Kimmel (Scott 2002). This analysis did not consider the cost of chemoprophylaxis or vaccination in the event of an outbreak, the cost of rehabilitating IMD survivors with sequelae, and the anxiety and stress due to an outbreak in the university community (Scott 2002). It has been estimated that routine vaccination of US adolescents 11 years old with MCV4 would prevent 270 cases of meningococcal disease and 36 deaths over 22 years at a cost of US$633,000 per case and US$121,000 per life-year saved (Shepard et al 2005). Although ﬁnancial costs of prevention are high, the mortal- ity and morbidity of IMD warrant the routine use of MCV4 in adolescents. Conclusion and future issues In addition to the devastation of the disease, considerable anxiety often accompanies an outbreak of IMD in the com- munity or affected regions. The MCV4 has demonstrated immunogenicity to serogroups A, C, Y, and W-135 with an acceptable degree of reactogenicity. Based on the experi- ence with conjugated meningococcal C vaccine in the UK, it is believed that MCV4 will have a similar impact on IMD caused by those serogroups. Because it is a conjugate vaccine, it is believed that the immunity provided by this vaccine will last longer then that provided by MPSV4. However, data suggest that serologic correlates of immunity to serogroup C may wane rapidly after 1 year in young children (Snape et al 2005; Borrow and Miller 2006). The conjugate vaccines prime for immune memory but it is not clear that this occurs quickly or sufﬁciently enough to provide protection from disease (Borrow and Miller 2006). Protection from disease may therefore depend on persistence of protective antibody levels and herd immunity. Thus far, antibody persistence in older children and adolescents appears good but it remains to be seen whether a booster dose of vaccine will be required at some future date. Disclosures Dr. Kimmel owns shares in GSK, and is a member of GSK Family/General Practitioner Advisory Board for Cervical Cancer effective February 2008. He is a consultant for Merck, Inc., and on the speaker’s bureau, and a consultant for Sanoﬁ Pasteur, and on the speaker’s bureau. He is also a consultant, CDC grant to Society of Teachers of Family Medicine Foundation for project “Increasing Immunizations by Family Physicians”. Richard Zimmerman, MD, MPH, University of Pittsburgh, is the primary investigator. Grant is now expired. References Abramson JS, Spika JS. 1985. Persistence of Neisseria meningitidis in the upper respiratory tract after intravenous antibiotic therapy for systemic meningococcal disease. J Infect Dis, 151:370–1. Barquet N, Domingo P, et al. 1999. Meningococcal disease in a large urban population (Barcelona, 1987–1992): predictors of dismal prognosis. Barcelona Meningococcal Disease Surveillance Group. Arch Intern Med, 159:2329–40. Bilukha OO, Rosenstein N. 2005. Prevention and control of meningococcal disease. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep, 54(RR-7):1–21. Borrow R, Andrews N, et al. 2001. Serological basis for use of meningococcal serogroup C conjugate vaccines in the United Kingdom: reevaluation of correlates of protection. Infect Immun, 69:1568–73. Borrow R, Balmer P, et al. 2005. Meningococcal surrogates of protection – serum bactericidal antibody activity. Vaccine, 23:2222–7. Borrow R, Miller E. 2006. Long-term protection in children with meningococcal C conjugate vaccination: lessons learned. Expert Rev Vaccines, 5:851–7. Bruce MG, Rosenstein NE, et al. 2001. Risk factors for meningococcal disease in college students. JAMA, 286:688–93. Campbell JD, Edelman R, et al. 2002. Safety, reactogenicity, and immunogenicity of a tetravalent meningococcal polysaccharide- diphtheria toxoid conjugate vaccine given to healthy adults. J Infect Dis, 186:1848–51. [CDC] Centers for Disease Control and Prevention. 2007. Active Bacterial Core Surveillance Report, Emerging Infections Program Network, Neisseria meningitidis, 2006 [online]. Accessed 26 Mar 2008. URL: http://www.cdc.gov/ncidod/dbmd/abcs/survreports/ mening06.pdf. Clark T. 2007. Meningococcal conjugate vaccine and Guillain Barre syn- drome. Advisory Committee on Immunization Practices meeting Oct 24 2007, Atlanta, Georgia, USA. Condon RJ, Riley TV, et al. 1994. Invasive meningococcal infection after splenectomy. BMJ, 308:792–3. Danzig L. 2004. Meningococcal vaccines. Pediatr Infect Dis J, 23(12 Suppl):S285–92. El Bashir H, Heath PT, et al. 2006. Antibody responses to meningococcal (groups A, C, Y and W135) polysaccharide diphtheria toxoid conjugate vaccine in children who previously received meningococcal C conjugate vaccine. Vaccine, 24:2544–9. EU-IBIS. 2006. Invasive Neisseria meningitidis in Europe – 2006 [online]. Accessed Apr 5 2008. URL: www.euibis.org. Gardner P. 2006. Clinical practice. Prevention of meningococcal disease. N Engl J Med, 355:1466–73. Girgis N, Frenck RW Jr, et al. 1998. Azithromycin compared with rifampin for eradication of nasopharyngeal colonization by Neisseria meningiti- dis. Pediatr Infect Dis J, 17:816–9. Goldschneider I, Gotschlich EC, et al. 1969a. Human immunity to the meningococcus. I. The role of humoral antibodies. J Exp Med, 129:1307–26. Goldschneider I, Gotschlich EC, et al. 1969b. Human immunity to the meningococcus. II. Development of natural immunity. J Exp Med, 129:1327–48. Gotschlich EC, Goldschneider I, et al. 1969. Human immunity to the menin- gococcus. IV. Immunogenicity of group A and group C meningococcal polysaccharides in human volunteers. J Exp Med, 129:1367–84. Granoff DM. 2004. Meningococcal vaccines. In Plotkin SA, Orenstein W, Ofﬁt PA (eds).Vaccines, 4th ed. Philadelphia, PA: Elsevier-Saunders: 959–87. Granoff DM, Gupta RK, et al. 1998. Induction of immunologic refractori- ness in adults by meningococcal C polysaccharide vaccination. J Infect Dis, 178:870–4. Granoff DM, Pollard AJ. 2007. Reconsideration of the use of meningococcal polysaccharide vaccine. Pediatr Infect Dis J, 26:716–22. 744 Therapeutics and Clinical Risk Management 2008:4(4)