Meningococcal vaccine

Meningococcal vaccine
Meningococcal vaccine
Vaccine description
Target disease Neisseria meningitidis
Type  ?
Clinical data
AHFS/Drugs.com monograph
MedlinePlus a607020
Pregnancy cat.  ?
Legal status  ?
Identifiers
ATC code J07AH01 J07AH02 J07AH03 J07AH04 J07AH05 J07AH06 J07AH07
 N(what is this?)  vaccine (verify)

Meningococcal vaccine is a vaccine used against Meningococcus, a bacterium that causes meningitis, meningococcemia, septicemia, and rarely carditis, septic arthritis, or pneumonia.[1]

Contents

Types

Neisseria meningitidis has 13 clinically significant serogroups. These are classified according to the antigenic structure of their polysaccharide capsule. Six serogroups, A, B, C, Y, W135 and X are responsible for virtually all cases of the disease in humans.

Quadrivalent (Serogroups A, C, W-135 and Y)

There are currently three vaccines available in the US to prevent meningococcal disease, all quadrivalent in nature, targeting serogroups A, C, W-135 and Y:

Mencevax (GlaxoSmithKline) and NmVac4-A/C/Y/W-135 (JN-International Medical Corporation) are used worldwide, but have not been licensed in the United States.

The first meningococcal conjugate vaccine (MCV4), Menactra, was licensed in the U.S. in 2005 by Sanofi Pasteur; Menveo, was licensed in 2010 by Novartis. Both MCV4 vaccines have been approved by the Food and Drug Administration (FDA) for people 2 through 55 years of age. In April 2011, Menactra received FDA approval for use in children as young as 9 months, although the Centers for Disease Control and Prevention (CDC) has not made recommendations for or against its use in children less than 2. [2]

Meningococcal polysaccharide vaccine (MPSV4), Menomune, has been available since the 1970s. It may be used if MCV4 is not available, and is the only meningococcal vaccine licensed for people older than 55. Information about who should receive the meningococcal vaccine is available from the CDC.[3]

Limitations

The duration of immunity mediated by Menomune (MPSV4) is three years or less in children aged under 5 because it does not generate memory T cells.[4][5] Attempting to overcome this problem by repeated immunization results in a diminished not increased antibody response, so boosters are not recommended with this vaccine.[6][7] As with all polysaccharide vaccines, Menomune does not produce mucosal immunity, so people can still become colonised with virulent strains of meningococcus, and no herd immunity can develop.[8][9] For this reason, Menomune is suitable for travelers requiring short-term protection, but not for national public health prevention programs.

Menveo and Menactra contain the same antigens as Menomune, but the antigens are conjugated to a diphtheria-toxoid polysaccharide–protein complex, resulting in anticipated enhanced duration of protection, increased immunity with booster vaccinations, and effective herd immunity.

Endurance

A study published in March 2006 comparing the two kinds of vaccines found that 76% of subjects still had passive protection three years after receiving MCV-4 (63% protective compared with controls), but only 49% has passive protection after receiving MSPV-4 (31% protective compared with controls).[10] As of 2010, there remains limited evidence that any of the current conjugate vaccines offer continued protection beyond three years; studies are ongoing to determine the actual duration of immunity, and the subsequent requirement of booster vaccinations. The CDC offers recommendations regarding who they feel should get booster vaccinations.[11][12]

Serogroup A

A vaccine called MenAfriVac has been developed through a program called the Meningitis Vaccine Project and it is a good option for preventing meningitis group A infections.[13][14]

Serogroup B

A vaccine for serogroup B was developed in Cuba in response to a large outbreak of meningitis B during the 1980s. The VA-MENGOC-BC vaccine proved safe and effective in randomized double-blind studies[15][16][17], but it was granted a license only for research purposes in the United States[18] as political differences limited cooperation between the two countries.[19]

Due to a similarly high prevalence of B-serotype meningitis in Norway between 1975 and 1985, Norwegian health authorities developed a vaccine specifically designed for Norwegian children and young adolescents. Clinical trials were discontinued after the vaccine was shown to cover only slightly more than 50% of all cases. Furthermore, lawsuits for damages were filed against the State of Norway by persons affected by serious adverse reactions. Information that the health authorities obtained during the vaccine development were subsequently passed on to Chiron (now a Novartis subsidiary), who developed a similar vaccine, MeNZB, for New Zealand.

Serogroup X

The occurrence of serogroup X was reported in North America, Europe, Australia, and West Africa.[20] Current meningoccocal meningitis vaccine is not known to protect from serogroup X N. meningitidis disease.

See also

References

  1. ^ Mascioni A, Bentley BE, Camarda R, et al. (December 2008). "Structural basis for the immunogenic properties of the meningococcal vaccine candidate LP2086". J. Biol. Chem. 284 (13): 8738–46. doi:10.1074/jbc.M808831200. PMC 2659232. PMID 19103601. http://www.jbc.org/cgi/pmidlookup?view=long&pmid=19103601. 
  2. ^ April 22, 2011 Approval Letter - Menactra http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm252511.htm
  3. ^ "Menningococcal Vaccines - What You Need to Know" (2008). Center for Disease Control and Prevention. http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-mening.pdf
  4. ^ Reingold AL, Broome CV, Hightower AW, et al. (1985). "Age-specific differences in duration of clinical protection after vaccination with meningococcal polysaccharide A vaccine". Lancet 2 (8447): 114–18. doi:10.1016/S0140-6736(85)90224-7. PMID 2862316. 
  5. ^ Lepow ML, Goldschneider I, Gold R, Randolph M, Gotschlich EC. (1977). "Persistence of antibody following immunization of children with groups A and C meningococcal polysaccharide vaccines". Pediatrics 60 (5): 673–80. PMID 411104. 
  6. ^ Borrow R, Joseh H, Andrews N, et al. (2000). "Reduced antibody response to revaccination with meningococcal serogroup A polysaccharide vaccine in adults". Vaccine 19 (9–10): 1129–32. doi:10.1016/S0264447454-410X(00)00317-0. PMID 11137248. 
  7. ^ MacLennan J, Obaro S, Deeks J, et al. (1999). "Immune response to revaccination with meningococcal A and C polysaccharides in Gambian children following repeated immunization during early childhood". Vaccine 17 (23–24): 3086–93. doi:10.1016/S0264-410X(99)00139-5. PMID 10462244. 
  8. ^ Hassan-King MK, Wall RA, Greenwood BM. (1988). "Meningococcal carriage, meningococcal disease and vaccination". J Infect 16 (1): 55–9. doi:10.1016/S0163-4453(88)96117-8. PMID 3130424. 
  9. ^ Moore PS, Harrison LH, Telzak EE, Ajello GW, Broome CV. (1988). "Group A meningococcal carriage in travelers returning from Saudi Arabia". J Am Med Assoc 260 (18): 2686–89. doi:10.1001/jama.260.18.2686. PMID 3184335. 
  10. ^ Vu D, Welsch J, Zuno-Mitchell P, Dela Cruz J, Granoff D (2006). "Antibody persistence 3 years after immunization of adolescents with quadrivalent meningococcal conjugate vaccine". J Infect Dis 193 (6): 821–8. doi:10.1086/500512. PMID 16479517. 
  11. ^ "Updated recommendations for use of meningococcal conjugate vaccines --- Advisory Committee on Immunization Practices (ACIP), 2010". MMWR Morb Mortal Wkly Rep 60 (3): 72-6. January 2011. PMID 21270745. 
  12. ^ "Updated recommendation from the Advisory Committee on Immunization Practices (ACIP) for revaccination of persons at prolonged increased risk for meningococcal disease". MMWR Morb Mortal Wkly Rep 58 (37): 1042-3. September 2009. PMID 19779400. 
  13. ^ LaForce FM, Okwo-Bele JM (June 2011). "Eliminating epidemic Group A meningococcal meningitis in Africa through a new vaccine". Health Aff (Millwood) 30 (6): 1049-57. doi:10.1377/hlthaff.2011.0328. PMID 21653956. 
  14. ^ Kristiansen PA, Diomandé F, Wei SC, Ouédraogo R, Sangaré L, Sanou I, Kandolo D, Kaboré P, Clark TA (March 2011). "Baseline meningococcal carriage in Burkina Faso before the introduction of a meningococcal serogroup A conjugate vaccine". Clin Vaccine Immunol 18 (3): 435-43. doi:10.1128/CVI.00479-10. PMC 3067389. PMID 21228139. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3067389. 
  15. ^ Pérez O, Lastre M, Lapinet J, Bracho G, Díaz M, Zayas C, Taboada C, Sierra G (July 2001). "Immune response induction and new effector mechanisms possibly involved in protection conferred by the Cuban anti-meningococcal BC vaccine". Infect Immun 69 (7): 4502-8. doi:10.1128/IAI.69.7.4502-4508.2001. PMC 98525. PMID 11401992. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=98525. 
  16. ^ Uli L, Castellanos-Serra L, Betancourt L, Domínguez F, Barberá R, Sotolongo F, Guillén G, Pajón Feyt R (June 2006). "Outer membrane vesicles of the VA-MENGOC-BC vaccine against serogroup B of Neisseria meningitidis: Analysis of protein components by two-dimensional gel electrophoresis and mass spectrometry". Proteomics 6 (11): 3389-99. doi:10.1002/pmic.200500502. PMID 16673438. 
  17. ^ http://www.finlay.sld.cu/english/products/pregunvamengocbcenglish.htm
  18. ^ "World: Americas Cuba vaccine deal breaks embargo". BBC News. 29 July 1999. http://news.bbc.co.uk/2/hi/americas/406780.stm. Retrieved 25 October 2009. 
  19. ^ "Cuban scientist barred from receiving U.S. prize". MSNBC. 12 November 2005. http://www.msnbc.msn.com/id/10010619/. Retrieved 25 October 2009. 
  20. ^ Clonal Groupings in Serogroup X Neisseria meningitidis.

Further reading

  • Conterno LO, Silva Filho CR, Rüggeberg JU, Heath PT (2006). "Conjugate vaccines for preventing meningococcal C meningitis and septicaemia". Cochrane Database Syst Rev 3: CD001834. doi:10.1002/14651858.CD001834.pub2. PMID 16855979. 
  • Patel M, Lee CK (2005). "Polysaccharide vaccines for preventing serogroup A meningococcal meningitis". Cochrane Database Syst Rev (1): CD001093. doi:10.1002/14651858.CD001093.pub2. PMID 15674874. 

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