AAP Updates Meningococcal Vaccine/Booster Dose Guidelines

Laurie Barclay, MD

December 07, 2011

December 7, 2011 — Adolescents should be routinely immunized with the quadrivalent meningococcal conjugate vaccine (MCV4) at 11 or 12 years of age and receive a booster dose at age 16 years, according to updated guidelines in an American Academy of Pediatrics (AAP) policy statement published online November 28 and in the December print issue of Pediatrics.

"In 2005, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention and the [AAP] developed recommendations for the use of [MCV4] with the objective of protecting adolescents as well as young adults aged 16 through 21 years, the time at which meningococcal disease rates peak," write Michael T. Brady, MD, and colleagues from the AAP's Committee on Infectious Diseases, 2010-2011. "Recent information on persistence of antibodies and the occurrence of breakthrough cases indicates that this recommendation for administration of MCV4 at 11 through 12 years of age may not provide protection for more than 5 years or throughout the full period of highest risk."

Available quadrivalent meningococcal conjugate vaccines, which protect against serogroups A, C, W-135, and Y, are Menactra (Sanofi Pasteur) and Menveo (Novartis).

Updated Recommendations

After reviewing recent evidence on immunogenicity in high-risk groups, persistence of bactericidal antibody after vaccination, current epidemiology of meningococcal disease, MCV4 efficacy, and cost-effectiveness of different strategies for vaccinating adolescents, the Advisory Committee on Immunization Practices and the AAP approved the following updated recommendations:

  • Adolescents should be routinely immunized at 11 to 12 years of age and receive a booster dose at 16 years of age.

  • Adolescents first vaccinated with MCV4 at 13 to 15 years of age should be given a booster dose at 16 to 18 years of age, or up to 5 years after their first dose.

  • Adolescents first vaccinated with MCV4 at 16 years of age or thereafter do not need a booster dose.

  • Persons at increased risk for invasive meningococcal disease should receive a 2-dose primary series 2 months apart. High-risk conditions include a persistent complement component (eg, C5 - C9, properdin, factor H, or factor D) deficiency in persons aged 9 months through 54 years of age, or functional or anatomic asplenia in persons aged 2 to 54 years, and human immunodeficiency virus (HIV) infection in adolescents.

  • If the primary 2-dose series was given from age 2 to 6 years of age, a booster dose should be given 3 years after the primary series. A booster dose should be given every 5 years for persons whose 2-dose primary series or booster dose was given at 7 years of age or older who are at risk for invasive meningococcal disease because of persistent complement component deficiency or functional or anatomic asplenia.

Additional Considerations

Whenever feasible, the same brand of vaccine should be used for all doses of the vaccination series, because evidence is limited regarding the interchangeability of meningococcal vaccine products from different manufacturers. However, if the previously used brand is unknown or unavailable, any product should be used to continue or complete the series.

Although MCV4 is safe and immunogenic among nonpregnant women aged 11 through 55 years, there are no available data on MCV4 safety when given during pregnancy. A pregnant woman should be vaccinated with MCV4 only if the potential benefit outweighs the potential for risk.

Breastfeeding is not a contraindication to MCV4 vaccination.

"Some states, secondary schools, colleges, or universities have policies that require immunization against meningococcal disease as a condition of enrollment," the policy statement authors conclude. "A single dose of MCV4 5 or fewer years before matriculation should be considered acceptable. A booster dose should be administered before matriculation if the adolescent was immunized more than 5 years previously."

All policy statement authors have filed conflict of interest statements with the AAP. Any conflicts have been resolved through a process approved by the Board of Directors. The AAP neither solicited nor accepted any commercial involvement in the development of the content of the policy statement.

Pediatrics. 2011;128:1213-1218. Full text

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