New Recommendations Aim to Broaden Meningococcal Vaccine Coverage

AAFP Board Chair Larry Fields, M.D., of Flatwoods, Ky., this week approved a recommendation to further expand the routine use of quadrivalent meningococcal polysaccharide-protein conjugate vaccine, or MCV4. The new recommendation calls for immunization of all individuals ages 11 to 18 years with one dose of MCV4 at the earliest opportunity.

The Academy recommendation, which aligns with policy developed in June by the CDC's Advisory Committee on Immunization Practices, or ACIP, moves beyond a previous recommendation that a single dose of MCV4 be administered to 11- and 12-year-olds; teens entering high school (i.e., at about age 15) if not previously vaccinated with MCV4; and others at increased risk for meningococcal disease.

The vaccine, which is manufactured by sanofi pasteur and marketed as Menactra, was first licensed in January 2005 for use in people ages 11 to 55.

ACIP continues to recommend routine vaccination for people ages 19 to 55 who are at increased risk for meningococcal disease. These individuals include college freshmen living in dormitories, researchers routinely exposed to isolates of Neisseria meningitidis, military recruits, travelers to or residents of countries in which N. meningitidis meningitis is hyperendemic or epidemic, people with terminal complement component deficiencies, and those with anatomic or functional asplenia.

The new ACIP recommendations, which were published Aug. 10 in Morbidity and Mortality Weekly Report, can be viewed on the CDC Web site.

It should be noted that in 2005 and 2006, peaks in vaccine demand were seen during the months of July and August, as children returned to school after summer vacation, leading to limited MCV4 availability. However, as of June 2007, ACIP expects the supply of MCV4 to be sufficient to meet the increased demand resulting from the revised recommendations.

It's also worth noting that instances of Guillain-Barré syndrome, or GBS, have been associated with administration of MCV4. In particular, patients with a history of GBS might be at increased risk for postvaccination GBS; therefore, a history of GBS is a relative contraindication to receiving MCV4. Individuals with a history of GBS who are among those recommended to receive MCV4 -- or their parents -- should discuss the decision to be vaccinated with their physician. Meningococcal polysaccharide vaccine, or MPSV4, is an acceptable alternative for short-term protection (i.e., 3 to 5 years) against meningococcal disease.

For questions about ordering MCV4 or MPSV4, physicians can contact sanofi pasteur by phone at (800) VACCINE [822-2463] or online.