given between 13 and 15 years of age, the booster should be given between 16 and 18. If the first dose (or series) is given after the 16th birthday, a booster is not needed.

Contraindication of vaccination

• Anyone who has ever had a severe (life-threatening) allergic reaction to a previous dose of MCV4 or MPSV4 vaccine should not get another dose of either vaccine.
• Anyone who has a severe (life threatening) allergy to any vaccine component should not get the vaccine.
• Anyone who is moderately or severely ill at the time the shot is scheduled should probably wait until they recover. Ask your doctor. People with a mild illness can usually get the vaccine.
• Meningococcal vaccines may be given to pregnant women. MCV4 is a fairly new vaccine and has not been studied in pregnant women as much as MPSV4 has. It should be used only if clearly needed. The manufacturers of MCV4 maintain pregnancy registries for women who are vaccinated while pregnant.

Complications

• Allergic reactions

• Hives
• Swelling of face and throat
• Difficulty breathing
• Palpitation
• Dizziness
• Weakness

• Fainting smells
• Seizure-like movements
• Fever

Prophylaxis

• Rifampin 600 mg PO q12h x 4 doses total or alternatively ciprofloxacin 500 mg PO x 1 in patients over 18 who cannot tolerate rifampin.