News & Views: Sorting Out Meningococcal Recommendations to Create an Office Policy for Healthy Adolescents and Teens
Published on in Vaccine Update for Healthcare Providers
Published on in Vaccine Update for Healthcare Providers
Recently, we have had several providers contact us with questions about addressing meningococcal vaccinations in practice, so we thought it might be helpful to provide some background and resources as practices work to create office-wide policies. The discussion herein is specific to healthy adolescents and teens, not those considered to be high risk based on health conditions.
From the recommendations, “Healthcare personnel should use every opportunity to provide the booster dose when indicated, regardless of the vaccine brand used for the previous dose or doses.”
Healthy individuals are at increased risk of meningococcal infection during three periods of life: younger than 1 year old, between 16 and 21 years of age, and 65 years of age and older. Although disease burden is greatest in infants, young adults are considered to be the greatest source of transmission as evidenced by their having the highest rates of nasopharyngeal carriage.
As data emerged about the effectiveness of meningococcal ACWY vaccine, it became apparent that one dose of vaccine during adolescence would not protect most teens during the period of greatest risk between 16 and 21 years old. The ACIP considered three dosing regimens in revising the recommendations and concluded that a dose in adolescence (11 to 12 years old) with a booster at 16 years of age would avert the most cases and deaths. Refer to table 5 in the recommendations to see this comparison.
Although the cases of meningococcal disease, including meningococcal serogroup B, have been low in recent years in the U.S., about 50 to 60 cases and 5 to 10 deaths result from meningococcal B disease each year. About 80 percent of these occur in 16- to 23-year-olds.
While the recommendations published in 2015 suggest that the incidence of meningococcal B infection is greatest among non-college students between 18 and 23 years of age, a study conducted between 2014 and 2016 indicated the reverse. Dr. Offit presented these data generated by the CDC in our Spring 2018 webinar:
About 15 to 29 cases and two to five deaths could be prevented with routine adolescent immunization depending on the age at which vaccination is recommended. Based on the data, immunizing 16- to 18-year-olds would be most effective at preventing disease and death. Refer to table 2 in the recommendations to see the comparison data.
When the CDC was considering recommendations, limited data were available related to alignment with circulating serogroup B strains, duration of protection, vaccine effectiveness related to clinical disease endpoints, and impact on both nasopharyngeal carriage and herd immunity.
All of these data, related to both disease epidemiology as well as vaccine effectiveness, and increased opportunity to gather more safety data, led to the category B recommendation.
Contributed by: Charlotte A. Moser, MS, Paul A. Offit, MD
Categories: Vaccine Update October 2018, News and Views About Vaccines