Use Of Meningococcal Vaccines Research Articles

Comparison of Adolescent Meningococcal B Vaccination Rates in Four Diverse Outpatient Clinics.

Meningococcal disease, caused by Neisseria meningitidis, is associated with severe illness and death. The Centers for Disease Control and Prevention Advisory Committee on Immunization Practices have published recommendations for the use of meningococcal vaccines in the United States. The primary objective of this study is to compare meningococcal serogroup B vaccination rates among adolescents at 4 diverse outpatient clinics. In this retrospective chart review, patients between the ages of 16 and 23 years were identified by using automated dispensing cabinet records of meningococcal serogroup ACWY vaccine removal. Immunization records were reviewed to determine if meningococcal serogroup B vaccine had been administered. Patients from 2 pediatric clinics and 2 family medicine clinics were included in our analysis. Two hundred sixty-five patients were identified for review and 134 patients were included in our study. Of these, 43 (32%) had received the full meningococcal serogroup B vaccine series and 32 (24%) had completed the vaccine series for both meningococcal serogroup B and meningococcal serogroup ACWY series. Most patients who had completed a meningococcal serogroup B vaccine series presented to a pediatric clinic. Less than half of adolescent patients completed their meningococcal B vaccine series at 4 diverse outpatient clinics, with a greater number of patients receiving vaccinations at pediatric clinics than family medicine clinics. Our findings highlight a need for increased education to providers regarding the current meningococcal B vaccination recommendations.

Invasive meningococcal disease in older adults in North America and Europe: is this the time for action? A review of the literature

BackgroundNeisseria meningitidis is an encapsulated Gram-negative diplococcus that asymptomatically colonises the upper respiratory tract in up to 25% of the population (mainly adolescents and young adults). Invasive meningococcal disease (IMD) caused by Neisseria meningitidis imposes a substantial public health burden,. The case fatality rate (CFR) of IMD remains high. IMD epidemiology varies markedly by region and over time, and there appears to be a shift in the epidemiology towards older adults. The objective of our review was to assess the published data on the epidemiology of IMD in older adults (those aged ≥ 55 years)in North America and Europe. Such information would assist decision-makers at national and international levels in developing future public health programmes for managing IMD.MethodsA comprehensive literature review was undertaken on 11 August 2020 across three databases: EMBASE, Medline and BIOSIS. Papers were included if they met the following criteria: full paper written in the English language; included patients aged ≥ 56 years; were published between 1/1/2009 11/9/2020 and included patients with either suspected or confirmed IMD or infection with N. meningitidis in North America or Europe. Case studies/reports/series were eligible for inclusion if they included persons in the age range of interest. Animal studies and letters to editors were excluded. In addition, the websites of international and national organisations and societies were also checked for relevant information.ResultsThere were 5,364 citations identified in total, of which 76 publications were included in this review. We identified that older adults with IMD were mainly affected by serogroups W and Y, which are generally not the predominant strains in circulation in most countries. Older adults had the highest CFRs, probably linked to underlying comorbidities and more atypical presentations hindering appropriate timely management. In addition, there was some evidence of a shift in the incidence of IMD from younger to older adults.ConclusionsThe use of meningococcal vaccines that include coverage against serogroups W and Y in immunization programs for older adults needs to be evaluated to inform health authorities’ decisions of the relative benefits of vaccination and the utility of expanding national immunization programmes to this age group.

Clinical and Laboratory Findings of 12 Children with Invasive Meningococcal Disease in Pediatric Intensive Care Unit

Introduction Invasive meningococcal disease (IMD) is a serious infectious disease requiring stay in a pediatric intensive care unit (PICU) that continues to be associated with high morbidity and mortality rates. Prompt recognition, early antibiotic therapy, and aggressive supportive therapies can reduce mortality. We aimed to assess the clinical and laboratory characteristics of children with IMD. Patients and Methods. We retrospectively evaluated the medical records of 12 children with IMD requiring PICU stay between January 2018 and July 2019. Results We followed up 12 patients (five girls and seven boys, 5–168 months of age, and four below one year of age) with IMD (nine patients have meningococcemia with meningitis, and three patients have meningococcemia) in PICU. All children were previously healthy and have not received meningococcal vaccines. Their pediatric risk of mortality (PRISM) scores varies between 5 and 37, four of the patients required mechanical ventilation, and the predicted mortality was 39% at admission. Seven patients had catecholamine refractory septic shock and disseminated intravascular coagulation (DIC). Three of the patients required extracorporeal treatment. The predominant serogroup is Men B (5/12). The mortality rate was 16.6% with early use of antibiotics, fluids, and other interventions. Conclusion Mortality related to IMD is higher among children with severe meningococcemia despite early interventions in PICU. Routine use of meningococcal vaccines during childhood would be a better strategy for controlling IMD in both developing and developed countries.

Meningococcal Vaccination: Recommendations of the Advisory Committee on Immunization Practices, United States, 2020.

SummaryThis report compiles and summarizes all recommendations from CDC’s Advisory Committee on Immunization Practices (ACIP) for use of meningococcal vaccines in the United States. As a comprehensive summary and update of previously published recommendations, it replaces all previously published reports and policy notes. This report also contains new recommendations for administration of booster doses of serogroup B meningococcal (MenB) vaccine for persons at increased risk for serogroup B meningococcal disease. These guidelines will be updated as needed on the basis of availability of new data or licensure of new meningococcal vaccines. ACIP recommends routine vaccination with a quadrivalent meningococcal conjugate vaccine (MenACWY) for adolescents aged 11 or 12 years, with a booster dose at age 16 years. ACIP also recommends routine vaccination with MenACWY for persons aged ≥2 months at increased risk for meningococcal disease caused by serogroups A, C, W, or Y, including persons who have persistent complement component deficiencies; persons receiving a complement inhibitor (e.g., eculizumab [Soliris] or ravulizumab [Ultomiris]); persons who have anatomic or functional asplenia; persons with human immunodeficiency virus infection; microbiologists routinely exposed to isolates of Neisseria meningitidis; persons identified to be at increased risk because of a meningococcal disease outbreak caused by serogroups A, C, W, or Y; persons who travel to or live in areas in which meningococcal disease is hyperendemic or epidemic; unvaccinated or incompletely vaccinated first-year college students living in residence halls; and military recruits. ACIP recommends MenACWY booster doses for previously vaccinated persons who become or remain at increased risk.In addition, ACIP recommends routine use of MenB vaccine series among persons aged ≥10 years who are at increased risk for serogroup B meningococcal disease, including persons who have persistent complement component deficiencies; persons receiving a complement inhibitor; persons who have anatomic or functional asplenia; microbiologists who are routinely exposed to isolates of N. meningitidis; and persons identified to be at increased risk because of a meningococcal disease outbreak caused by serogroup B. ACIP recommends MenB booster doses for previously vaccinated persons who become or remain at increased risk. In addition, ACIP recommends a MenB series for adolescents and young adults aged 16–23 years on the basis of shared clinical decision-making to provide short-term protection against disease caused by most strains of serogroup B N. meningitidis.

Summary of the NACI Statement on the Use of Bivalent Factor H Binding Protein Meningococcal Serogroup B (MenB-fHBP) Vaccine for the Prevention of Meningococcal B Disease.

TrumenbaTM, a bivalent, factor-H binding protein meningococcal serogroup B (MenB-fHBP) vaccine was authorized for use in Canada in October 2017 for the prevention of invasive meningococcal disease (IMD) caused by Neisseria meningitidis serogroup B in individuals 10-25 years of age. The National Advisory Committee on Immunization (NACI) provides recommendations regarding the use of meningococcal vaccines to the Public Health Agency of Canada. To summarize NACI recommendations regarding the use of MenB-fHBP vaccine in Canada. The NACI Meningococcal Disease Working Group developed a predefined search strategy to identify all eligible studies, assessed the quality of these studies, and summarized and analyzed the findings. According to the NACI evidence-based process, the working group then proposed recommendations and identified the grade of evidence that supported them. In light of the evidence, the recommendations were then considered and approved by NACI. The two serogroup B meningococcal vaccines currently authorized for use in Canada are not interchangeable as they contain different antigens and there are no published studies on the immunogenicity resulting from a vaccination series combining the two products. Following the review of evidence, NACI recommends that MenB-fHBP vaccine may be considered as an option for use in individuals 10 years of age and older in situations when a serogroup B meningococcal vaccine should be offered: 1) during serogroup B meningococcal disease outbreaks or with the emergence of hyperendemic N. meningitidis strains that are predicted to be susceptible to the vaccine; 2) for individuals who are close contacts with a case of invasive meningococcal disease caused by serogroup B N. meningitidis; 3) for individuals with underlying medical conditions that would put them at higher risk of meningococcal disease than the general population; or 4) for individuals at higher risk of exposure to serogroup B meningococcal isolates than the general population. NACI also recommends that MenB-fHBP vaccine may be considered as an option for individuals 10-25 years of age who are not at higher risk of meningococcal disease than the general population, but who wish to reduce their risk of invasive serogroup B meningococcal disease. NACI recommends immunization against serogroup B IMD for all individuals who are at a higher risk of disease due to an underlying medical condition or an increased risk of exposure. In addition to providing guidance to public health decision-makers (i.e. provinces/territories making decisions for publicly-funded immunization programs), these NACI recommendations provide information to individuals, vaccine providers and organizations about vaccines that may not currently be included in publicly funded immunization programs. NACI continues to recommend against the use of the serogroup B vaccines in routine universal immunization programs in Canada at this time.

Invasive meningococcal disease epidemiology and characterization of Neisseria meningitidis serogroups, sequence types, and clones; implication for use of meningococcal vaccines

ABSTRACTBackground and aims: Neisseria meningitidis (N. meningitidis) is a Gram-negative bacterium that can cause life-threatening invasive infections referred to as invasive meningococcal disease (IMD). In the last decade the incidence of IMD in Israel is about 1/100,000 population annually. We aimed to describe the epidemiology of IMD in Israel combining epidemiological data and characterization of N. meningitidis isolates.Methods: Invasive infection caused by N. meningitidis is a notifiable disease in Israel. Data were collected by epidemiological investigations and control measures were employed. Laboratory work-up included serogrouping, N. meningitides molecular characterization and whole-genome sequencing.Results: During 1998–2017, 1349 cases of IMD were notified in Israel (mean annual incidence rate 0.94/100,000). The peak incidence rates were observed in infants under 1 year of age (10.9/100,000). Case fatality rate was 9.7%. The majority of the N. meningitidis isolates were of serogroup B (67.9%). During 2007–2017, three clonal complexes (CC) 32, 41/44 and 23 (hyper-invasive clonal complexes) were the leading CC (61%). CC32 was the leading CC causing meningococcemia and mortality. In 2017, 35 isolates were tested for 4CMenB antigens variants; of the serogroup B isolates tested 46.7% showed a match to one or more antigens (fHbp or PorA:VR1), most were ST32 (CC32).Conclusions: Preliminary analysis based on limited number of samples suggests that the 4CMenB coverage would be about half the strains; further research is necessary. Integration of clinical, epidemiological and laboratory data is essential to support decision-making on the introduction of the novel MENB vaccines in Israel.

Recommendations for the use of meningococcal vaccines in South Africa

Background: Although meningococcal disease (MD) incidence in South Africa is low, Neisseria meningitidis (NM) causes severe disease that is often life-threatening and can cause long-term disabilities. A quadrivalent protein-conjugated meningococcal vaccine (MCV4) is available, and provides protection against 75% of disease causing serogroups in South Africa. Recommendations: We advise vaccination of persons at high risk of meningococcal disease including those with complement deficiency and asplenia; laboratory personnel from reference laboratories who work with NM; and travellers to Saudi Arabia. The need for routine vaccine against meningococcal disease in South Africa is controversial given the current burden of disease. However, due to the high morbidity/mortality of MD we recommend that clinicians consider vaccination of healthy infants and children; HIV-infected persons with a CD4 count 25%; students attending college /university /military academies; and miners.Conclusion: Protein-conjugated meningococcal vaccine is preferable to the polysaccharide vaccine given the ability of the protein-conjugated meningococcal vaccine to induce immune memory, allow for booster responses and eliminate carriage of the organism in the person vaccinated.

Recommendations for the use of meningococcal vaccines in South Africa

Background: Although meningococcal disease (MD) incidence in South Africa is low, Neisseria meningitidis (NM) causes severe disease that is often life-threatening and can cause long-term disabilities. A quadrivalent protein-conjugated meningococcal vaccine (MCV4) is available, and provides protection against 75% of disease causing serogroups in South Africa.Recommendations: We advise vaccination of persons at high risk of meningococcal disease including those with complement deficiency and asplenia; laboratory personnel from reference laboratories who work with NM; and travellers to Saudi Arabia.The need for routine vaccine against meningococcal disease in South Africa is controversial given the current burden of disease. However, due to the high morbidity/mortality of MD we recommend that clinicians consider vaccination of healthy infants and children; HIV-infected persons with a CD4 count > 25%; students attending college /university /military academies; and miners.Conclusion: Protein-conjugated meningo...

Diagnosis, management, and causes of meningitis in the Gaza Strip: an analysis of guidelines, field assessment, and microbiological study

BackgroundReported rates of bacterial and viral (aseptic) meningitis are much higher in the Gaza Strip than in the West Bank. In the Gaza Strip the capacity for microbiological diagnostic testing is limited. The aim of the study was to assess clinical laboratory diagnosis and management of meningitis in the Gaza Strip and to identify the microbiological causes of meningitis. MethodsThe assessment followed general guidelines of WHO and the US Centers for Disease Control and Prevention, using a preparatory questionnaire sent to all microbiological laboratories in the Gaza Strip. A joint assessment was conducted in May, 2014. Guidelines and procedures for microbiological services, surveillance systems, and clinical procedures for diagnosing and treating clinical meningitis were assessed. On-site field visits were done at four hospitals, including clinical wards and laboratories, and at the Gaza Ministry of Health central laboratory. Cerebrospinal fluid samples from 123 patients with clinical meningitis were consecutively collected from the Ministry of Health central laboratory from November, 2013 to June, 2014. Samples were sent in three batches (January, May, and June 2014) for microbiological analysis at the Norwegian Institute of Public Health. FindingsThe assessment showed a lack of antibiotic policy and regulation of prescription in the Gaza Strip. Hospital meningitis guidelines did not follow international guidelines. All patients with suspected clinical meningitis were treated with antibiotics even when a viral cause was suspected, and often before hospital admission. Laboratories had dedicated staff and high productivity, but lacked sufficient space, equipment, and reagents, and some standard operating procedures. No molecular methods were available for bacterial and viral detection. Of 123 cerebrospinal fluid samples tested for bacteria, serogroup B Neisseria meningitidis was detected in eight and Streptococcus pneumoniae in one. Of 102 samples available for virus testing, enteroviruses were detected in 63, one of which was also positive for serogroup B N meningitidis. InterpretationNational guidelines and policies to promote prudent use of antibiotics in the health services are needed. Clinical guidelines for classifying and treating patients with suspected meningitis should be revised with stakeholders. A reference laboratory with defined tasks should be established. Up-to-date laboratory diagnosis of viral meningitis is urgently needed. Laboratory protocols should be improved and equipment upgraded. Spring-summer meningitis outbreaks seem to be dominated by enteroviruses. In our assessment serogroup B N meningitidis was the main cause of bacterial meningitis. Use of meningococcal vaccine should be considered. FundingThe study was funded by in kind contributions from the organisations involved. The Palestinian National Institute of Public Health is a project managed by WHO and funded by the Norwegian Ministry of Foreign Affairs.

WHO position paper, Meningococcal A conjugate vaccine: Updated guidance, February 2015

This article presents the World Health Organization’s (WHO) updated recommendations on the use of meningococcal vaccines excerpted from the WHO position paper on Meningococcal A conjugate vaccine: updated guidance, February 2015, published in the Weekly Epidemiological Record [1].A position paper on meningococcal vaccines was published in 2011 and its recommendations remain valid [2]. This update adds to the previous recommendations specifically concerning routine immunization of infants and young children in the African meningitis belt with meningococcal A conjugate vaccine.Footnotes to this paper provide a number of core references including references to grading tables that assess the quality of the scientific evidence. In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of vaccines against diseases that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programmes; they summarize essential background information on diseases and vaccines, and conclude with WHO's current position on the use of vaccines in the global context. Recommendations on the use of the Meningococcal A conjugate vaccine were discussed by SAGE in October 2014; evidence presented at these meetings can be accessed at: http://www.who.int/immunization/sage/meetings/2014/october/presentations_background_docs/en/.

Updated recommendations on the use of meningococcal vaccines.

Since the last policy statement from the American Academy of Pediatrics (AAP) concerning meningococcal vaccine was published in 2011, 2 meningococcal conjugate vaccines have been licensed for use in infants (Hib-MenCY-TT and MenACWY-CRM). The Centers for Disease Control and Prevention (CDC) has published new recommendations, "Prevention and Control of Meningococcal Disease: Recommendations of the Advisory Committee on Immunization Practices," which have been endorsed by the AAP. However, the CDC recommendations were published before licensure of MenACWY-CRM for infant use. This policy statement updates the AAP recommendations for use of meningococcal vaccines in children and adolescents. A more comprehensive review of background and technical information can be found in the CDC publication.

Global epidemiology of invasive meningococcal disease.

Neisseria meningitidis is one of the leading causes of bacterial meningitis globally and can also cause sepsis, pneumonia, and other manifestations. In countries with high endemic rates, the disease burden places an immense strain on the public health system. The worldwide epidemiology of invasive meningococcal disease (IMD) varies markedly by region and over time. This review summarizes the burden of IMD in different countries and identifies the highest-incidence countries where routine preventive programs against Neisseria meningitidis would be most beneficial in providing protection. Available epidemiological data from the past 20 years in World Health Organization and European Centre for Disease Prevention and Control collections and published articles are included in this review, as well as direct communications with leading experts in the field. Countries were grouped into high-, moderate-, and low-incidence countries. The majority of countries in the high-incidence group are found in the African meningitis belt; many moderate-incidence countries are found in the European and African regions, and Australia, while low-incidence countries include many from Europe and the Americas. Priority countries for vaccine intervention are high- and moderate-incidence countries where vaccine-preventable serogroups predominate. Epidemiological data on burden of IMD are needed in countries where this is not known, particularly in South- East Asia and Eastern Mediterranean regions, so evidence-based decisions about the use of meningococcal vaccines can be made.

Isolation and characterization of Neisseria meningitidis in the vaccine era. Who needs what and when?

Diagnosing invasive meningococcal disease can require a number of different approaches. The logic behind and the practical steps for diagnosis are described and discussed. The characterization of Neisseria meningitidis can be performed with a number of methods, depending on the problem/question that is formulated. Increased availability and use of meningococcal vaccines with new immunizing proteins requires diagnostic and surveillance systems of high quality. It is foreseen that a combination of genetic characterization and proof of corresponding production/exposure of the protein by a phenotypic method will be an optimal strategy for dealing with candidate vaccine antigens that have genetic and phenotypic variability. Such an approach will make use of the best qualities of both systems. Who needs what and when concerning the characterization is outlined, including future situations when new meningococcal vaccines are available.

Use of Meningococcal Vaccines in the United States

In January 2005, Food and Drug Administration licensed a new tetravalent (serogroups A, C, Y, W-135) meningococcal conjugate vaccine ([MCV4] Menactra) for use in persons 11-55 years of age. In February 2005, CDC's Advisory Committee on Immunization Practices (ACIP) recommended routine vaccination of adolescents and college freshmen living in dormitories with MCV4. The manufacturer started shipments of MCV4 in March 2005. MCV4 should become a key addition to existing meningococcal disease prevention measures.

Prevention and Control of Meningococcal Disease: Recommendations for Use of Meningococcal Vaccines in Pediatric Patients

Two peaks in the incidence of invasive meningococcal disease (IMD) occur in pediatric patients: infants younger than 1 year and adolescents 15 to 18 years of age. Although the incidence of IMD is highest in infants, the case-fatality rate is highest in adolescents (approximately 20%). Epidemiologic studies also have demonstrated increased risk of IMD among college freshman living in dormitories compared with other college students and similarly aged persons in the general population. At least 75% of cases of IMD in 11- to 18-year-olds are caused by serogroups A, C, Y, and W-135; thus, IMD potentially is preventable by immunization with quadrivalent meningococcal vaccines. Meningococcal A, C, Y, W-135 conjugate vaccine (MCV4) was licensed in 2005 for use in people 11 to 55 years of age. On the basis of data indicating increased risk of meningococcal disease and fatality among certain adolescents and college students, the American Academy of Pediatrics recommends administration of MCV4 to young adolescents (at the 11- to 12-year visit), students entering high school or 15-year-olds, and college freshmen who will be living in dormitories. For pediatric patients 11 years and older who are at increased risk of meningococcal disease, MCV4 also is recommended. The purposes of this statement are to provide the rationale for routine use of MCV4 in adolescents and to update recommendations for use of the meningococcal polysaccharide vaccine in pediatric patients.

Review of the Cost Effectiveness of Immunisation Strategies for the Control of Epidemic Meningococcal Meningitis

Outbreaks of meningococcal disease have caused devastation worldwide. Effective vaccines have not been used routinely, due to perceived limitations of the duration of effectiveness as well as immunogenicity when administered during infancy. Given the sporadic nature of outbreaks, the optimal use of these vaccines to control both short-term epidemic and endemic meningococcal disease has been the subject of much debate. Seven economic studies on the use of polysaccharide vaccination strategies help to highlight the relevant epidemiological and economic issues surrounding the decisions for their use. Five of these studies were based in Africa, the region where annual incidence rates can be several orders of magnitude greater than the rest of the world. These studies demonstrated that vaccination against meningococcal disease during outbreak situations is suboptimal given the inability to rapidly immunise populations in a timely fashion in resource-poor areas. However, depending on the disease incidence and the ability to deliver vaccines, the polysaccharide vaccine can be cost effective for preventive strategies when given prior to the start of outbreaks, either through presumptive vaccination or through a modified routine delivery strategy. Economic analyses of mass immunisation campaigns and modelled routine vaccination suggest that routine use of meningococcal vaccines for preventive strategies could be within the range of cost-effective public health interventions in those regions of the world where meningococcal disease is endemic. This includes the meningococcal belt of Africa, the Sahelian region.

Rates of Neisseria meningitidis increasing in young adults.

The burden of meningococcal disease has remained unchanged in the United States for the past 4 decades. The currently available meningococcal vaccine is safe and effective, however, due to immunogenic limitations inherent to polysaccharide vaccines, it has been available only for high-risk populations older than 2. Incorporation of a more immunogenic and effective conjugated vaccine into the routine immunization schedule offers an opportunity to substantially affect the incidence of meningococcal disease. The routine use of a meningococcal conjugate vaccine in the United States will save lives and prevent significant morbidity in children and young adults.

The evolving epidemiology of invasive meningococcal disease: a two-year prospective, population-based study in children in the area of Athens

In response to an increase in the incidence in invasive meningococcal disease (IMD) due to Neisseria meningitidis, a system of hospital- and laboratory-based surveillance was used in a prospective epidemiological and clinical assessment of IMD in children 0–13 years of age hospitalized in the Athens area between 1 January 1999 and 31 December 2000. The annual incidence of laboratory-confirmed disease was 10.2/100 000. Serogroup B strains were predominant. There was a sharp decrease in serogroup C from 19% of cases in 1999 to 3% in 2000 ( P=0.013). Of note was the emergence of serogroup A responsible for 7% of the cases. The overall case fatality rate was 4.5%, but 2.8% for microbiologically confirmed cases. A remarkable decrease in disease severity assessed by admissions to intensive care units was noted during the second study year. Polymerase chain reaction-based methods for detection of meningococcal DNA were the sole positive laboratory test in 45% of the cases and the only test on which serogroup determination was based in 52% of groupable cases. The epidemiological and clinical profile of meningococcal disease appears to be rapidly evolving and close monitoring is required particularly for input into decisions regarding use of meningococcal vaccines.

Meningococcal vaccine use in college students.

To discuss the role of meningococcal vaccine in prevention of meningococcal disease. A MEDLINE search (1966-June 2001) was performed to identify key literature. Search terms included, but were not limited to, meningococcal vaccines, meningococcal meningitis, meningococcal infection, and meningococcus. The search was limited to English-language literature and references dealing with humans. The MEDLINE search was supplemented by a hand search of various bibliographies. The impact of meningococcal disease has caused national and regional organizations to develop recommendations for use of meningococcal vaccine. Even though the meningococcal vaccine can provide benefit, limitations exist. The available vaccine does not cover all meningococcal strains and is not useful in all age groups. The appropriate target groups for prevention of disease through vaccination have been difficult to determine; vaccine use in college students is especially controversial. Although a meningococcal vaccine is available, meningococcus causes significant morbidity and mortality. Controversy exists over the meningococcal vaccine and its use. Students entering college who will be living in dormitories should be informed of the increased risk of meningococcal disease and be offered vaccination.

Meningococcal Vaccine Use in College Students

AbstractOBJECTIVE:To discuss the role of meningococcal vaccine in prevention of meningococcal disease.DATA SOURCES:A MEDLINE search (1966–June 2001) was performed to identify key literature. Search terms included, but were not limited to, meningococcal vaccines, meningococcal meningitis, meningococcal infection, and meningococcus. The search was limited to English-language literature and references dealing with humans. The MEDLINE search was supplemented by a hand search of various bibliographies.DATA SYNTHESIS:The impact of meningococcal disease has caused national and regional organizations to develop recommendations for use of meningococcal vaccine. Even though the meningococcal vaccine can provide benefit, limitations exist. The available vaccine does not cover all meningococcal strains and is not useful in all age groups. The appropriate target groups for prevention of disease through vaccination have been difficult to determine; vaccine use in college students is especially controversial.CONCLUSIONS:Although a meningococcal vaccine is available, meningococcus causes significant morbidity and mortality. Controversy exists over the meningococcal vaccine and its use. Students entering college who will be living in dormitories should be informed of the increased risk of meningococcal disease and be offered vaccination. ResumenOBJETIVO:Discutir el papel de la vacuna antimeningocócica en la prevención de enfermedad causada por meningococos.FUENTES DE INFORMACIÓN:Una búsqueda bibliográfica se realizó en MEDLINE para identificar literatura relevante publicada en el período entre enero de 1996 y junio de 2001. Entre los términos de búsqueda, se utilizaron vacuna antimeningocócica, meningitis por meningococos, infección por meningococos, y meningococos. La búsqueda se limitó a manuscritos en inglés y a estudios con humanos. La búsqueda en MEDLINE se suplementó con una búsqueda a mano de varias bibliografías.SÍNTESIS:Las enfermedades causadas por meningococos han ocasionado que organizaciones nacionales y regionales desarrollen recomendaciones para el uso de la vacuna antimeningocócica. Aunque la vacuna puede tener sus beneficios, también existen limitaciones para su uso. La vacuna que está disponible no cubre todas las cepas de meningococos y no es útil en todos los grupos de edad. También, ha sido dificil determinar el grupo apropiado de la población que debe ser vacunada para prevenir la enfermedad. En estudiantes a nivel de colegio, el uso de esta vacuna ha sido particularmente controversial.CONCLUSIONES:Los meningcococos han ocasionado morbilidad y mortalidad significativa, aún cuando existe una vacuna antimeningocócica. Existe una controversia sobre la vacuna y su uso. En este artículo, se presentan guías para el uso de la vacuna en estudiantes de colegio a base de datos epidemiológicos e información sobre costo-efectividad. RésuméOBJECTIF:Discuter le rôle du vaccin méningococcique dans la prévention des affections à méningocoque.SOURCES DE DONNÉES:Une recherche MEDLINE (janvier 1966–juin 2001) a été effectuée pour identifier l'essentiel de la littérature. Les termes de recherche comprenaient, mais non limitativement, vaccins méningococciques, méningites méningococciques, infection méningococcique, et méningocoque. La recherche a été limitée aux documents en anglais et aux références ayant trait à l'espèce humaine. La recherche MEDLINE a été complétée par une recherche manuelle dans diverses bibliographies.SYNTHÈSE DE DONNÉES:L'impact des affections à méningocoque a amené des organisations régionales et nationales à émettre des recommandations pour l'utilisation du vaccin méningococcique. Même si le vaccin méningococcique peut apporter un bénéfice, des limitations existent. Le vaccin disponible ne couvre pas toutes les souches de méningocoques. Le vaccin n'est pas utile pour tous les groupes d'âges. Les groupes-cibles appropriés pour la prévention des affections par la vaccination on été difficiles à déterminer. L'utilisation du vaccin chez les étudiants est particulièrement controversée.CONCLUSIONS:Le méningocoque est responsable d'une morbidité et d'une mortalité significatives, même si un vaccin méningococcique est disponible. Il existe une controverse à propos du vaccin méningococcique et de son utilisation. Nous proposons des recommandations pour l'utilisation du vaccin méningococcique chez les étudiants, basées sur des données épidémiologiques et des notions de coût-efficacité.