3 Facts About Meningococcal Vaccine Recommendations for Patients With HIV

The CDC is now recommending the routine use of the meningococcal conjugate vaccine for patients with human immunodeficiency virus (HIV).

The CDC had previously recommended routine vaccination for all adolescents and individuals at risk for meningococcal disease.¹ Meningococcal disease is considered any illness caused by the bacteria Neisseria meningitides.¹ The 5 serogroups (strains) causing the most infections worldwide are A, B, C, W, and Y.¹ Additionally, serogroups B, C, and Y cause the most illness in the United States.¹ Individuals infected with meningococcal disease can develop severe infections including meningitis, bacteremia, or septicemia. These 3 facts will serve as counseling points to assist patients with HIV with important vaccine information.

• New recommendations include individuals > 2 months of age with HIV.²

The CDC's Advisory Committee on Immunization Practices recommended at its June 2016 meeting the routine use of the meningococcal conjugate vaccine (serogroups A, C, W, and Y) for individuals > 2 months of age with HIV infection. The same vaccine product should be used for all doses. However, if the product is unknown or unavailable for previous doses, then the series can be completed with any age and formulation appropriate vaccine.

• The recommendations include a 2-dose primary series and booster dose recommendations²

Patients > 2 years of age with HIV infection who have not been previously vaccinated should receive a 2-dose primary series of MenACWY conjugate vaccine. Additionally, individuals > 2 years of age with HIV infection who have been previously vaccinated with one dose of the meningococcal conjugate vaccine should receive a booster dose at the earliest opportunity, separated by at least 8 weeks from the previous dose. If the most recent dose was administered before age 7 years, then a booster dose should be given 3 years later. If the most recent dose was received at > 7 years of age, then a booster dose should be administered 5 years later and every 5 years throughout life.

• Evidence suggests there is an increased risk of meningococcal disease in patients with HIV.²

There is growing evidence suggesting that patients with HIV have an increased risk of developing meningococcal disease. Additionally, the risk increases in patients with a low CD4 count or high viral load. The CDC utilized the Grading of Recommendations, Assessment, Development, and Evaluation for the new recommendations. The risks and benefits were reviewed through 2 open-label observational studies. Even though these study designs provided a low level of evidence, the CDC evaluated the risks and benefits of the vaccine for this patient population. It was determined that the meningococcal vaccine provides efficacy in the short term and is safe. Since the efficacy wanes over time, the booster doses are recommended. The most common adverse effect associated with the vaccine is pain at the injection site. Other less common adverse events may include mild fever, sever pain at the injection site, and anaphylactic reactions.

References

• Meningococcal disease. CDC website. Accessed November 26, 2016.
• MacNeil JR, Rubin JL, Patton M, et al. Recommendations for use of meningococcal conjugate vaccines in HIV-infected persons-Advisory Committee on Immunization Practices, 2016. MMWR Morb Mortal Wkly Rep. 2016;65:1189-1194. Accessed November 26, 2016.