Meningococcal Vaccine

A new meningococcal vaccine in combination with Hib-another cause of meningitis in children has been approved by FDA for use in infants and toddlers.

The meningococcal conjugate vaccines, used presently, are not recommended for under 2 years of age, who compromise the highest affected group of children along with the teenagers.

Meningococcal disease is relatively uncommon, yet imposes a serious threat to child health.

The consequences suffered by the affected children and teenagers are often devastating and hence it is one of the most dreaded infectious diseases.

Meningococci, Neisseria Meningitidis Diplococcal Bacteria, are part of the normal upper air passage flora.

About 10 percent of the adult human population harbor them in nose, mouth and pharynx.

They have not been isolated in animals.
The spread of the organisms is by direct
close contact and fomites.

Meningococcal disease occurs only in humans, and is the only form of bacterial meningitis known to occur epidemically.

Cases occur throughout the year but may be more common in the winter and spring and following influenza virus infections.

The disease has a rapid onset. Initially, the symptoms mimic a viral illness, causing headache, sore throat, fever, muscle pains, weakness, vomiting and diarrhea.

Early in the course of infection, about 7 percent of affected children develop fine maculopapular rash. Limb pain with refusal to walk occurs often and is the primary complaint in some of the otherwise clinically unsuspected cases.

Invasive meningococcal disease has a potential to progress into life threatening or crippling illness in a matter of hours, in spite of the ongoing medical management.

Available statistics indicate the case-fatality rate of more than
10 percent and almost 20 percent of survivors sustain permanent neurologic deficits.

Vaccination is the best control strategy for prevention of this disease. Plain polysaccharide vaccines for serotypes A, C, W135 and Y meningococcal disease have been available since the 1970s.

Currently available vaccines, tetravelent polysaccharide-protein conjugate meningococcal vaccines (MCV4, Menactra, Sanofi Pasteur; and Menveo, Novartis), are being routinely recommended for children above 11 years of age.

Children between 02 and 11 years of age are prescribed the currently available vaccine only in face of increased risk.

They are not recommended for infants and toddler under 2 years of age, who are the most frequent victims of meningococcal meningitis and meningococcemia.

The efforts to prevent invasive meningococcal disease have continued to remain challenging. Till recently, the attempts to obtain an immunogenic effective and safe vaccine for infants had failed.

The approval of U.S. Food and Drug Administration (FDA)for the new vaccine, MenHibrix, to prevent invasive disease caused by Neisseria meningitidis serogroups C and Y for use in children aged 6 weeks through 18 months is a great breakthrough for the future of child health.

The product is a combinationwith vaccine against Haemophilus b and Tetanus Toxoid.

The vaccination schedule for MenHibrix is a 4-dose series given at 2, 4, 6, and 12 through 15 months of age. The first dose can be given as early as 6 weeks of age and the last as late as 18 months of age.

However, an effective vaccine to prevent serotype B meningococcal disease yet remains to be discovered.

Studies show that in the USA, serotypes B, C, and Y each account for about 30 percent of the cases. Half of the infants affected by meningococcal disease are noted to be due to serotype B strains, which is also the usual cause of epidemics in developed nations. Whereas, the epidemics in developing countries, is usually caused by serotype A.

MenHibrix is expected to be available for use in the near future. Its use is reported to be safe based on the results of the study of about 7,500 infants and toddlers in the United States, Mexico, and Australia.

Pain, redness and swelling at the injection site, irritability, and fever were the common adverse reactions noted.

We await more information on the subject and details on the forthcoming product.

References:

1. Cohn AC, MacNeil JR, Harrison LH, et al. Changes in Neisseria meningitidis disease epidemiology in the United States, 1998-2007: implications for prevention of meningococcal disease. Clin Infect Dis. 2010;50(2):184-191. p 190, col 1, par 3, lines 2-4.http://dx.doi.org/10.1086/649209

2. Dr Gregory A. Poland, 200 First St SW, 611C Guggenheim Bldg, Rochester, MN 55905 (poland.gregory@mayo.edu). Clinical Infectious Diseases 2010; 50:S45–S53

3. Epidemiology of meningococcal disease in Latin America: current situation and opportunities for prevention by Marco Aure´lio Palazzi Sa´fadi and Ota´vio Augusto Leite Cintra Neurological Research 2010 VOL 32 NO 3 pg 263

4. Prevention of Meningococcal Disease: Current Use of Polysaccharide and Conjugate Vaccines Gregory A. Poland Mayo Vaccine Research Group, Mayo Clinic College of Medicine, Rochester, Minnesota S46; CID 2010:50 (Suppl 2); Poland

5. Nelson Text Book of Pediatrics 19th ed.

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