• Basic Info
• Top Questions
• Clinical Info

Uses

Prevention of Meningococcal Infection

Prevention of meningococcal infection in adults, adolescents, and children ≥2 years of age.

Meningococcal infection is an acute, life-threatening illness caused by N. meningitidis and is transmitted person-to-person by the respiratory route. Annual US incidence of meningococcal disease is approximately 0.8–1.3 cases per 100,000 population resulting in an estimated 2000–3000 cases each year. Overall case-fatality rate is 9–12%, even with anti-infective treatment, and increases to about 25% in adolescents. Meningococcal infection may result in substantial morbidity; long-term sequelae (e.g., hearing loss, neurologic disability, digit or limb amputations) reported in 11–20% of patients. While N. meningitidis generally causes sporadic disease in the US, the frequency of localized outbreaks of meningococcal disease has increased in the US since 1991.

USPHS Advisory Committee on Immunization Practices (ACIP), AAP, and American Academy of Family Physicians (AAFP) recommend that all children and adolescents be vaccinated against meningococcal infection at 11–12 years of age, with catch-up vaccination at 13–18 years of age for those not previously vaccinated.

ACIP, AAP, and AAFP also recommend vaccination of selected children 2–10 years of age and adults >18 years of age at high risk for meningococcal disease (See Preexposure Vaccination Against Meningococcal Infection in High-risk Groups under Uses) and for any other unvaccinated individual in these age groups desiring protection from meningococcal disease. ACIP, AAP, and AAFP recommend vaccination against meningococcal disease for all college freshmen living in dormitories who have not previously received the vaccine.

Quadrivalent meningococcal vaccines may be used for outbreak control when such outbreaks are caused by vaccine-preventable N. meningitidis serogroups (i.e., A, C, Y, W-135).

Although safety and efficacy of quadrivalent meningococcal vaccines have not been established in children <2 years of age, ACIP, AAP, and other clinicians state that use of MPSV4 (Menomune^®) may be considered when necessary to elicit short-term protection against serogroup A in children 3–23 months of age† under certain circumstances (e.g., infant will be traveling to or residing in areas where N. meningitidis is hyperendemic or epidemic or for outbreak control).

ACIP, AAP, and AAFP state that MCV4 (Menactra^® ) is preferred over MPSV4 (Menomune^®) for meningococcal vaccination in adults ≤55 years of age, adolescents, and children ≥2 years of age. MPSV4 (Menomune^®) should be used in adults >55 years of age and when MCV4 (Menactra^® ) is contraindicated or unavailable and is an acceptable alternative for short-term protection (i.e., 3–5 years) in other individuals.

Quadrivalent meningococcal vaccines will not prevent meningococcal infection caused by N. meningitidis serogroups not represented in the vaccines (e.g., serogroup B) and will not prevent infections caused by other pathogens.

Quadrivalent meningococcal vaccines are not indicated for treatment of acute meningococcal infections.

Although the meningococcal antigens in MCV4 (Menactra^®) are conjugated to diphtheria toxoid protein, this vaccine is not indicated for immunization against diphtheria.

Preexposure Vaccination Against Meningococcal Infection in High-risk Groups

Preexposure vaccination in previously unvaccinated adults, adolescents, and children ≥2 years of age who are or will be at high risk of exposure to N. meningitidis or at high risk of developing invasive meningococcal disease if they become infected with N. meningitidis.

Children 2–10 years of age may be at increased risk of meningococcal infection. Although ACIP, AAP, and AAFP do not currently recommend routine vaccination against meningococcal infection in this age group, preexposure vaccination with MCV4 (Menactra^®) is recommended for previously unvaccinated children 2–10 years of age at increased risk, including those who travel to or reside in countries where meningococcal disease is hyperendemic or epidemic, those who have terminal complement deficiencies or anatomic or functional asplenia, and for outbreak control.

Adolescents should receive primary immunization against meningococcal disease with MCV4 (Menactra^®) at 11–12 years of age, with catch-up vaccination at 13–18 years for those not previously vaccinated. Because the incidence of meningococcal disease increases during adolescence, previously unvaccinated individuals 11–18 years of age should receive MCV4 (Menactra^®) at the earliest possible health-care visit.

College freshmen planning to live in dormitories are at increased risk for meningococcal infection and previously unvaccinated individuals in this age group should receive primary immunization with MCV4 (Menactra^®) before entering college. Although the risk for meningococcal disease for nonfreshmen college undergraduates is similar to that for the general population of similar age (i.e., 18–24 years), ACIP and AAP state that MCV4 (Menactra^®) also can be used in these undergraduates if they want to reduce their risk for meningococcal disease.

HIV-infected individuals are likely to be at increased risk for meningococcal disease. Although efficacy has not been evaluated in HIV-infected individuals to date, ACIP and AAP state that HIV-infected individuals 2–55 years of age desiring protection may receive MCV4 (Menactra^®). In addition, HIV-infected individuals who previously received MPSV4 (Menomune^®) and continue to be at increased risk for meningococcal disease may be revaccinated with MCV4 (Menactra^®) if 3–5 years have elapsed since MPSV4 (Menomune^®) was administered. Consider that meningococcal vaccines may be less immunogenic in immunocompromised individuals. (See Individuals with Altered Immunocompetence under Cautions.)

Travelers to and residents of areas where N. meningitidis is hyperendemic or epidemic and where there is a recognized risk of exposure to meningococcal disease should be vaccinated against the disease. Incidence of meningococcal disease (usually caused by serogroup A or C) peaks regularly during the dry season (December to June) in areas of sub-Saharan Africa known as the “meningitis belt” extending from Mali to Ethiopia. Therefore, ACIP, CDC, and AAP recommend primary immunization against meningococcal disease prior to travel to these high-risk areas for individuals ≥2 years of age, especially if prolonged contact is expected with local populations. Immunization against meningococcal disease is not a requirement for entry into any country, but officials in Saudi Arabia require that travelers to their country for the annual Hajj and Umrah pilgrimage have a certificate of vaccination against meningococcal disease. The most recent information concerning geographic areas for which vaccination against meningococcal disease is recommended can be obtained from international health clinics for travelers, state health departments, CDC at 877-394-8747, or CDC Travelers’ Health website (http://wwwn.cdc.gov/travel).

Household and other close contacts of individuals with invasive meningococcal disease or those with direct exposure to nasopharyngeal secretions from an infected individual should be immunized against meningococcal infection because of increased risk of exposure to N. meningitidis. Whenever a case of invasive meningococcal disease occurs, anti-infective prophylaxis (rifampin, ceftriaxone, or ciprofloxacin) is indicated for close contacts of the index case (e.g., household contacts, day-care center contacts, individuals exposed to the index case's oropharyngeal secretions) and is the principal means of preventing secondary cases. Because protective levels of anticapsular antibodies are not achieved until 7–14 days following vaccination, meningococcal vaccine cannot prevent early onset disease in close contacts and usually is not recommended following sporadic cases of invasive meningococcal disease. However, if cluster cases of invasive disease occur, public health officials may recommend use of meningococcal vaccine in close contacts as an adjunct to anti-infective prophylaxis. AAP states that adjunctive use of the vaccine may be indicated when an outbreak is caused by a serogroup represented in the vaccine.

Individuals with terminal complement deficiency, properdin deficiency, or anatomic or functional asplenia are at increased risk for meningococcal disease, and ACIP, AAP, and other clinicians recommend that these individuals be vaccinated against the disease. Individuals with component deficiencies in the final common complement pathway (C3, C5-C9) are more susceptible to severe and/or recurrent N. meningitidis infection, particularly serogroup Y, than complement-sufficient individuals. Inherited properdin deficiency also is associated with an increased risk of contracting severe and/or recurrent meningococcal disease. Because individuals with functional or anatomic asplenia may not be able to effectively clear encapsulated bacteria from the bloodstream, they are at increased risk of severe meningococcal disease. Administer meningococcal vaccine at least 2 weeks before elective splenectomy, if possible. MCV4 (Menactra^®) is the preferred meningococcal vaccine for individuals 2–55 years of age at high risk for meningococcal disease; MPSV4 (Menomune^®) is an acceptable alternative in this age group if the conjugated vaccine is unavailable.

Health-care workers who have close contact with nasopharyngeal secretions from patients with invasive meningococcal disease and laboratory personnel who are routinely exposed to isolates of N. meningitidis are at increased risk of meningococcal infection and should be vaccinated against meningococcal disease.

Military recruits are at increased risk of meningococcal disease and should be vaccinated against the disease. MCV4 (Menactra^®) is the preferred meningococcal vaccine in adults ≤55 years of age; MPSV4 (Menomune^®) is an acceptable alternative for adults in this age group if the conjugated vaccine is unavailable.