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CDC updates meningococcal vaccine guidelines
CDC. MMWR. 2011;60:72-75.
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When the CDC releases its 2011 Child and Adolescent Immunization schedule on Feb. 11, it will include updated recommendations for the use of quadrivalent meningococcal conjugate vaccines in adolescents, according to today’s Morbidity and Mortality Weekly Report.
Based on a review of data that included the vaccine-effectiveness and cost-effectiveness of different vaccination strategies for adolescents, the CDC’s Advisory Committee on Immunization Practices now recommends routine vaccination of adolescents aged 11 or 12 years, with a booster dose at 16 years; and a two-dose primary series given 2 months apart for those aged 2 to 54 years with persistent complement component deficiency and functional or anatomic asplenia, and for adolescents with HIV.
Meningococcal conjugate vaccines were licensed in 2005. Since then, further data on bacterial antibody persistence, US trends in meningococcal disease epidemiology, and vaccine-effectiveness indicated that many vaccinated adolescents were only protected for 5 years. This meant a dose given at age 11 or 12 years may only provide immunity until age 16 years, when risk of the disease begins to peak.
Although the disease incidence rate has been on the decline since 2000, the peak in disease among 18-year-olds has persisted, even after routine vaccination. From 2000-2004 to 2005-2009, the number of serogroups C and Y cases, which represent most vaccine-preventable incidences of the disease, were down 74% in 11- to 14-year-olds; for 15- to 18-year-olds, the decrease was 27%. Cases of infected people who were vaccinated against the disease have also been reported.
A case-control study (case patients, n=108; controls, n=158) of a meningococcal conjugate vaccine (Menactra, Sanofi-Pasteur) showed the overall vaccine-effectiveness in those vaccinated 0 to 5 years before the study was 78% (95% CI, 29-93). The vaccine-effectiveness for those vaccinated less than 1 year earlier was 95% (95% CI, 10-100); vaccine-effectiveness for those vaccinated 1 year earlier was 91% (95% CI, 10-101); vaccine-effectiveness for those vaccinated 2 to 5 years earlier was 58% (95% CI, –72 to 89).
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