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Diseases & Vaccines / More Vaccine Preventable Diseases / Meningococcal Disease / Vaccine

VACCINE: MENINGOCOCCAL DISEASE

vaccine indication;  rationale for vaccination;  type of vaccine;  composition of the vaccine;  immunogenicity of vaccines;  efficacy and long-term protection;  candidates for vaccination;  vaccination regimen and route of administration;  side effects and special precautions

1.     Vaccine indication

Meningococcal vaccine is indicated for the active primary prevention of Neisseria meningitidis infection in persons at increased risk of infection.

2.     Rationale for vaccination

N. meningitidis is the leading cause of bacterial meningitis and is capable of causing epidemics of meningitis which are more often fatal even with chemoprophylaxis. Vaccination with a safe and effective vaccine is the best way to prevent infection and associated sequelae such as meningitis, kidney failure and death.

3.     Type of vaccine

Meningococcal polysaccharide vaccine.

4.     Composition of the vaccine

Meningococcal vaccine consists of freeze-dried polysaccharide components for serogroups A, C, W135 and Y. The vaccines are stored at 2⁰C to 8⁰C for several years and are reconstituted with appropriate diluent just before use. The vaccines are available either as monovalent (groups A or C), bivalent (groups A and C) or tetravalent (groups A, C, W135 and Y).

5.     Immunogenicity of vaccines

There is an age-related antibody response to meningococcal vaccines. Serogroup A vaccine induces antibody response in children as young as 3 months although a response comparable to adults is only achieved at 4 or 5 years of age. Serogroup C vaccine is not immunogenic in children less than 2 years of age. Vaccines made from serogroups W135 and Y induce an immune response in adults and children above 2 years of age.

6.     Efficacy and long term protection

The efficacy of meningococcal vaccines is group and age-specific. However, in clinical trials it has been established that serogroups A and C vaccines confer protection of between 85% and 100% for children above 2 years of age and adults. The efficacy of serogroups W135 and Y has not been established.

7.     Candidates for vaccination

Meningococcal vaccine is not available as part of the EPI (SA) schedule, however there are persons who are at an increased risk of N. meningitidis infection and should be vaccinated. They include the following:

• Children under 5 years of age
• Travellers to meningococcal disease endemic countries
• Immunocompromised individuals
• Military personnel
• Laboratory workers who might handle meningococcal samples
• Any person who might be at risk during an outbreak

8.     Vaccination regimen and route of administration

• Meningococcal vaccine is given by intramuscular injection to the anterolateral aspect of the thigh for infants, or the deltoid muscle for older children and adults
• Children under 2 years of age should get three doses of the vaccine one month apart
• Children above two years and adults should get one dose

9.     Side effects and special precautions

Reactions to meningococcal vaccine are mild. Side-effects include fever and soreness at the site of injection. Individuals sensitive to thimerosal (mercury) should receive preservative-free vaccine.