The American Academy of Pediatrics (AAP) Committee on Infectious Diseases does not recommend routine vaccination of children between 2 months and 10 years of age unless they are at increased risk for meningococcal disease, according to new guidelines on the use of meningococcal vaccines in children and adolescents published in the August issue ofPediatrics.
The guidelines update those published by AAP in 2011 and supplement the more recent AAP-endorsed Centers for Disease Control and Prevention recommendations published last year. The latter guidelines were issued before the MenACWY-CRM vaccine was licensed for infant use.
The guidelines recommend use of meningococcal vaccines routinely in adolescents but advise limiting their use in children younger than 10 years to those children with increased or persistent risk for invasive meningococcal disease. The AAP recommends conjugate vaccines over polysaccharide vaccines unless there is a contraindication for the meningococcal conjugate vaccine because of the more robust T-cell-mediated immune response of the conjugate.
Adolescents should be immunized with a quadrivalent conjugated meningococcal vaccine beginning at age 11 or 12 years, followed by a booster dose at age 16 years. If the first dose occurs at age 13 to 15 years, the booster should come at age 16 to 18 years. Teenagers who receive their first vaccine at or after age 16 years do not need a booster.
First-year college students through age 21 years who live in residence halls and are unvaccinated or who received their last vaccine before their 16th birthday should receive a single quadrivalent conjugate vaccine.
Those at increased risk for meningococcal disease because of persistent complement deficiency or functional or anatomic asplenia should receive a 2-dose primary series (MenACWY-D or MenACWY-CRM) between the ages of 2 and 55 years.
For high-risk infants aged 2 months to 18 months, the AAP recommends a 4-dose primary series (MenACWY-CRM or Hib-MenCY-TT). MenACWY-D can be administered in a 2-dose series to infants aged 9 to 23 months with persistent complement deficiency. This can also be administered to infants with functional or anatomic asplenia up to age 23 months after the administration of a fourth dose of the primary pneumococcal conjugate vaccine.
Neisseria meningitides causes meningitis, bacteremia, and pneumonia. Five serogroups (A, B, C, W, and Y) cause most of the disease in children and adults. In the United States, serogroup B is predominant in children younger than age 5 years, whereas C and Y are most often seen in adolescents. Serogroup A is endemic in sub-Saharan Africa but is rarely seen in the United States.
Meningococcal disease has been on the decline in the United States, although the reason for this is unclear.
There are 4 licensed vaccines for meningococcal disease. One is a quadrivalent polysaccharide vaccine active against serotypes A, C, W-135, and Y; 2 are quadrivalent conjugate vaccines active against A, C, W, and Y; and 1 is bivalent conjugate vaccine active against C and Y. This vaccine, HibMenCY-TT, is also approved for Haemophilus influenza type B.
All authors have filed conflict of interest statements with the American Academy of Pediatrics, and any conflicts have been resolved through a process approved by the AAP Board of Directors.
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Comment: In India there is a lot of pressure on Pediatricians to use the recently available MCV 4 vaccine (Menactra). There is significant confusion however regarding when & in whom to use the same. These guidelines do suggest that we may be better off targeting just the adolescents for this vaccine, & may not offer it to younger kids. However, caution needs to be maintained since the epidemiology of Meningococcal disease varies greatly across countries and in an ideal situation we need to have our own independent guidelines.