Meningococcal Vaccination June 2017

Vaccination There is no single vaccination that offers protection against all serotypes that cause meningococcal disease. There are 3 types of meningococcal vaccines registered in Australia , which cover the different serotypes Meningococcal C conjugate vaccines (MenCCV) Multicomponent meningococcal B vaccine (MenBV) Quadrivalent (A,C,W,Y) meningococcal conjugate vaccines(polysaccharide vaccines were withdrawn early 2017)

Meningococcal C (MenCCV) Conjugate vaccine – Meningitec, NeisVac C, Menjugate Introduced in 2003 initially with catch up program Routine part of 12 month vaccination in combination with Hib - Menitorix

Meningococcal B MenBV Now available in Australia Currently only one in Australia – Bexsero(GSK) Not on NIP or PBS Safe from 2 months Complex Dosing – age dependent Funded in SA for a 2 year trial in students in years 10,11 and 12

Meningococcal B Based on their higher disease risk 4CMenBis recommended for these groups Infants and young children, particularly less than 24 months Adolescents aged 15 to 19 years Children and adults with medical conditions that place them at higher risk of IMD, such as functional or anatomical asplenia or complement component disorders Laboratory personnel who frequently handle Neisseria meningitidis

Meningococcal B 4CMenB 2-5 months old Primary Vaccination 3 doses > 1 month apart Booster Second year of life Given deep IMI preferably anterolateral aspect of thigh Fever prophylaxis recommended Can be co-administered with other vaccines but Fever less if not co-administered with other vaccines

Meningococcal B 4cmenb 6-11Months Primary vaccination 2 doses > 2 months apart Booster 2nd year of life Given deep IMI preferably anterolateral aspect of thigh Fever prophylaxis recommended Fever less if not co-administered with other vaccines

Meningococcal B 4cmenb 1-10years OLD Primary vaccination 2 doses >2 months apart Booster – need not established Given deep IMI deltoid muscle upper arm Fever prophylaxis recommended if under 2 Fever less if not co-administered with other vaccines

Meningococcal B 4cmenb 11-50years OLD Primary vaccination 2 doses >1 months apart Booster – need not established Given deep IMI deltoid muscle upper arm No data in over 50s

Fever prophylaxis in children under 2 1st Dose paracetamol (15mg/kg) 30mins prior to vaccination VACCINATE 2nd dose 6 hours later 3rd dose 6 hours later again This was shown to reduce fever and not affect immunogenicity

Meningococcal ACWY who to vaccinate? Children and adults with medical conditions that place them at higher risk of IMD, such as functional or anatomical asplenia or complement component disorders People with increased incidence of IMD or high carriage rates Infants under 2 Adolescents 15-19 years especially if living in close quarters such as residential accommodation Travellers –inc sub-Saharan Africa and the Hajj in Mecca Anyone wishing to reduce their risk of IMD

4vMencv 3 vaccines available in Australia Menactra (Sanofi Pasteur) Menveo(GSK) Nimenrix(Pfizer) Brands not interchangeable Can be co-administered with MenC-Hib in opposite limb

4vMencv Funded for teenagers NSW year 11 and 12 Victoria and Queensland 15-19 years WA year 10-12 Private script otherwise

Recommended brands and doses of 4Mencv by age group for healthy individuals and travellers Age at commencement of vaccine course Recommended brand Primary dose Vaccination interval 2-6 Months 7-11 Months 12-23 months Over 2 years Menveo Either Menveo or Nimerix Menactra,Menveo or Nimerix 3 doses 8 weeks 2 doses 12 weeks 1 dose N/A 1 dose N/A

Meningococcal 4vmencv Booster? Recommended for travellers to high risk area every 5 years Those at high risk of IMD every 5 years Laboratory personnel who handle Niesseria meningitidis every 5 years

Variations from PI Atagi recommendations The product information for Menveo states that this vaccine is indicated for use in persons ≥11 years of age. The ATAGI recommends instead that Menveo can be given to persons ≥2 months of age (refer to 4.10.4 Vaccines). The product information for Menactra states that this vaccine is indicated for use in persons between 2 and 55 years of age. The ATAGI recommends instead that this vaccine can be given to persons >55 years of age. The product information for Nimenrix states that this vaccine is indicated for use in persons between 1 and 55 years of age. The ATAGI recommends instead that this vaccine can be given to persons >55 years of age. The product information for Menactra states that a previous episode of GBS is a contraindication to vaccination with Menactra. The ATAGI recommends instead that any of the available 4vMenCVs can be administered to a person with a history of GBS. The product information for all meningococcal vaccines (MenCCV, 4vMenCV, MenBV and 4vMenPV) states that there are no data on the use of these vaccines in lactating women. The ATAGI recommends that breastfeeding women can be vaccinated. The product information for all 4vMenCVs states that vaccine should be administered as a single dose. The ATAGI recommends that these vaccines can be given in a 2- or 3-dose primary schedule to infants, children and adults who are at increased risk of IMD according to Tables 4.10.2 and 4.10.3.

Vaccination of close contacts The meningococcal vaccine with the coverage of the relevant serogroup may be considered for individuals who have close household or household-like contact with some-one who has meningococcal disease, or for individuals at an increased risk of disease because of a local disease outbreak(such as an outbreak in a residential facility) – Public Health would be involved

Additional resources for primary medical care/vaccination providers The Australian Immunisation Handbook, 10th edition – the most up-to-date clinical recommendations are contained in the online version of the Handbook www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handb ook10-home Immunise Australia website www.immunise.health.gov.au For more detailed information and complete reference list see the NCIRS factsheet Meningococcal disease