MARK B. LEVIN, M.D.
JOHN M. COTTON, M.D.
TIMOTHY J. PATRICK-MILLER, M.D.
LOUIS J. TESORO, M.D.
HELEN M. ROSE, M.D.

THE PEDIATRIC GROUP, P.A.
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New Meningococcal Vaccination Recommendations: April, 2005

1. Introduction: The Centers for Disease Control (CDC), the American Academy of Pediatrics (AAP) and the American Committee on Immunization Practices (ACIP) have endorsed (Menactra®), a new diphtheria-conjugate meningococcal vaccine, to be included in the adolescent immunization schedule. Vaccines have greatly reduced the incidence of meningitis caused by hemophilus influenza type b and pneumococcus. Meningococcus is now the most common cause of bacterial meningitis in children. Hopefully, meningococcal vaccine will lower the incidence of meningitis cause by this organism, as well.
2. The Disease: Neisseria meningitides, or meningococcus, may live as an asymptomatic passenger in the nasal and oral cavities of some people. These carriers unknowingly transmit the infection to the rest of us. Although the incidence of this disease in the general population is low (about 1 per 100,000) the consequences of infection are severe with about 60% becoming ill on exposure and 6% succumbing to the infection. Survivors are often left with some neurologic impairment. Unfortunately, this disease does not induce early symptoms that allow it to easily be distinguished from other respiratory infections. By the time unique symptoms develop, (high fever, stiff neck, vomiting, bleeding into the skin, mental deterioration and shock) the victim is often critically ill. First year college students have triple the incidence of acquiring this disease due to exposure to an international population in a closed setting (dormitory) where personal items are commonly shared and personal hygiene is often sub-optimal. Conversely, 12-18 year olds have the highest mortality rate with this disease after infants. Five strains (A,C,Y,W and B) of this germ cause most of the human infections. The B strain is responsible for about 40% of the infections in the U.S.A. Most cases are due to sporadic occurrence, not outbreaks due to the same strain. The AAP, the ACIP and the CDC recommend the meningococcal conjugate vaccine for all children between the ages of 11-12 years old to cover the pre-college age group that has increased mortality and the first year college students who have increased frequency of disease.
3. Vaccines: There are two types of this vaccine: Menomune®, a polysaccharide vaccine and Menactra®, a diphtheria-conjugate vaccine, both made by Aventis. Both are killed vaccines and can not transmit or cause disease. Menomune®, has been used for years for individuals over two years of age, especially if they are in a high risk group (foreign travel or first year college students). Menomune® has an expected duration of immunity of 3 years. Reactions to Menomune® are minor and occur in 40-90% of recipients. They consist of a transient headache, slight fever and/or local inflammation at the injection site within the first 2 days after the injection and lasting for several hours.

   The newer diphtheria-conjugate vaccine (Menactra®) is currently approved for use in children aged 11 and over. Menactra® has an expected duration of immunity of at least 8 years. Studies are in progress to determine how much longer it will last. Menactra® reactions are minor and occur at a frequency of 50%. They consist of local injection site inflammation, transient headache, malaise and/or slight fever.

4. Schedule: Before the introduction of the longer lasting Menactra®, the primary target age group for Menomune® was first year college students. Other targets included travelers to endemic areas and anyone wishing to minimize their risk of acquiring this infection. Since Menactra®-induced immunity lasts at least eight years, national agencies have recommended that it be administered at 11-12 year olds to cover their first year in college and also to reduce the frequency of the disease in the higher mortality 12-18 year age group. Menomune® is still available for high risk travelers under the age of 11 years.
5. Notes:

1. 1. No vaccine is 100% effective. Good hygiene is appropriate in every circumstance.
   2. Neither vaccine contains the B strain of the germ. Immunity against other strains does not protect against the B strain. Prescription medication to prevent disease is recommended for all immediate contacts of an infected person, regardless of immunization status.
   3. Colleges and universities often recommend meningococcal vaccine prior to entry. Some states have enacted legislation that requires college students in that state to be immunized against meningococcus.
   4. Although boarding schools and overnight camps often request that a child receive meningococcal vaccine, these settings do not generally have the international population that places college freshmen at increased risk.
   5. This vaccine is not obligatory at this time.
   6. Please feel free to ask any of the doctors about the appropriateness of this vaccine for your child.

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