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Am Fam Physician. 2001;64(7):1256

Neisseria meningitidis is a leading cause of bacterial meningitis. Even though effective antimicrobial treatment is available, the mortality rate is approximately 10 percent in persons with invasive disease. From 11 to 19 percent of survivors have significant sequelae, which can include neurologic disabilities, deafness and loss of limb. The incidence of meningococcal disease in 15- to 24-year-olds has increased disproportionately. In particular, outbreaks of group C disease have increased, with the majority of such cases occurring in institutions such as colleges, other schools and correctional facilities. Peter reviewed the current status of meningococcal vaccine use.

The quadrivalent A, C, Y and W-135 vaccine, the only formulation available in the United States, is not protective against group B strains and, with the exception of group A polysaccharide, has poor immunogenicity in children younger than two years. Recommendations for vaccination are based on risk factors for meningococcal disease (see the accompanying table) and have been limited primarily to controlling group A and C disease and group C outbreaks. Adverse reactions to meningococcal vaccine are generally mild, and serious adverse events are rare. Three to five years after the initial dose has been given, revaccination can be considered in persons at increased risk for meningococcal disease. However, the efficacy of re-vaccination is not yet known, and duration of immunity may be considerably longer in young adults (perhaps 10 years or older) than in young children.

Persons with functional anatomic asplenia
Persons with deficiencies of terminal complement or properdin
Travelers to geographic areas where meningococcal disease is hyperendemic or epidemic
Persons who attend college, particularly if they live in a dormitory

The author noted that the development of conjugate vaccines that are immunogenic in infants and toddlers is essential to reduce the incidence of meningococcal disease. Clinical trials of these vaccines are currently being conducted, and new preparations are expected within the next few years. At that time, vaccine advisory committees will probably consider routine immunization beginning in the first two years of life. Because the B polysaccharide is poorly immunogenic, vaccine protection against serotype B is not expected in the near future.

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