Meningococcal Vaccine

MenB ADR

Local reactions Fatigue, headache, muscle or joint pain, fever or chills Nausea and diarrhea

Meningococcal outbreaks

less than 2% of reported cases Most recent outbreaks caused by serogroup C and B

Neisseria meningitidis incidence

*Peaks in 3 age groups:* Infants children 5 years or younger Young adults 16-21 years Adults 65 years or older Incidence decreases since peak in late 1990s 800-1200 case/year in the US Epidemic in sub-Saharan Africa

MenACWY Recommendations for Persistent complement component deficiences (PCCD) or asplenic patients

2 dose series 8 weeks apart May also require MenB Booster every 5 years

Outbreak Definition

3 more more confirmed or probable primary cases Period of less than 3 months Primary attack rate: >10 cases/100,000 population

MenACWY Recommendations

Administer 11-12 years - booster at 16 years old Catch up - 13-15 years if not previously with booster 16-18 years Over 16 - one dose, no booster Not recommended after 21 years old unless at increased risk

Neisseria Meningitidis Serogroups

At least 13 serogroups based on characteristics of polysaccharide capsule Most invasive disease caused by serogroups A, B, C, Y, W Relative importance of serogroups - depends on geographic location and other factors (age)

MenB dosing

Bexsero: 2 doses *1 month apart* Trumenba: 3 doses *0, 1-2 and 6 months* Not interchangeable Both IM

Meningococcemia

Bloodstream infection May occur with or without meningitis Clinical findings: fever, petechial/purpuric rash, hypotension/shock, acute adrenal hemorrhage, multi-organ failure

Clinical features of Meningococcal disease

Colonizes nasopharynx - transmitted by direct contact with large-droplet respiratory secretions from patients or asymptomatic carriers Antecedent URI may be contributing factor Incubation period 3-4 days (range 2-10 days) Abrupt onset of fever, meningeal symptoms, hypotension, and rash Fatality rate 10-15% (40% or less in meningococcemia)

Neisseria meningitidis disease course

Develops rapidly and has high morbidity and mortality Case-fatality ratio of 10-15% 11-19% of survivors have long-term sequelae (neurologic disability, limb or digit loss, hearing loss)

Vaccine differention

Differences based on serogroup coverage, type of vaccine, approved ages, and route of administration

Treatment

Empiric antibiotic therapy with 3rd gen cephalosporin/ vancomycin after appropraite cultures are obtained

MenACWY - high risk reccomendations

First year college students (21 years or younger) who have not received MenACWY at 16 or older Microbiologists routinely exposed to isolates Military recruits Travellers to hyperendemic or epidemic areas, particularly the meningitis belt Booster every 5 years as long as person remains at risk

Chemoprophylaxis

For close contacts of infected person during 7 days before symptom onset Start within 24 hours of onset of disease in contact, not useful after 14 days

Risk Factors: Enivronmental

Household exposure to carrier or sick individual House crowding Antecedent viral infection Active and passive smoking

Meningococcal Serogroup B - Recommendation

Insufficient evidence to recommend vaccinating all adolescents ACIP - encourages individual clinical decision making

ADR

Local reactions for 1-2 days, fever >100 F, systemic reactions (HA, malaise, fatigue)

Outbreak Recommendations

MenACWY - control of outbreaks caused by vaccine-preventable serogroups MenB - only for outbreak of serogroup B

MenACWY Recommendations for HIV-infected patients

MenACWY-D routine immunization for all patients at 2 months or older Adults with no history of vaccination: 2 doses 8 weeks apart, booster every 5 years Patients who have received a dose at 7 years or older: booster every 5 years

Infections caused by Neisseria meningitidis

Meningitis, sepsis, focal infections (pneumonia and arthritis)

Precautions

Moderate or severe acute illness - delay immunization until recovered

Meningococcal meningitis

Most common pathologic presentation Result of Hematogenous dissemination Clinical findings: fever, headache, stiff neck

MenB indications

Patients with complement component deficiency or taking Soliris Patients with asplenia Microbiologists routinely exposed to Neisseria meningitidis People identified to be at increased risk because of serogroup B outbreak Individual clinical decision making - age 16-23 years for short term protection (2 dose series)

Vaccines available

Quadrivalent Meningococcal Conjugate Vaccine (MenACWY), Menactra, Menveo, Menhibrix (MCV4) Serogroup B (MenB), Bexsero and Trumenba

Neisseria meningitidis

Severe acute gram negative bacterial infection

Contraindications

Severe allergic reactions to vaccine component or following prior dose of vaccien

Meningococcal Serogroup B - Incidence

Stable and low in adolescents and young adults ~ 50-60 cases and 5-10 deaths reported/year College students: similar to/lower than incidence in non-college of same age

Risk Factors: Host

Terminal complement pathway deficiency Asplenia Genetic risk factors