New meningococcal vaccine recommended - HealthLINK (Pediatrics)

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UPDATE: September 30, 2005
The US Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) are investigating six cases of Guillain-Barre syndrome, which occurred after receipt of meningococcal conjugate vaccine. Please read the FDA and CDC-issued alert. The American Academy of Pediatrics continues to recommend the meningococcal conjugate vaccine for adolescents while the investigation of these cases is continuing. However, prior to vaccination, adolescents and care givers should be informed of this ongoing investigation as part of the consent process for immunization and anyone who has ever had Guillain-Barre syndrome should talk with their doctor before getting vaccinated.

September 16, 2005

News this month
New meningococcal vaccine recommended

In February 2005, the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) recommended a new vaccine, known as Menactra, for use to prevent meningococcal disease. The CDC and ACIP determined that establishing the target age at 11 years may give lasting immunity through college.

Certain groups of college students have six times the risk of contracting the potentially fatal bacterial infection.

These recommendations have also been endorsed by the American Academy of Pediatrics, the American Association of Family Practitioners and the American College Health Association.

The new meningococcal vaccine was licensed by the U.S. Food and Drug Administration on January 14, 2005, for use in people 11 to 55 years of age and is manufactured by Sanofi Pasteur.

Meningococcal disease on the increase among college students
The incidence of meningococcal disease has increased since the early 1990s, including cases at U.S. colleges and universities. The CDC found that certain groups of college students had six times the risk of contracting the potentially fatal bacterial infection.

Data suggests that certain social behaviors, such as exposure to passive and active smoking, bar patronage and excessive alcohol consumption may increase students’ risk for contracting the disease.

Bacterial meningitis in
children 2-18
Meningococcal disease is a leading cause of bacterial meningitis in children two through 18 years old in the U.S. According to the National Meningitis Association, one in four adolescents infected will die and of those who survive, up to 20 percent will experience permanent disabilities such as amputation, brain damage, hearing loss and skin scarring.

While meningococcal disease is rare—about 2,000 cases of the disease occur in the U.S. each year—the infection is highly contagious and can spread rapidly throughout the body if not treated promptly.

New vaccine to provide longer protection
One shot of Menactra is expected to increase immunity against four of the five deadliest strains of meningococcal bacteria for eight to 10 years—twice as long as the protection provided by an earlier vaccine—Menomune—manufactured by the same company.

“With the licensure of the new conjugate vaccine, up to 70 to 80 percent of cases theoretically could be prevented among adolescents and young adults through widespread vaccination,” said Dr. William Schaffner, a board member of the National Foundation for Infectious Diseases.

The vaccine provides protection against four out of the five strains that cause meningococcal disease: Serogroups A, C, Y and W-135. There is currently no vaccine for serogroup B.

American Academy of Pediatric vaccine guidelines
The American Academy of Pediatrics advocates the new Menactra meningitis vaccine be given to the following groups:

All children 11 to 12 years of age at the time they enter middle school, or
Adolescents 14 to 15 years old at the time they enter high school, and
All new college freshmen who are going to be living in
dorms.

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The facts about meningococcal disease

Meningococcal disease is a serious bacterial infection that can cause meningitis—severe swelling of the brain and spinal cord and can also manifest as sepsis—a dangerous and potentially life-threatening blood infection.

“Many people think only college students living on campus are at increased risk for meningococcal disease, when in fact younger adolescents are also at risk.”

Many people think only college students living on campus are at increased risk for meningococcal disease, when in fact younger adolescents are also at risk.

Outbreaks of meningococcal disease can be very disruptive to society, threatening the life and livelihood of millions of people each year. This disease is an important cause of death worldwide. Even with its lower incidence in the U.S. than in the developing world, prevention is crucial.

College students more at risk
Teens and young adults, especially college students, are more at risk for the disease than others because they spend a lot of time with many of their peers, in close quarters like dormitories, where germs can rapidly spread.

If bacterial meningitis is diagnosed early and treated promptly, most people make a full recovery.

Researchers have recently cited smoking, second-hand smoke and binge drinking as risk factors in contracting bacterial meningitis. Alcohol and tobacco smoke interfere with the immune system so greatly that the bacteria overwhelm the host defenses and leave the body vulnerable to attack.

“Meningitis is often difficult to recognize because initial symptoms more often than not resemble more common viral infections.”

Know the signs and symptoms
Meningitis is often difficult to recognize because initial symptoms more often than not resemble more common viral infections. Symptoms typically include headache, fever, nausea and exhaustion. These symptoms can develop over several hours or they may take one to two days.

Other symptoms may include discomfort looking into bright lights, confusion and sleepiness. In newborns and small infants, the classic symptoms of fever, headache and neck stiffness may be absent or difficult to detect. The infant may only appear slow or inactive or be irritable, vomiting or feeding poorly. As the disease progresses, patients of any age may have seizures.

It is important to seek medical attention immediately if you suspect your child has meningitis or if your child exhibits symptoms such as vomiting, headache, lethargy or confusion, neck stiffness, rash and fever.

Communicable disease
Meningococcal disease is contagious and progresses very rapidly. The bacteria are spread person-to-person through the air by respiratory droplets (e.g., coughing, sneezing). The bacteria also can be transmitted through direct contact with an infected person, such as oral contact with shared items like cigarettes or drinking glasses and through kissing.

While antibiotics are routinely used to treat meningococcal disease following exposure to the bacteria, vaccination can greatly reduce the risk of getting this very serious disease. In fact, up to 83 percent of the cases in adolescents and young adults are caused by strains of the bacteria that are potentially vaccine preventable.

New vaccine provides longer-lasting response
Vaccination with either Menactra or Menomune can prevent four of the five strains of the disease. Menomune was first developed for use in the military and has limited use in the civilian world because of its lack of efficacy for infants and young children as well as the need to reimmunize recipients periodically. Due to a newer method of manufacturing vaccines for childhood bacteria infections, linking the extract of the organism to a protein, it is expected that Menactra will induce a more potent and longer-lasting protective response than Menomune.

If your child has been in contact with someone who has meningitis (for example, in a child care center or a college dorm), call your child’s pediatrician to determine whether your child should take preventive medication.

Wash your hands
In addition to vaccination, practicing good personal hygiene such as washing hands often and keeping hands away from the nose and mouth is always recommended.

Dr. Baltimore is a board-certified pediatric infectious disease specialist at Yale-New Haven Children’s Hospital and professor of pediatrics and epidemiology at the Yale University School of Medicine.