IAP Recommended ScheduleThe IAP COI does not recommend this vaccine for universal immunization in our country at present. It can be given to children above 2 years of age during disease epidemic and is administered subcutaneously or intramuscularly. In special circumstances (e.g. during group A epidemic to close household contacts, close household contact) it may be offered to even younger infants but the protective efficacy is likely to be low in this age group. The dose is 0.5 ml. Revaccination may be considered after 3-5 years if the individual is still at risk. |
Adverse ReactionsFever and pain at injection site. |
Neisseria meningitides accounts for 30-40% cases of meningitis in children up to the age 15 years. It is the only bacterium capable of causing large scale epidemics of meningitis. There are 12 known serogroups but majority of the disease causing isolates belong to serogroups A, B, C. Y and W135. Epidemic disease is typically associated with type A (occasionally type C) and usually occurs in cycles every 7-14 years, especially in the African meningitis belt which extends across Africa from Senegal to Ethiopia.
In India also almost all epidemics were of type A. Such group A epidemics are usually due to a single strain of the pathogen. Some of the recent outbreaks in Western Asia have been due to W135. Endemic disease occurs worldwide and is mostly caused by serogroups B, A, or C, although group Y has been increasingly incriminated in recent reports. In India endemic cases are mainly due to type B.
As a rule, endemic disease occurs primarily in children and adolescents, with highest attack rates in infants aged 3-12 months. Severe meningococcal disease occurs primarily in children and adolescents, with highest attack rates in infants aged 3-12 months. Severe meningococcal disease is associated with high case-fatality rates (5-15%) even where adequate medical facilities are available. Chemoprophylactic measures are in general insufficient for the control of this disease because secondary cases comprise only 1-2 % of all meningococcal cases.
Immunity following meningococcal infection is serogroup specific. Unconjugated meningococcal vaccines are based on combinations of group-specific capsular polysaccharides - either bivalent (A and C) or tetravalent (A, C, Y and 135). The recommended single dose of the reconstituted vaccine contains 50 mcg of each of the individual polysaccharides. A conjugate group C vaccine has also been marketed in developed countries.
Unconjugated meningococcal vaccines, like all other polysaccharide vaccines, do not induce immunological memory. The group C, Y, and W135 components, moreover, are not very immunogenic in children below 2 years of age. Meningococcal group C conjugate vaccine, on the other hand, is efficacious even in the youngest children.
Meningococcal vaccine is indicated for use (as an adjunct along with chemoprophylaxis) in close contacts of patients with the disease. It may be considered in children with complement deficiency, prior to splenectomy and those asplenia and sickle cell anemia. It is also recommended during disease outbreaks (caused by serogroups included in the vaccine) and prior to travel to the high endemicity meningococcal belt in the African continent. Meningococcal vaccine is mandatory for all Haj pilgrims and is necessary for residential students in some of the universities abroad.
The vaccine is stored at 2-8°C.
A conjugate meningococcal serogroup C vaccine has been part of
routine immunization in the United Kingdom since Novemer 1999 as it
is the commonest cause of meningococcal disease in children there. Three doses are given at 4-8 weeks interval along with the routine childhood immunisation. Two doses of the vaccine suffice for children in age group 6-12 months and one dose in older children.