VACCINE UPDATE ON
MENINGOCOCCAL DISEASE
Stanley A. Gall, MD
M
eningococcal disease comprises a
spectrum of infections caused by
Neisseria meningitidis and includes
meningitis (50.2 percent), bacteremia (37.5
percent) or bacteremia pneumonia (9.2 percent). (1) (2) Neisseria meningitis colonizes the
mucosal surfaces of the nasopharynx and is
transmitted by large droplet respiratory tract
secretions. Nasopharyngeal carriage rates are
highest in adolescents and young adults. (3)
It is estimated that 800-1,200 cases of meningococcal disease
occurred annually during 2005-2011 representing an incidence
of 0.3 cases per 100,000 populations. (4) Incidence has decreased
annually since a peak in the late 1990s. There has been a decrease
from 1.1 cases per 100,000 populations to 0.4 cases per 100,000
populations (64 percent). Although the incidence is at historical
lows, the overall case fatality remains at 10-15 percent, and 1119 percent of the survivors have long term sequelae (neurologic
disability, limb or digit loss and hearing loss).(5)
Serogroups B, C and Y are the major causes of meningococcal
disease in the United States, each causing approximately one-third
of the cases. However, they vary by age. About 60 percent of disease
among children aged 0-59 months is caused by serogroup B, which
is not prevented by older vaccines but is included in recently recommended vaccines. Serogroups C, Y or W cause 73 percent of all
cases of meningococcal disease among persons age 11 or greater. (4)
The incidence of meningococcal disease peaks among persons
in three age groups :( 4)
--
infants and children aged <5 (serogroups C and Y in infants,
60 percent serogroup B up to age 5)
--
adolescents and young adults aged 16-25 years
--
adults ≥ 65 years of age (^0 percent serogroup Y and 43 percent
with bacteremia pneumonia).
The highest case fatality rate nearly 24 percent is seen in those
older than 65.
CURRENT MENINGOCOCCAL
VACCINES AVAILABLE IN THE
UNITED STATES
Trade Name
Type of Vaccine
Meningococcal
Sero-Types
covered
Bexsero
recombinant (Men B)
B
Menactra
conjugate (Men
ACWY)
A, C, W, Y
MenHibrix
conjugate
C, Y and
Haemophilus
influenza type b
Menomune
polysaccharide
(MPSV4)
A, C, W, Y
Menveo
conjugate (Men
ACWY)
A, C, W, Y
Trumenba
recombinant (Men B)
B
OCTOBER 2015
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