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ACIP recommends adding booster dose to meningococcal vaccination
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The Advisory Committee on Immunization Practices recommended routine vaccination with the quadrivalent meningococcal conjugate vaccine for children aged 11 to 12 years followed by a one-time booster dose 5 years after administration of the first dose through 21 years of age.
The panel’s decision represents a departure from previous recommendations for routine vaccination with one dose of quadrivalent MCV4 (Menactra, Sanofi-Pasteur) in children aged 11 to 12 years or at the earliest opportunity in adolescents aged 13 to 18 years.
The ACIP’s meningococcal vaccine workgroup based its proposal for an amended recommendation on data indicating that protection conferred by MCV4 will wane in 5 years as opposed to the 10 years originally denoted by previous studies.
At the meeting held today in Atlanta, the workgroup presented results from two clinical trials involving MCV4 that demonstrated the booster dose’s ability to improve immunogenicity when administered after primary vaccination, suggesting prolonged duration of immunity. The studies also yielded no safety concerns, although the workgroup recommends continued monitoring of safety in children aged 2 to 18 years who receive the booster dose.
Additionally, although cost-effectiveness analyses linked the added booster dose to increases in vaccine program costs, results also indicated that this strategy prevents the greatest number of disease cases. The workgroup also noted that attaining high coverage is feasible.
During discussion, ACIP members expressed concern that results supporting the recommendations derive from small studies and are limited. They also said the cost-effectiveness analyses were dependent upon vaccine prices and coverage rates among adolescents. Other issues, including the frequency of adolescents’ preventive visits to physicians, the currently low incidence of meningococcal disease and practical implementation of changes to the adolescent vaccine program, also generated discussion.
The panel also accepted the language proposed by the Vaccines for Children’s Program. Coverage for eligible groups of children will match the committee’s recommendations, panel member Lance Rodewald, MD, of the CDC, said. He noted, however, that recommending the booster dose 5 years after administering the primary vaccination through 21 years of age may place a child outside the eligible range for coverage depending on when the initial dose was received.
The ACIP also accepted the language of recommendations for a two-dose primary series with meningococcal conjugate vaccine (MenACWY; Menveo, Novartis) in those with persistent complement component deficiencies, such as asplenia and HIV, who have not been previously vaccinated at 0 and 2 months followed by a booster dose at a recommended interval.