Meningococcal vaccination

• Meningococcal C conjugate (MenC) vaccine
  • made from capsular polysaccharide that has been extracted from cultures of group C Neisseria meningitidis
  • polysaccharide is linked (conjugated) to a carrier protein - in the UK, MenC vaccines have been used that have been conjugated with either CRM197 (a non-toxic variant of diphtheria toxin) or tetanus toxoid
  • conjugation increases the immunogenicity, especially in young children in whom the plain polysaccharide vaccines are less immunogenic
  • vaccine confers no protection against other types of meningococcal disease, such as serogroup B, A or W135
    
    
• Hib/MenC conjugate vaccine
  • Hib/MenC conjugate vaccine is made from capsular polysaccharides of Haemophilus influenzae type b and group C Neisseria meningitidis, which are conjugated to tetanus toxoid
  • vaccine has been shown to elicit booster responses to both Hib and MenC when given in the second year of life to children who were primed in infancy with Hib and MenC conjugate vaccines
    
    
• quadrivalent (ACWY) polysaccharide vaccine
  • this polysaccharide (non-conjugated) vaccine is made from the outer capsules of serogroup group A,C,W135 and Y Neisseria meningitidis organisms
  • protection is not long-lasting - vaccine-induced immunity lasts approximately three to five years in older children and adults; in younger children, a more rapid decline in antibody has been noted
  • response to MenC is good, regardless of the MenC vaccine received as a child
    
  • confers no protection against group B organisms
    
    
• four component meningococcal B (4CMenB) protein vaccine was authorised for use by the European Medicines Agency
  • made from three N. meningitidis proteins produced by recombinant DNA technology (Neisseria heparin binding antigen (NHBA), Neisserial adhesion A (NadA), factor H binding protein (fHbp)) and a preparation of N. meningitidis capsular group B outer membrane vesicles (OMV)
  • 4CMenB vaccine is immunogenic in young infants and adolescents and is licensed for use from two months of age.
  • laboratory-based studies suggest that 4CMenB may protect against up to 88% of circulating meningogoccal B strains in England and Wales
  • 4CMenB may also protect against infection by capsular groups other than group B

Check uptodate details in the The Green Book before prescribing/administering a vaccine.

Check the Summary of Product Characteristics (SPC) before prescribing/administering a vaccine.

Notes:

• a systematic review concluded that the MenC vaccine appears to be safe, immunogenic and able to induce immunological memory in all age groups (2)
• although the summary of product characteristics for 4CMenB states that three doses should be given in those less than one year of age, the Joint Committee on Vaccination and Immunisation have advised that the provision of two doses of 4CMenB in infancy at two and four months of age with a booster dose at 12-13 months of age would likely be sufficient to provide substantial protection against MenB invasive meningococcal disease in infants and toddlers

Reference:

1. Immunisation Against Infectious Disease - "The Green Book".Chapter 22 Meningococcal (April 2019)
2. Conterno LO et al. Conjugate vaccines for preventing meningococcal C meningitis and septicaemia. Cochrane Database Syst Rev. 2006 Jul 19;3:CD001834