Update on Meningococcal Vaccines

Hi,
I have recently posted a blog on the recent Meningococcal scare in North India, yesterday American Academy of Pediatrics has come out with new recommendations for Meningococcal vaccination, and I am reproducing thier policy statement here

AAP ENDORSES NEW MENINGOCOCCAL VACCINE GUIDELINES

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For Release: May 25, 2005 - Immediately

The American Academy of Pediatrics (AAP) has released a new policy statement recommending routine meningococcal vaccination for certain age groups. The guidelines call for the quadrivalent meningococcal vaccine (MCV4) for:

• Young adolescents (11-12 years of age)
• Adolescents at high school entry or 15 years of age (whichever comes first) for those who have not previously been vaccinated
• All college freshmen living in dormitories
• Other groups at high risk such as those with underlying medical conditions or travelers to areas with high rates of meningococcal disease

The recommendations will help prevent meningococcal disease, a potentially fatal bacterial infection. Although rare, meningococcal disease is dangerous because the disease progresses rapidly, and within hours of the onset of symptoms it may cause permanent disability or death.

Meningococcal disease is the most common cause of bacterial meningitis in U.S. toddlers, adolescents and young adults. Symptoms include high fever, headache, stiff neck, confusion, nausea, vomiting and exhaustion, and a rash may appear. Lifestyle factors thought to contribute to the disease include direct contact with an infected person, e.g., exchanging saliva, often through kissing; crowded living conditions, e.g., dormitories; and active or passive smoking. Vaccination is the best method of preventing meningococcal disease.

Meningococcal infections can be treated with drugs such as penicillin. "Still," says AAP President Carol Berkowitz, MD, FAAP, "about one in every ten people who get the disease dies from it, and many others are affected for life. That is why preventing the disease through use of meningococcal vaccine is important for the high-risk groups."

The Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP) determined that establishing the target age at 11 years may give lasting immunity through college. Studies have determined that the disease peaks in 16- to 18-year-olds, supporting vaccination of 15-year-olds.

More information on the vaccine can be found at the AAP Web site at http://www.aap.org or from the CDC at http://www.cdc.gov

Menigococcal meninigitis: Scare in North India: What you need to know !

What is meningococcal disease?

Meningococcal disease is a serious illness caused by bacteria. It is the leading cause of bacterial meningitis in children 2-18 years of age. Meningitis is an infection of the brain and spinal cord coverings. Meningococcal bacteria can also cause infection in the blood. Apart from epidemics, at least 1.2 million cases of bacterial meningitis are estimated to occur every year; 135,000 of them are fatal. Approximately 500,000 of these cases and 50,000 of the deaths are due to meningococci. In developing countries, the mortality rate from bacterial meningitis is often higher (20-40%) than in developed countries. Of those who live, another 10 percent lose their arms or legs, become deaf, have problems with their nervous systems, become mentally retarded, or suffer seizures or strokes.

Anyone can get meningococcal disease. But it is most common in infants less than one year of age, and in people with certain medical conditions.

People living in crowded locations are at a higher risk. This includes slum dwellers, college students living in dormitories, military personnel living in barracks, religious gatherings etc.

How is meningococcal disease spread?

Meningococcal disease is spread by intimate or direct exposure to someone who has the disease. Intimate or direct exposure includes being touched or kissed, sharing eating utensils, or contact with any fluids from the body of the person who has the disease.

What are the symptoms of meningococcal disease?

Symptoms are usually sudden and begin like the flu: fever, feeling generally unwell, headache, vomiting, and in some cases a stiff neck.

People with this disease are visibly sick and may be confused, excited, or drowsy. Sometimes a reddish-purple rash that may look like bruises appears. The rash is flat and smooth, does not itch, and may spread quickly once it starts.

Because the disease spreads quickly in the body, it is important to go to a doctor or an emergency room immediately if you have a fever greater than 101 degrees and a severe sudden headache along with any of these symptoms:

• neck or back stiffness,

• mental changes (feeling edgy or confused),

• rash

Who should get meningococcal vaccine?

Meningococcal vaccine is not routinely recommended for most people.

People who should get the vaccine include:

• Military recruits

• Anyone traveling to, or living in, a part of the world where

meningococcal disease is common, such as West Africa.

• Anyone who has a damaged spleen, or whose spleen has been

removed, and certain immunological diseases

• Lab workers who are routinely exposed to meningococcal bacteria

According to the latest Indian Academy of Pediatrics guidelines “ Meningococcal vaccine is indicated for use in close contacts of patients with the disease. It is also indicated in high risk individuals (eg. Those with hyposplenia/ asplenia, complement deficiency) and during epidemics.”

Meningococcal vaccine is usually not recommended for children under two years of age. But under special circumstances it may be given to infants as young as three months of age (the vaccine does not work as well in very young children). Ask your health care provider for details.

Should my children receive meningococcal vaccine?

Meningococcal vaccine is only indicated for close contacts of patients with the disease; also it may be given in epidemic situations in a well defined community.

On the basis if this it is premature to consider meningococcal vaccine to children other than those at high risk (as mentioned above).

How many doses are given?

• For people two years of age and over: one dose

(Sometimes an additional dose is recommended for people who

continue to be at high risk. Ask your doctor or nurse.)

• For children three months to two years of age who need the

vaccine: Two doses, three months apart.

Who should not get the vaccine?

• People who have ever had a serious allergic reaction to a previous dose of the vaccine.

• People with moderate or severe illnesses should usually wait until they recover.

What are the possible side effects from meningococcal vaccine?

• redness or pain where the shot was given

• fever in a small percentage of people

Where can I get this vaccine?

Call your doctor,

For more information:

Centers for Disease Control and Prevention:

http://www.cdc.gov/ncidod/dbmd/diseaseinfo/meningococcal_a.htm

Meningitis Foundation of America: www.musa.org

American College Health Association:

http://www.acha.org/projects_programs/men.cfm

Advisory Committee on Immunization Practices:

http://www.cdc.gov/nip/publications/ACIP-list.htm

Medline Plus Health Information:

http://www.nlm.nih.gov/medlineplus/ency/article/000608.htm

Central Michigan University, University Health Services:

http://www.healthservices.cmich.edu/meningitis.htm

Michigan State University, Olin Health Center:

http://olin.msu.edu/mening.htm

Northern Michigan University, Ada B. Vielmetti Health Center:

http://www.nmu.edu/healthcenter/meningitis.htm

University of Michigan, University Health Service:

http://www.uhs.umich.edu/uhs/whatsup/meningitis.html

Michigan Government website

http://www.michigan.gov/documents/meningococcal_23962_7.pdf

Information collected, edited and reviewed by Dr. Gaurav Gupta, Pediatrician, Charak Child Care, Mohali.