neisseria meningitidis - university of wisconsin–madison · meningococcal disease five major...
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Neisseria meningitidis
CDC
Invasive Meningococcal Disease
AAP
2005
Meningococcal Disease Five major serogroups A, B, C, Y, and W-135 Transmission via direct contact with respiratory
secretions of a nasopharyngeal carrier Most common cause of bacterial meningitis in
individuals 2-18 years Approximately 3000 cases each year Mortality rates 10-13% 10% of survivors with severe morbidity
– mental retardation– hearing loss– loss of limbs
Meningococcal Vaccines
Polysaccharide vaccine covering serogroups A, C, Y, and W-135
Single dose Revaccination if at high risk
for infection– children after 2-3 years if
<4 at time of 1st dose– consider for older children
and adults after 3-5 years
Meningococcal conjugate vaccine covering serogroups A, C, Y, and W-135
Repeat dose(s) for high risk Licensed for use in individuals
aged 9 months to 55 years (Menactra) and 2 months-55 years (Menveo)
Recommended for routine use in 11-12 year olds and repeat dose at age 16
Meningococcal Vaccine Recommendations
Also recommended for– control of serogroup C outbreaks
– individuals with immune deficiencies
– individuals with asplenia
– travelers to endemic areas
– military recruits
Incidence in College Students
Immunization Action Coalition
Vaccine Limitations
Not very effective in children less than 2 years
Does not confer 100% protection against serogroups contained in vaccine
Confers no protection from serogroup B
Short duration of protection
Confers no protection from serogroup B
Polysaccharide Conjugate
Revaccination with MCV4
Revaccinate individuals at prolonged risk of invasive disease
– Complement deficiencies– Anatomic or functional splenectomy– Prolonged exposure (microbiologists, travelers or
residents of hyperendemic or epidemic areas)
Revaccination Schedule
Revaccinate adolescents at 16 years of age
Revaccinate after 5 years if age >7 years
Revaccinate after 3 years of age 2-6 years
Continue to revaccinate at 5 year intervals if
remain in high risk group
Meningococcal Immunization for Infants MCV4 Hib-Men CY-TT
– Combination vaccine for infants– Meningococcal serotypes C and Y– Haemophilus influenzae type b – All conjugated to tetanus toxoid
MCV4 or Hib-Men CY-TT recommended for infants at high risk of invasive meningococcal disease
– Four dose series in infant immunization schedule
Vaccines for Meningococcal Serogroup B (MenB)
Meningococcal Serogroup B
Trumenba: Recombinant serogroup B fHBP protein
– (H binding protein)
Induces complement dependent antibody responses
No clinical protection confirmed 3 dose series for 10-25 year olds
Meningococcal Serogroup B
Bexsero: multicomponent; Recombinant Big increases in antibody concentrations Used in Princeton and UCSB outbreaks 2 dose series at least one month apart for
10-25 year olds
ACIP Recommendations
Either vaccine for individuals at high risk for invasive meningococcal disease starting at age 10 years
– Use same risks as for MCV4– No upper age limit
16-23 year olds may be vaccinated to provide short-term protection