# Presentation: 381175

## Meningococcal Disease and Meningococcal Vaccines

**Epidemiology and Prevention of Vaccine-Preventable Diseases**
**National Immunization Program**
**Centers for Disease Control and Prevention**

**Revised January 2007**

## NOTICEContent and order of the slides in this file may differ from those presented on the broadcast and webcast

## Neisseria meningitidis

**Aerobic gram-negative bacteria**
**At least 13 serogroups based on characteristics of the polysaccharide capsule**
**Most invasive disease caused by  serogroups A, B, C, Y, and W-135**
**Relative importance of serogroups depends on geographic location and other factors (e.g. age)**

## Meningococcal DiseaseClinical Features

**Incubation period 3-4 days (range 2-10 days)**
**Abrupt onset of fever, meningeal symptoms, hypotension, and rash**
**Fatality rate 9%-12%; up to 40% in meningococcemia**

## Neisseria meningitidisClinical Manifestations*

***1992-1996 data**

## Meningococcal Disease Epidemiology

**Reservoir****	****	****   ****	****Human****	****	****	****	****  **
**Transmission****	****   ****	****	****Respiratory droplets**
**Temporal pattern   ****	****	****Peaks in late winter–early ****	****	****	****	****   ****	****spring**
** **
**Communicability****	****   ****	****Generally limited**
**	****	****	****	****	**

**Notes:**
Limited communicability implied from lack of secondary cases in household settings.  Secondary cases may occur in some situations, such as day care settings.

## Meningococcal Disease, 1998Incidence by Age Group

**Meningococcal Disease, 1998****Incidence by Age Group**

***Rate per 100,000 population**

**U.S. Rate**

## Rates of Meningococcal Disease* by Age, United States, 1991-2002

*** Serogroups ****A/C/Y/W135**

**U.S. Rate**

## Meningococcal Disease in the United States

**Distribution of cases by serogroup varies by time and age group**
**In 1996-2001:**
**31% serogroup B**
**42% serogroup C**
**21% serogroup Y**
**65% of cases among children <1 year of age due to serogroup B**

## Risk Factors for Meningococcal Disease in the United States

**Deficiencies in the terminal complement pathway**
**Functional or anatomic asplenia**
**HIV infection**
**Smoking**
**Passive exposure to smoke**
**Upper respiratory tract infection**
**Crowding**

## 18-23 years old						1.4 / 100,000 
18-23 years oldnot college student			1.4 / 100,000 
Freshmen								1.9 / 100,000 
Freshmen in dorm				5.1 / 100,000

**18-23 years old****not college student****	****	****	****1.4 / 100,000**** **
**Freshmen****	****	****	****	****	****	****	****	****1.9 / 100,000**** **
**Freshmen in dorm****	****	****	****	****5.1 / 100,000**

**Meningococcal Disease Among Young Adults, United States, 1998-1999**

**Bruce et al, *****JAMA***** 2001;286;688-93**

## Meningococcal PolysaccharideVaccine (MPSV) - Menomune

**Quadrivalent polysaccharide vaccine (A, C, Y, W-135)**
**Approved for persons 2 years of age and older**
**Administered by subcutaneous injection**

## Meningococcal ConjugateVaccine (MCV) - Menactra

**Quadrivalent polysaccharide vaccine (A, C, Y, W-135) conjugated to diphtheria toxoid**
**Approved for persons 11 through 55 years of age**
**Administered by intramuscular injection**

## MPSV Recommendations

**Not recommended for routine vaccination of civilians**
**Should be used only for persons at increased risk of *****N. meningiditis***** infection who are 2-10 years or >55 years of age, or if MCV is not available**

## Meningococcal VaccineRecommendations

**Use of MCV is preferred for persons 11-55 years of age for whom meningococcal vaccine is recommended**
**MPSV should be used for persons 2-10 years and 56 years of age and older**
**Use of MPSV is an acceptable alternative for persons 11-55 years of age if MCV is not available **

## MCV Recommendations

**Recommended for:**
**All children at 11-12 years of age**
**Unvaccinated children at entry to high school (age 15 years)**
**All college freshmen living in a dormitory**
**Other persons 11-55 years of age at increased risk of invasive meningococcal disease**

***MMWR***** 2005; 54(RR-7);1-21 **

**Notes:**
At its February 2005 meeting the Advisory Committee on Immunization Practices voted to recommend routine meningococcal vaccination for several other groups. Meningococcal conjugate vaccine is recommended for all persons at their preadolescent visit, which should occur at ages 11 or 12 years. This is also the time when most children should receive their first TD booster dose. 

In order to produce a more rapid reduction of meningococcal disease among adolescents ACIP also recommended that for the next 2 to 3 years teens about to enter high school also be vaccinated, at about age 15 years. 

College freshmen living in a dormitory should be routinely vaccinated because of their increased risk of invasive disease. 

Other adolescents who wish to reduce their risk for meningococcal disease may elect to receive vaccine. 

MCV is preferred for all these groups. 

## Meningococcal VaccineRecommendations

**Recommended for persons at increased risk of meningococcal disease:**
**terminal complement component deficiency**
**HIV infection**
**functional or anatomic asplenia**
**Military recruits**
**Microbiologists who are routinely exposed to isolates of *****N. meningitidis***
**Travelers to and U.S. citizens who reside in countries in which *****N. meningitidis***** is hyperendemic or epidemic**

***MMWR***** 2005; 54(RR-7);1-21 **

## Meningococcal Vaccine Revaccination

**May be indicated for persons who received MPSV and continue to be at increased risk for infection**
**Revaccination may be considered 5 years after receipt of the MPSV **
**MCV is recommended for revaccination of persons 11-55 years of age although use of MPSV is acceptable **
**Revaccination after receipt of MCV is not recommended at this time**

***e.g., asplenic persons  and those who reside in areas in which disease is  endemic (does not include college settings)**

## Meningococcal VaccinesAdverse Reactions

**Local reactions          3%-29%    11%-59%**
**   ****for 1-2 days**
**Fever **_**>**_**100****o****F                   3%               5%**
**Systemic reactions    8%-29%     11%-36%**
**  ****(headache, malaise**
**   ****fatigue) **

**MPSV**

**MCV**

## Meningococcal Conjugate Vaccine and Guillain-Barré Syndrome (GBS) 

**17 cases* of GBS among within 6 weeks of MCV**
**Available data cannot determine if MCV increases the risk of GBS**
**No change in vaccine recommendations at this time**
**CDC recommends that persons with a history of GBS not receive MCV**
**Persons with a history of GBS who are at especially high, prolonged risk for meningococcal disease, such as certain microbiologists, might consider vaccination **

***As of September 22, 2006.***** MMWR***** 2006;55:1120-4**

## Meningococcal VaccinesContraindications and Precautions

**Severe allergic reaction to vaccine component or following prior dose of vaccine**
**Moderate or severe acute illness**

## National Immunization ProgramContact Information

**Telephone****	****	****800.CDC.INFO**** **
**Email****	****	****	****nipinfo@cdc.gov**** **
**Website****	****	****www.cdc.gov/nip**