Menactra: Conjugated Meningococcal vaccine (MCV)
Meningitis is infection of the meninges. Meninges are the protective covering of the brain inside the cranium. Meningitis is caused by the Neisseria meningitides. Neisseria meningitides is also called as meningococcus. Meningococcal vaccine is used to prevent the disease meningitis.
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About Menactra Meningococcal vaccine:
There are two types of meningitis vaccines: polysaccharide vaccine and meningococcal conjugate vaccine (MCV).
- Meningococcal polysaccharide vaccine: These are either bivalent (A+C) or quadrivalent (A, C, Y, W-135) and contain 50 μg of each of the individual polysaccharides, available in lyophilized form, reconstituted with sterile water and stored at 2–8°C. These “T cell independent” vaccines do not induce immunological memory and the response in children younger than 2 years is poor. Hence these are indicated for adults and children older than 2 years (only under special circumstances in children 3 months to 2 years of age).
- Meningococcal Conjugate vaccine (MCV) : This is a quadrivalent (A, C, W-135, Y) meningococcal conjugate vaccine (MCV) using diphtheria toxin as carrier protein (A, C, W-135, Y-D), and was licensed in the US in 2005. The Advisory Committee on Immunization Practices (ACIP) recommended a two-dose series of this vaccine for use in children aged 9–23 months. This vaccine contains 4 μg each of A, C, Y and W-135 polysaccharide conjugated to 48 μg of diphtheria toxoid. A single dose of 0.5 mL intramuscular (IM) is recommended. This vaccine had comparable immunogenicity to the previously used polysaccharide vaccine.
How Menactra meningococcal conugate vaccine (MCV) is stored?
During all stages of transport from production facility to the patient this vaccine should be stored in 2 – 8 degree Celsius. At all storage points the temperature range should be maintained.
How the Menactra meningococcal vaccine is given?
Meningococcal conjugate vaccine is given in form of injection usually on anterolateral surface of thigh.
About use of Menactra meningococcal vaccine:
- Recommended only for certain high-risk group of children, during outbreaks, and international travelers, including students going for study abroad and travelers to Hajj and sub-Sahara Africa.
- Following are high risk groups to whom vaccination with meningococcus is duggested:
- During disease outbreaks: Due to the limited efficacy of polysaccharide vaccines in children < 2 years of age, conjugate vaccines should be used for protection of those aged 12–24 months, particularly for Men A disease. Since majority of documented outbreaks in India are caused by Men A, monovalent MCV, like PsATT should be employed in mass vaccination.
- Vaccination of persons with high-risk conditions/situations.
- Children with terminal complement component deficiencies: A two-dose primary series of MCV administered 8–12 weeks apart is recommended for persons aged 24 months through 55 years with persistent deficiencies of the late complement component pathway. A booster dose should be administered every 5 years. Children who receive the primary series before their seventh birthday should receive the first booster dose in 3 years and subsequent doses every 5 years.
- Children with functional/anatomic asplenia/hyposplenia (including sickle cell disease): Administer two primary doses of either MCV with at least 8 weeks between doses for individuals aged 24 months through 55 years. Vaccination should ideally be started two weeks prior to splenectomy.
- Persons with human immunodeficiency virus: Administer two doses at least 8 weeks interval.
- Laboratory personnel and healthcare workers: Who are exposed routinely to N. meningitidis in solutions that may be aerosolized should be considered for vaccination. A single dose of MCV is recommended. A booster dose should be administered every 5 years if exposure is ongoing.
- Adjunct to chemoprophylaxis: In close contacts of patients with meningococcal disease (healthcare workers in contact with secretions, household contacts, day care contacts) single dose of appropriate group MCV is recommended.
- International travelers: Students going for study abroad: Some institutions have policies requiring vaccination against meningococcal disease as a condition of enrolment (mandatory in most universities in the USA). Persons aged ≤21 years should have documentation of receipt of a MCV not more than 5 years before enrolment. In the US, ACIP recommends routine vaccination of all adolescents with single dose of MCV4 at age 11–12 years, with a booster dose at age 16 years
- Hajj pilgrims: Vaccination in the 3 years before the date of travel is required for all travelers to Mecca during the annual Hajj. The quadrivalent vaccine is preferred for Hajj pilgrims and international travelers as it provides added protection against emerging W-135 and Y disease in these areas. A single dose 0.5 mL IM is recommended in age group 2–55 years.
- Travelers to countries in the African meningitis belt: A single dose of monovalent or quadrivalent vaccine is recommended. Conjugate vaccine is preferred to polysaccharide vaccine. A booster dose of MCV is needed if the last dose was administered 5 or more years previously.
- Both meningococcal conjugate vaccines (Quadrivalent MenACWY-D, Menactra® by Sanofi Pasteur and monovalent group A, PsA-TT, MenAfriVac® by Serum Institute of India) and polysaccharide vaccines (bi- and quadrivalent) are licensed in India. PsA-TT is not freely available in market.
- Conjugate vaccines are preferred over polysaccharide vaccines due to their potential for herd protection and their increased immunogenicity, particularly in children <2 years of age.
- As of today, quadrivalent conjugate and polysaccharide vaccines are recommended only for children 2 years and above.
- Monovalent group A conjugate vaccine, PsA-TT can be used in children above 1 year of age.
What are side effects of meningococcal vaccine?
- Side effects are minimal and commonly they are manageable at home on oral medications.
- Fever may occur. Fever may range from moderate to high grade. Fever can be easily controlled with oral medication.
- Localized pain and swelling occurs at injection site. This can be easily controlled with local cold fomentation. Sometimes may need oral medicine like paracetamol to control the local pain.