New Meningococcal Vaccine Recommended for High-Risk Infants

Miriam E. Tucker

January 24, 2013

Infants who are at high risk for meningococcal disease should receive a recently licensed vaccine that protects against 2 strains of meningococcal disease as well as Haemophilus influenzae type b, according to the Centers for Disease Control and Prevention (CDC).

The new recommendation was published in the January 25 issue of the CDC's Morbidity and Mortality Weekly Report.

Infants recommended to receive meningococcal groups C and Y and Haemophilus b tetanus toxoid conjugate vaccine (Hib-MenCY-TT [MenHibrix, GlaxoSmithKline Biologicals]) include those with persistent complement component pathway deficiencies and functional or anatomical asplenia, including sickle cell disease.

"The number of U.S. infants in these high-risk groups is small (estimated at 3,000-5,000), making a targeted high-risk vaccination policy feasible and reasonable given the potential increased risk in these infants," the CDC writes.

The Hib-MenCY-TT vaccine, licensed in June 2012, is the first meningococcal vaccine approved for use in young infants, with an indication for ages 6 weeks through 18 months. High-risk infants in that age group should receive 4 doses of the vaccine.

The new vaccine can also be used in any infants aged from 6 weeks to 18 months in local outbreak situations, but not for travel to the Hajj or the "meningitis belt" of sub-Saharan Africa because it does not contain the necessary serogroups A and W135. Two other meningococcal vaccines containing those strains are available but cannot be used in children younger than 9 months, according to the CDC.

Data supporting use of Hib-MenCY-TT came from a single-blinded, multicenter study of healthy infants. After 3 doses given at ages 2, 4, and 6 months, protective antibody titers against meningococcal serogroups C and Y were 99% and 96%, respectively, and against Hib they were 96%. Further protection was seen after a fourth dose given at 12 to 15 months, and no decreases in immunogenicity were seen when Hib-MenCY-TT was coadministered with other routine vaccinations.

At a meeting in October 2012, the CDC's Advisory Committee on Immunization Practices debated a possible recommendation for routine use of Hib-MenCY-TT in all infants. The committee ultimately decided against that recommendation because of the current frequency of meningococcal disease, which reached a historic overall low of 0.21 per 100,000 population in 2011.

Moreover, similar to other meningococcal vaccines, Hib-MenCY-TT does not contain serotype B, which is responsible for 60% of meningococcal disease among children aged 0 to 59 months. The Advisory Committee on Immunization Practices will continue to monitor trends in epidemiology to determine whether further recommendations are needed, according to the CDC.

Morb Mortal Wkly Rep. 2013;62:52-54. Full text