Meningococcal Vaccination in Children and Young Adults Updated: An In-Depth Guide

Learn what the latest guidelines from the American Academy of Pediatrics recommend for meningococcal vaccination among children, adolescents, young adults, and young adults entering college.

In some states, the role of vaccinating pharmacists is beginning to extend to children.^1,2 With these changes in the scope of practice of pharmacists, it is important to be aware of changes in pediatric guidelines with respect to certain vaccines.

On July 28, 2014, the American Academy of Pediatrics (AAP) updated recommendations for the administration of the meningococcal vaccine in children. This vaccine helps reduce the risk of developing Neisseria meningitidis infection, which may lead to diverse complications including meningitis, bacteremia, and pneumonia. Most of the adverse consequences of infection with Neisseria meningitidis are associated with 5 serogroups of bacteria: A, B, C, W, and Y.³

While type B is the most common serogroup to infect children 5 years or younger, serogroups C and Y are the most common types to infect adolescents. Types A and W are generally more common outside of the United States, and are mostly a concern for travelers.⁴ Despite the fact that serogroup B meningitis affects children disproportionately, currently, no vaccine is available in the United States that protects patients against serogroup B, which may be why the meningococcal vaccine is only recommended in selected groups of very young children.³

Available formulations include³:

• Menomune
• Menactra
• Menveo
• MenHibrix

All but 1 of these vaccines is quadrivalent, meaning that each vaccine provides protection against serogroups A, C, W, and Y. The single exception is MenHibrix, which only offers protection against serogroups C and Y. However, unlike the other vaccines, MenHibrix may be used in children as young as 6 weeks (as a 4-dose series).³

Other formulations that are used in infants include Menveo, which may be used in children as young as 2 months (as a 4-dose series), and Menactra, which is licensed for use in infants 9 months or older (as a 2-dose series).³

Menactra and Menveo may be also be used in children 2 years or older (as a single dose) and in adults up to 55 years of age. Although Menomune is not approved for use in patients younger than 2 years, patients 2 years or older may receive Menomune, and there is no upper limit on the age of administration for Menomune.³

All formulations of the meningococcal vaccine are conjugated polysaccharide vaccines, with the exception of Menomune, which is a polysaccharide vaccine. Because conjugated vaccines stimulate a T-cell response, conjugated vaccines induce a more robust immune response and better immunologic memory than the polysaccharide-only meningococcal vaccine (Menomune), which does not stimulate a T-cell response.³

Unless use of the meningococcal conjugate vaccine is contraindicated, for pediatric patients, meningococcal conjugate vaccines (ie, Menveo, Menactra, or MenHibrix) are preferred over the meningococcal polysaccharide vaccine (ie, Menomune).³

Infants and Children

Most infants should not receive the meningococcal vaccine. For most pediatric patients, the first meningococcal vaccine is administered between 11 and 15 years of age.³

The AAP recommends that young children receive the meningococcal vaccine if they have the following conditions that place them at high risk for developing Neisseria meningitidis infection³:

• Persistent complement deficiencies or deficiencies of components of complement including: C3, C5, C6, C7, C8, or C9 Properdin Factor D Factor H
• Functional or anatomic asplenia
• Travel to area where Neisseria meningitidis infection is hyperendemic/endemic or living in areas where Neisseria meningitidis infection is hyperendemic/endemic (eg, Saudi Arabia or sub-Saharan Africa, where the disease is endemic; Chile, where the disease occurs in frequent outbreaks)
• Living in a community with a meningococcal outbreak

In these at-risk children, the AAP recommends administering a primary vaccine series as indicated followed by a booster dose 3 years after the primary series, and vaccination every 5 years thereafter.³

Adolescents and Young Adults

Adolescents should receive an immunization between 11 and 12 years of age, with a booster dose administered at 16 years of age.³

If a child misses the immunization window between 11 and 12 years of age, the booster can still be administered in adolescents 13 to 15 years of age. Because the next dose is typically administered 16 years of age, it is important to remember that subsequent doses of the meningococcal vaccine must be administered at least 8 weeks apart. If a 15-year-old adolescent receives a meningococcal vaccine 4 weeks before his or her 16th birthday, the next (and final) dose of meningococcal vaccine can be administered (at the earliest) when he or she has been 16 years of age for at least 4 weeks.³

However, if an adolescent reaches 16 years of age without receiving the adolescent booster, only 1 dose of the meningococcal vaccine is needed, and the extra booster dose administered between 11 and 15 years of age is forgone.³

If a young adult entering college (as old as 21 years) has not received the meningococcal vaccine after 16 years of age, or is unsure if he or she was vaccinated after 16 years of age, the young adult should receive another dose of meningococcal vaccine before living in a dormitory.³

Pharmacists Vaccinating Children in Some States

In New Jersey, an update to the pharmacy practice act allows pharmacists to vaccinate adolescents 12 years or older with parental consent, bringing the administration of meningococcal vaccine in adolescent children into the purview of the community pharmacist.² Other states have enabled similar extensions of the pharmacy practice act for certain vaccines.¹

Recent Concerns

Outbreaks of meningococcal disease occurred at 2 universities in the United States within the last year: Princeton University, and the University of California, Santa Barbara. In those outbreaks, the type of meningitis was of a strain—serogroup B— against which no approved vaccine in the United States offers protection. Bexsero, a vaccine that is approved in Europe and Australia, was offered to students and staff to quell the outbreak.⁵

In Summary

Guidelines from the AAP recommend vaccination for adolescents between 11 and 15 years of age, with a second vaccination recommended when young adults reach 16 years of age. Importantly, subsequent administrations should be no less than 8 weeks apart in cases in which the vaccines are administered late in a child’s 15th year of life and early in the 16th year of life. In many cases, when no vaccination records are available, young adults entering college before 21 years of age should receive a meningococcal vaccine to reduce the risk of acquiring bacterial meningitis in dormitories. Meningococcal vaccines are generally not recommended for children unless they belong to certain high-risk groups.³

References

1. Pharmacies can now provide children with flu vaccination — governor changes age requirement. Fort Hudson health system website. www.forthudson.com/2013/01/17/pharmacies-can-now-provide-children-with-flu-vaccination-governor-changes-age-requirement. Published January 17, 2013. Accessed July 31, 2014.

2. Pharmacists may vaccinate children under revised NJ Law. Law Office of Deniza Gertsberg website. www.gertsberg.com/2014/02/pharmacists-may-vaccinate-children-under-revised-nj-law . Published February 17, 2014. Accessed July 31, 2014.

3. Committee on Infectious Disease. Updated Recommendations on the Use of Meningococcal Vaccines [published online July 28, 2014]. Pediatrics. 2014.

4. Meningococcal disease in other countries. Centers for Disease Control and Prevention website. www.cdc.gov/meningococcal/global.html. Accessed July 31, 2014.

5. Doheny K. Meningitis outbreaks: FAQ. WebMD website. www.webmd.com/news/20131205/meningitis-outbreaks-faq. Published December 5, 2013. Accessed July 31, 2014.