Meningococcal Polysaccharide Vaccine

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Contents 1 Indications 2 Contraindications 3 Dosage 4 Pharmacokinetics 5 Adverse-effects 6 Mechanism-of-action 7 More General Terms 8 Additional Terms 9 References

Indications

• immunization against infection caused by Neisseria meningitidis A, C, Y & W-135 in persons >= 9 months of age (Menactra) [18]
• recommended for all adolescents age 11-18 (Menactra) [12,16]
• risk factors ( vaccine candidates)

• househould or institutional contacts
• college freshman living in dormatories [13]
• medical personnel
• travelers planning on visiting endemic areas
• increased risk of morbidity from meningococcal disease

• asplenic patients [3]
• patients with terminal complement component deficiency

• revaccination 5 years after their previous vaccination recommended for patients with risk factors (d or e above)

Contraindications

• children < 2 years of age (Menamune)
• hypersensitivity to diphtheria toxoid, latex (Menactra)
  

• does NOT provide protection against meningococcus serogroup B, 30% of invasive infection with Neisseria meningitidis in USA [13]

Dosage

• Menomune: 0.5 mL SC
• Menactra: 0.5 mL IM (preferably deltoid)

• do NOT administer IV or SC

• routinely administered at age 11-12 years [17]
• booster at age 16 [17]
• patients age 2-54 years with complement deficiency, or asplenia & adolescents with HIV infection, should receive two doses given 2 months apart [17]

• Injection: single dose vials Warnings:

• subcutaneous ( SC) injection only
• asplenic patients with lymphoid tumors who receive either chemotherapy or irradiation respond poorly

Pharmacokinetics

• antibody persistence 3 years after vaccination [8] (protection alledgedly longer than Menomune) [4,5]

Adverse-effects

• common (> 10%)

• pain, tenderness & local induration

• less common (1-10%)

• headache, malaise, anorexia, fever/ chills

• serious adverse effects 1.3% (Menactra, Menamune)
• Guillain Barre Syndrome 2-5 weeks after vaccination 5 cases reported [6,7,8,10]

Mechanism-of-action

• Menactra is conjugated with diphtheria toxoid protein to elicit T-cell response & prolong immunity [4]

More General Terms

• vaccine

Additional Terms

• Neisseria meningitidis (meningococcus)

References

1. Kaiser Permanente Northern California Regional Drug Formulary, 1998
2. Neal KR et al BMJ 320:846 2000
3. Prescriber's Letter 10(4):21 2003
4. Prescriber's Letter 12(4): 2005 New Drug: Menactra (Meningococcal Polysaccharide Vaccine) Detail-Document#: [1] (subscription needed) [2]
5. Journal Watch 25(7):59, 2005 Pichichero M, Casey J, Blatter M, Rothstein E, Ryall R, Bybel M, Gilmet G, Papa T. Comparative trial of the safety and immunogenicity of quadrivalent (A, C, Y, W-135) meningococcal polysaccharide- diphtheria conjugate vaccine versus quadrivalent polysaccharide vaccine in two- to ten-year-old children. Pediatr Infect Dis J. 2005 Jan;24(1):57-62. PMID: [3]
6. MedWatch, FDA [4]
7. Centers for Disease Control and Prevention (CDC). Guillain-Barre syndrome among recipients of Menactra meningococcal conjugate vaccine-United States, June-July 2005. MMWR Morb Mortal Wkly Rep. 2005 Oct 14;54(40):1023-5. PMID: [5]
   - Prescriber's Letter 12(9): 2005 Guillain-Barre syndrome among recipients of Menactra meningococcal conjugate vaccine--United States, June-July 2005. Detail-Document#: [6] (subscription needed) [7]
8. Vu DM, Welsch JA, Zuno-Mitchell P, Dela Cruz JV, Granoff DM. Antibody persistence 3 years after immunization of adolescents with quadrivalent meningococcal conjugate vaccine. J Infect Dis. 2006 Mar 15;193(6):821-8. Epub 2006 Feb 8. PMID: [8]
9. Notice to Readers: Limited Supply of Meningococcal Conjugate Vaccine, Recommendation to Defer Vaccination of Persons Aged 11-12 Years MMWR Morb Mortal Wkly ReMay 19, 2006 / 55(Dispatch);1 [9]
   - Prescriber's Letter 13(8): 2006 Limited Supply of Meningococcal Conjugate Vaccine, Recommendation to Defer Vaccination of Persons Aged 11-12 Years Detail-Document#: [10] (subscription needed) [11]
10. FDA MedWatch [12]
11. Centers for Disease Control Revised Recommendations of the Advisory Committee on Immunization Practices to Vaccinate All Persons Aged 11- 18 Years with Meningococcal Conjugate Vaccine MMWR 56(31);794-795 <PubMed> PMID: [13] <Internet> [14]
12. Prescriber's Letter 14(9): 2007 Immunization Update 2007 Detail-Document#: [15] (subscription needed) [16]
13. Medical Knowledge Self Assessment Program (MKSAP) 14, 15 American College of Physicians, Philadelphia 2006, 2009
14. Centers for Disease Control and Prevention (CDC) Updated Recommendation from the Advisory Committee on Immunization Practices (ACIP) for Revaccination of Persons at Prolonged Increased Risk for Meningococcal Disease MMWR September 25, 2009 / 58(37);1042-1043 [17]
    - Prescriber's Letter 16(12): 2009 Detail-Document#: [18] New Recommendations for Revaccination of Patients at High-Risk for Meningococcal Disease (subscription needed) [19]
15. Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR) MMWR: March 12, 2010, 59(09);273 Licensure of a Meningococcal Conjugate Vaccine (Menveo) and Guidance for Use --- Advisory Committee on Immunization Practices (ACIP), 2010 <PubMed> PMID: [20] <Internet> [21]
16. Advisory Committee on Immunization Practices Revised Recommendations of the Advisory Committee on Immunization Practices to Vaccinate All Persons Aged 11- 18 Years with Meningococcal Conjugate Vaccine [22]
17. Centers for Disease Control and Prevention (CDC) Updated Recommendations for Use of Meningococcal Conjugate Vaccines - Advisory Committee on Immunization Practices (ACIP), 2010 Morbidity and Mortality Weekly Report (MMWR) January 28, 2011 / 60(03);72-76 <PubMed> PMID: [23] <Internet> [24]
18. FDA NEWS RELEASE: April 22, 2012 FDA approves the first vaccine to prevent meningococcal disease in infants and toddlers [25]
19. Prescriber's Letter 19(1): 2012 Detail-Document#: [26] Meningococcal Disease: Who Should be Vaccinated? (subscription needed) [27]
20. National Guideline Clearinghouse Prevention and control of meningococcal disease: recommendations for use of meningococcal vaccines in pediatric patients. (American Academy of Pediatrics) ngc-guideline: [28]
    - (1) Prevention and control of meningococcal disease. Recommendations of the Advisory Committee on Immunization Practices (ACIP). (2). Notice to readers: revised recommendations of the Advisory Committee on Immunization Practices to vaccinate all persons aged 11--18 years with meningococcal conjugate vaccine. ngc-guideline: [29]
    - Prevention and control of meningococcal disease. Recommendations of the Advisory Committee on Immunization Practices (ACIP). (Addendum 1) Recommendations for all persons aged 11-18 years; (Addendum 2) Recommendations for children aged 2-10 years at increased risk for invasive meningococcal disease; (Addendum 3) Updated recommendation from the Advisory Committee on Immunization Practices (ACIP) for revaccination of persons at prolonged increased risk for meningococcal disease. ngc-guideline: [30]

meningococcal polysaccharide vaccine (Menomune-A/C/Y/W-135, Menactra, MenACWY-CRM, Menveo)