Update on invasive meningooccal vaccination for Canadian children and youth

Question 1

5 serogroups of meningococcus that cause invasive meningococcal disease in Canada?

Answer 1

A B C Y W

Question 2

What is the preferred quadrivalent ACYW?

Answer 2

Menveo - conjugated to CRM protein

* recommended product in 2mo-2yr who are at high risk of invasive disease

Question 3

What meningococcal vaccines do all people get?

Answer 3

• MenC at 12 months (may receive MenC at earlier age if recommended by province/territory)
• MenC or Men-C-ACYW as one booster in adolescence

Question 4

What are the 2 predominant serogroups in invasive meningococcal disease?

Answer 4

• serogroups B and C
• B has peak incidence <5 years and accounts for >70% of cases in this age group and > 1/2 of cases in all age groups
• C often occurs in outbreaks (peak incidence in adolescents)

Question 5

What are common manifestations of invasive meningococcal disease?

Answer 5

septic shock
sepsis
meningitis
pneumonia
septic arthritis
pericarditis
bacteremia

Question 6

Which patients are at increased risk for invasive meningococcal disease?

Answer 6

Underlying medical conditions:

• asplenia or functional asplenia (including SCD)
• Properdin, factor D or complement deficiency
• Primary antibody deficiency
• HIV

Increased risk for exposure:

• lab workers with meningococcus
• military personnel living in close quarters
• travellers to endemic areas (sub-Saharan Africa and Hajj pilgrims)
• close contacts of a case of IMD

Question 7

What interval do you give the meningococcal vaccine for kids with underlying medical condition or travel (as booster)?

Answer 7

• <7 yrs: booster of Men-C-ACYW and 4CMenB q3-5 yrs
• > 7 yrs: q5 yrs

During vaccinations, give it 8 wk apart (except 4CMenB which can be given 4 wk apart for >=11 years)

Question 8

What is the meningococcal vaccine regimen for people at increased risk for invasive meningococcal disease?

Answer 8

• begin Men-C-ACYW and 4CMenB at time of diagnosis (if at least 2 months) and even if they already got Men-C-C
• need 2-3 doses of both Men-C-ACYW and 4CMenB at least 8 weeks apart (4CMenB can be given 4 wk apart if child at least 11 yrs)
• 12-23 month booster of both vaccines required when initial doses given in first year of life
• do not need routine MenC at 12 months
• Preferred MenACYW before 2 years is Menveo

Question 9

What is the meningococcal vaccine regimen for transplant recipients?

Answer 9

• routine meningococcal immunizations
• give immunizations for solid organ pretransplant even if they haven’t reached typical age
• needs to be repeated post-transplant for HSCT

Question 10

What is the meningococcal vaccine regimen for travellers to high risk meningococcal areas?

Answer 10

• should have Men-C-ACYW even if they had MenC
  
  • 2-3 doses if <12 mo
  • 2 doses if 12-23 mo
  • 1 dose >=2yrs
• Dose should be given 8 wks apart but can be given 4 wk apart if travel imminent
• 4CMenB recommended only if travel to area with serogroup B outbreak with strain that is vaccine-preventable

Question 11

What is the meningococcal vaccine regimen for laboratory personnel who work with meningococcus and military personal?

Answer 11

• should have one dose of both Men-C-ACYW and 4CMenB