Meningococcal vaccines in Canada: An update

Question 1

What meningococcal vaccines are available in Canada?

Answer 1

1. MCV-4 Quadrivalent meningococcal conjungate (A,C,Y,W-135) Menactra or Menveo
   - -> adolescent booster, after age 2 in groups at increased risk
2. MCV-C Meningococcal serogroup C conjugate vaccine Meningitec, Menjugate or Neis Vac-C
   - -> one dose @12mo, for infants @ increased risk dose @ 1m, 4m, and 12mo, adolescent booster
3. Polysaccharide A,C,Y,W-135 Menomune
   - -> no longer useful in pediatrics

Question 2

What is Neisseria meningitidis?

Answer 2

Gram negative diplococcus

Causes: septicemia, meningitis, septic arthritis, pnumonia, conjunctivitis

Question 3

What is the mortality rate for invasive disease?

Answer 3

10%

Question 4

What is the epidemiology of serogroup B?

Answer 4

Endemic in Canada
Peak incidence <5yo
70% cases due to serogroup B in <5yo

Question 5

What is the epidemiology of serogroup C?

Answer 5

Outbreaks
Peak incidence 15-19yo
Higher rate of septicemia disease
Higher mortality

Question 6

What are the CPS recommendations?

Answer 6

1. Canadian children should be immunized with a MCV-C at 12 months of age. Other infants may begin MCV-C immunizations at an earlier age, depending on provincial or territorial vaccine programs and the most up-to-date recommendations published by the National Advisory Committee on Immunization.
2. Infants at increased risk for invasive meningococcal infection (Table 2) should begin MCV-C immunization at two months of age.
3. MCV-4 should be given to children two years of age and older who are at increased risk for meningococcal infection (Table 2). MCV-4 may also be considered for HIV-positive children two years of age or older.
4. All adolescents should be offered a booster dose with MCV-4 or MCV-C at approximately 12 years of age. How often boosters will be required later in life is unknown. Both vaccines are generally safe and well tolerated.

Question 7

Which groups are at increased risk of invasive meningococcal disease?

Answer 7

1. Persons with anatomical or functional asplenia (eg, patients with sickle cell anemia)
2. Children with primary antibody deficiency disorders
3. Persons who have complement, properdin or factor D deficiency
4. Travellers to areas where meningococcal risk is high
5. Laboratory personnel with exposure to meningococcus
6. The military