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4/30/2020
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Meningococcal101Heidi Gurov, RN BSN CMSRN ONC
Clinical Consultant & Quality Improvement SpecialistWyoming Department of Health Immunization Unit
DiseasePresentation• Incubation period of 1‐4 days• Rapidly progresses• Reportable in all states• Cases peak in January and February• Natural cyclic pattern with peaks of disease every 7‐10 years
• 1st vaccine developed for developing regions and broader temperature range than the traditional cold chain
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MeningococcalConjugateVaccine
• MenACWY‐D
• Menactra® (Sanofi Pasteur)
• Licensed in 2005
• Approved for 9 months – 55 years of age
• Efficacy: 80‐90% in adolescents / 70‐90% in adults
• MenACWY‐CRM
• Menveo® (GlaxoSmithKline)
• Licensed in 2010
• Approved for 2 months – 55 years of age
• Efficacy: 70‐90% in adolescents / 70‐90% in adults25
SerogroupBVaccines
• MenB‐FHbp• Trumenba® (Pfizer)• Licensed in 2014• Approved for 10‐25 years of age• 2 or 3 dose series depending on indication• 2 dose series: 0, 6 months• 3 dose series: 0, 1‐2, 6 months
• Efficacy: 80%• MenB‐4C
• Bexsero® (GlaxoSmithKline)• Licensed in 2015• Approved for 10‐26 years of age• 2 dose series (0, 1 month)• Efficacy: 60‐90% 26
Whytwodifferentvaccines?!
• Serogroup B capsule is not as immunogenic as ACWY serogroups
• MenB vaccines utilize Factor H binding proteins as the vaccine antigen
• MenACWY vaccines provide no protection against MenB serogroup, and vice versa
• MenB can administered at the same time as MenACWY vaccines
• Remember, serogroups B, C, and Y are the prevailing serogroups in the U.S. two vaccines are needed for full protection.
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ACIPRecommendations
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FDALicensingvs.ACIPRecommendations
• FDA Licensure• Approval from Food & Drug Administration
• Can take years, even decades to occur
• Safety and effectiveness studied in animals and human trials
• ACIP Recommendation
• Occurs after FDA licensure
• Considers costs and benefits
• Determines which groups of people within the population would benefit from the vaccine, and on what schedule the vaccine should be given• Sometimes this can differ from the FDA license 29
Adolescents• MenACWY (Menactra® /Menveo®)
• All 11‐12 year olds should be vaccinated with one dose
• All 16 year olds should be vaccinated with one booster dose
• MenB (Trumenba® /Bexsero®)
• All 16‐23 year olds may be vaccinated with a complete series • Preferably at 16‐18 years old
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Infants&Children
• See meningococcal footnote of Child/Adolescent ACIP Schedule• MenACWY recommended for certain children 2 months – 10 years of age• Complement component deficiencies (including eculizamab or ravulizamabuse)
• Asplenia• Sickle cell disease• HIV infection• Travel to or reside in countries of hyperendemic or epidemic disease• Outbreak situation
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Adults‐MenACWY
• See meningococcal footnote of Adult ACIP Schedule• MenACWY is recommended to certain adults at high risk:• Complement component deficiencies (including eculizamaband ravulizumab use)
• Asplenia• HIV infection• Microbiologist routinely exposed to isolates• Travel to or residing in countries of hyperendemic or epidemic disease
• Outbreak situation• First year college student living in a residence hall• Military recruit
• For those who remain high risk:• Booster every 5 years after primary series
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Adults–MenB
• See meningococcal footnote of Adult ACIP Schedule
• Recommended:
• Those 18‐23 years old with shared clinical decision making
• Complement component deficiencies (including eculizamab and ravulizamab use)
• Asplenia
• Microbiologists
• Outbreak situation attributed to serogroup B
• For those who remain high risk:
• Booster in 1 year, then every 2‐3 years as needed
• Use same vaccine product 33
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Travel
• CDC Travel Website: www.cdc.gov/travel• African Meningitis Belt
• MenACWY if traveling December‐June• Booster every 5 years if still at risk• Serogroup B disease is not seen in this region
• Umrah or Hajj Pilgrimage in Saudi Arabia• ≥2 years old: Required to have documentation of conjugate MenACWY vaccination received no more than 5 years before travel 34