Meningococcal vaccine refers to anyvaccine used to prevent infection byNeisseria meningitidis.[15] Different versions are effective against some or all of the following types of meningococcus: A, B, C, W-135, and Y.[15][16] The vaccines are between 85 and 100% effective for at least two years.[15] They result in a decrease inmeningitis andsepsis among populations where they are widely used.[17][18] They are given either byinjection into a muscle orjust under the skin.[15]
TheWorld Health Organization recommends that countries with a moderate or high rate of disease or with frequent outbreaks shouldroutinely vaccinate.[15][19] In countries with a low risk of disease, they recommend that high-risk groups should be immunized.[15] In theAfrican meningitis belt efforts to immunize all people between the ages of one and thirty with the meningococcal Aconjugate vaccine are ongoing.[19] InCanada and theUnited States the vaccines are effective against four types of meningococcus (A, C, W, and Y) are recommended routinely for teenagers and others who are at high risk.[15] Saudi Arabia requires vaccination with the quadrivalent vaccine for international travellers toMecca forHajj.[15][20]
Meningococcal vaccines are generally safe.[15] Some people develop pain and redness at the injection site.[15] Use in pregnancy appears to be safe.[19]Severe allergic reactions occur in less than one in a million doses.[15]
Inspired by the response to the 1997 outbreak in Nigeria, the WHO,Médecins Sans Frontières, and other groups created the International Coordinating Group on Vaccine Provision for Epidemic Meningitis Control, which manages global response strategy. ICGs have since been created for other epidemic diseases.[23]
Neisseria meningitidis has 13 clinically significantserogroups, classified according to the antigenic structure of their polysaccharide capsule.[medical citation needed] Six serogroups, A, B, C, Y, W-135, and X, are responsible for virtually all cases in humans. Serogroup B is a major cause of meningococcal disease in younger children and adolescents.[medical citation needed]
There are two pentavalent vaccines available in the United States targeting serogroups A, B, C, W, and Y:
Penbraya was approved for use in the United States in October 2023.[10] It combines the vaccines Trumenba[6] and Nimenrix.[24] Penbraya was authorized for medical use in the European Union in November 2024.[25] It is approved for use in individuals 10 through 25 years of age.[10]
Penmenvy was approved for use in the United States in February 2025.[11][26][27][28] Penmenvy is approved for use in people aged 10 through 25 years of age.[27][28]
Pentavalent (serogroups A, C, W, X, and Y) (MenFive)
There are one pentavalent vaccine available targeting serogroups A, C, W, X, and Y:
MenFive: Approved in several countries, and WHO prequalified. It is approved for use in individuals aged 9 months to 85 years against invasive meningococcal disease caused by Neisseria meningitidis groups A, C, Y, W, and X.[29] It is a freeze-dried conjugate vaccine, recommended as a single intramuscular dose, and is available as 1-dose and 5-dose vials.
There are three quadrivalent vaccines available in the United States targeting serogroups A, C, W-135, and Y:
threeconjugate vaccines (MCV-4), Menactra,[7] Menveo,[8] and Menquadfi.[9] The pure polysaccharide vaccine Menomune, MPSV4, was discontinued in the United States in 2017.[30]
Menveo and Menquadfi are approved for medical use in the European Union.[12][13][31]
The first meningococcal conjugate vaccine (MCV-4), Menactra, was licensed in the US in 2005, bySanofi Pasteur; Menveo was licensed in 2010, byNovartis. Both MCV-4 vaccines are approved by theFood and Drug Administration (FDA) for people 2 through 55 years of age. Menactra received FDA approval for use in children as young as 9 months in April 2011,[32] while Menveo received FDA approval for use in children as young as two months in August 2013.[33] TheCenters for Disease Control and Prevention (CDC) has not made recommendations for or against its use in children less than two years.[34] In November 2024, theEuropean Commission (EC) approved Menveo to protect individuals aged two years and older againstinvasive meningococcal disease.[35]
Meningococcal polysaccharide vaccine (MPSV-4), Menomune, has been available since the 1970s. It may be used if MCV-4 is not available, and is the only meningococcal vaccine licensed for people older than 55. Information about who should receive the meningococcal vaccine is available from the CDC.[34]
Nimenrix (Pfizer). Meningococcal group A, C, W-135, and Y conjugate vaccine
Nimenrix (developed by GlaxoSmithKline and later acquired byPfizer), is a quadrivalent conjugate vaccine against serogroups A, C, W-135, and Y.[36] In April 2012 Nimenrix was approved as the first quadrivalent vaccine against invasive meningococcal disease to be administered as a single dose in those over the age of one year, by the European Medicines Agency.[37] In 2016, they approved the vaccine in infants six weeks of age and older, and it has been approved in other countries including Canada and Australia, among others.[14][38][39] It is not licensed in the United States.[40]
The duration of immunity mediated by Menomune (MPSV-4) is three years or less in children aged under five because it does not generatememory T cells.[41][42] Attempting to overcome this problem by repeated immunization results in a diminished, not increased,antibody response, so boosters are not recommended with this vaccine.[43][44] As with all polysaccharide vaccines, Menomune does not producemucosal immunity, so people can still become colonised with virulent strains of meningococcus, and noherd immunity can develop.[45][46] For this reason, Menomune is suitable for travellers requiring short-term protection, but not for national public health prevention programs.
Menveo and Menactra contain the same antigens as Menomune, but the antigens are conjugated to adiphtheria toxoid polysaccharide-protein complex, resulting in anticipated enhanced duration of protection, increased immunity with booster vaccinations, and effective herd immunity.[47]
A study published in March 2006, comparing the two kinds of vaccines found that 76% of subjects still had passive protection three years after receiving MCV-4 (63% protective compared with controls), but only 49% had passive protection after receiving MPSV-4 (31% protective compared with controls).[48] As of 2010, there remains limited evidence that any of the current conjugate vaccines offer continued protection beyond three years; studies are ongoing to determine the actual duration of immunity, and the subsequent requirement of booster vaccinations. The CDC offers recommendations regarding who they feel should get booster vaccinations.[47][49]
In June 2012, the FDA approved a combination vaccine against two types of meningococcal disease andHib disease for infants and children 6 weeks to 18 months old. The vaccine, Menhibrix, prevents disease caused byNeisseria meningitidisserogroups C and Y andHaemophilus influenzae type b. This was the first meningococcal vaccine that could be given to infants as young as six weeks old.[50] Menhibrix isindicated for active immunization to prevent invasive disease caused byNeisseria meningitidis serogroups C and Y andHaemophilus influenzae type b for children 6 weeks of age through 18 months of age.[51]
A vaccine calledMenAfriVac has been developed through a program called theMeningitis Vaccine Project and has the potential to prevent outbreaks of group A meningitis, which is common in sub-Saharan Africa.[52][53]
Vaccines against serotype B meningococcal disease have proved difficult to produce, and require a different approach from vaccines against other serotypes. Whereas effectivepolysaccharide vaccines have been produced against types A, C, W-135, and Y, the capsular polysaccharide on the type B bacterium is too similar tohuman neural adhesion molecules to be a useful target.[54]
Several "serogroup B" vaccines have been produced. Strictly speaking, these are not "serogroup B" vaccines, as they do not aim to produce antibodies to the group B antigen: it would be more accurate to describe them as serogroup-independent vaccines, as they employ different antigenic components of the organism; indeed, some of the antigens are common to differentNeisseria species.[medical citation needed]
A vaccine for serogroup B was developed in Cuba in response to a large outbreak of meningitis B during the 1980s. This vaccine was based on artificially producedouter membrane vesicles of the bacterium. The VA-MENGOC-BC vaccine proved safe and effective in randomized double-blind studies,[55][56][57] but it was granted a licence only for research purposes in the United States[58] as political differences limited cooperation between the two countries.[59]
Due to a similarly high prevalence of B-serotype meningitis in Norway between 1974 and 1988, Norwegian health authorities developed a vaccine specifically designed for Norwegian children and adolescents. Clinical trials were discontinued after the vaccine was shown to cover only slightly more than 50% of all cases.[60] Furthermore, lawsuits for damages were filed against the State of Norway by persons affected by serious adverse reactions. Information that the health authorities obtained during the vaccine development was subsequently passed on toChiron (now GlaxoSmithKline), who developed a similar vaccine,MeNZB, for New Zealand.[61]
A MenB vaccine was approved for use in Europe in January 2013. Following a positive recommendation from the European Union'sCommittee for Medicinal Products for Human Use, Bexsero, produced byNovartis, received a licence from theEuropean Commission.[62] However, deployment in individual EU member countries still depends on decisions by national governments. In July 2013, the United Kingdom'sJoint Committee on Vaccination and Immunisation (JCVI) issued an interim position statement recommending against the adoption of Bexsero as part of a routine meningococcal B immunisation program, on the grounds of cost-effectiveness.[63] This decision was reverted in favor of Bexsero vaccination in March 2014.[64] In March 2015 the UK government announced that they had reached agreement withGlaxoSmithKline who had taken over Novartis's vaccines business, and that Bexsero would be introduced into the UK routine immunization schedule later in 2015.[65]
In November 2013, in response to an outbreak of B-serotype meningitis on the campus ofPrinceton University, the acting head of theCenters for Disease Control and Prevention (CDC) meningitis and vaccine-preventable diseases branch toldNBC News that they had authorized emergency importation of Bexsero to stop the outbreak.[66] Bexsero was subsequently approved by the FDA in February 2015 for use in individuals 10 through 25 years of age.[67][68] In October 2014, Trumenba, a serogroup B vaccine produced byPfizer, was approved by the FDA for use in individuals 10 through 25 years of age.[6][16]
The occurrence of serogroup X has been reported in North America, Europe, Australia, and West Africa.[69] Until recently, there was no vaccine to protect against serogroup XN. meningitidis disease.[15]
However, a new pentavalent vaccine that protects against serogroups A, C, W, X and Y (MenFive; Serum Institute of India) has become available and has been recommended by the WHO in 2023 for use in endemic countries in Africa[70] In 2014, Nigeria became the first country in the world to roll out the new vaccine[71]
Common side effects include pain and redness around the site of injection (up to 50% of recipients). A small percentage of people develop a mild fever. A small proportion of people develop a severe allergic reaction.[72] In 2016 Health Canada warned of an increased risk of anemia orhemolysis in people treated witheculizumab (Soliris). The highest risk was when individuals "received a dose of Soliris within 2 weeks after being vaccinated with Bexsero".[73]
Despite initial concerns aboutGuillain-Barré syndrome, subsequent studies in 2012 have shown no increased risk of GBS after meningococcal conjugate vaccination.[74]
Travellers who wish to enter or leave certain countries or territories must be vaccinated against meningococcal meningitis, preferably 10–14 days before crossing the border, and be able to present a vaccination record/certificate at the border checks.[75]: 21–24 Countries with required meningococcal vaccination for travellers includeThe Gambia, Indonesia, Lebanon, Libya, the Philippines and, most importantly and extensively, Saudi Arabia for Muslims visiting or working inMecca during theHajj orUmrah pilgrimages.[76] For some countries inAfrican meningitis belt, vaccinations prior to entry are not required, but highly recommended.[75]: 21–24
Meningococcal vaccination requirements for international travel[76]
Proof of vaccination with quadrivalent ACYW-135 is required for travellers departing Lebanon and going to Hajj, Umrah, and to certain African countries.[79]
Proof of vaccination is required for travellers two years of age and older who are Hajj or Umrah pilgrims and seasonal or pilgrim workers in Hajj and Umrah areas. Vaccination with quadrivalent ACYW135 (either polysaccharide or conjugate) must be issued not less than 10 days before arrival and not more than 3 years (polysaccharide vaccine) or 5 years (conjugate vaccine) before arrival. The immunisation certificate should clearly state if the traveller was vaccinated with the conjugate vaccine for the 5-year validity to apply.[82]
Vaccination is also required for domestic pilgrims, residents of Mecca and Medina, and any persons participating in Hajj or Umrah or seasonal or pilgrimage work in Hajj and Umrah zones. At the discretion of the Ministry of Health, travellers may be administered prophylactic antibiotics upon arrival.[82]
^Conterno LO, Silva Filho CR, Rüggeberg JU, Heath PT (July 2006). Conterno LO (ed.). "Conjugate vaccines for preventing meningococcal C meningitis and septicaemia".The Cochrane Database of Systematic Reviews (3) CD001834.doi:10.1002/14651858.CD001834.pub2.PMID16855979.
^World Health Organization (2023).The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023). Geneva: World Health Organization.hdl:10665/371090. WHO/MHP/HPS/EML/2023.02.
^Reingold AL, Broome CV, Hightower AW, et al. (1985). "Age-specific differences in duration of clinical protection after vaccination with meningococcal polysaccharide A vaccine".Lancet.2 (8447):114–18.doi:10.1016/S0140-6736(85)90224-7.PMID2862316.S2CID36704156.
^Lepow ML, Goldschneider I, Gold R, Randolph M, Gotschlich EC (1977). "Persistence of antibody following immunization of children with groups A and C meningococcal polysaccharide vaccines".Pediatrics.60 (5):673–80.doi:10.1542/peds.60.5.673.PMID411104.S2CID24021572.
^Borrow R, Joseh H, Andrews N, et al. (2000). "Reduced antibody response to revaccination with meningococcal serogroup A polysaccharide vaccine in adults".Vaccine.19 (9–10):1129–32.doi:10.1016/s0264-410x(00)00317-0.PMID11137248.
^MacLennan J, Obaro S, Deeks J, et al. (1999). "Immune response to revaccination with meningococcal A and C polysaccharides in Gambian children following repeated immunization during early childhood".Vaccine.17 (23–24):3086–93.doi:10.1016/S0264-410X(99)00139-5.PMID10462244.
^Moore PS, Harrison LH, Telzak EE, Ajello GW, Broome CV (1988). "Group A meningococcal carriage in travelers returning from Saudi Arabia".J Am Med Assoc.260 (18):2686–89.doi:10.1001/jama.260.18.2686.PMID3184335.
^abCenters for Disease Control and Prevention (CDC) (January 2011). "Updated recommendations for use of meningococcal conjugate vaccines --- Advisory Committee on Immunization Practices (ACIP), 2010".MMWR. Morbidity and Mortality Weekly Report.60 (3):72–76.PMID21270745.
^Centers for Disease Control and Prevention (CDC) (September 2009). "Updated recommendation from the Advisory Committee on Immunization Practices (ACIP) for revaccination of persons at prolonged increased risk for meningococcal disease".MMWR. Morbidity and Mortality Weekly Report.58 (37):1042–1043.PMID19779400.
^Uli L, Castellanos-Serra L, Betancourt L, Domínguez F, Barberá R, Sotolongo F, et al. (June 2006). "Outer membrane vesicles of the VA-MENGOC-BC vaccine against serogroup B of Neisseria meningitidis: Analysis of protein components by two-dimensional gel electrophoresis and mass spectrometry".Proteomics.6 (11):3389–99.doi:10.1002/pmic.200500502.PMID16673438.S2CID10828810.
^NBC News Digital (12 November 2015)."Cuban scientist barred from receiving U.S. prize". Associated Press.Archived from the original on 7 June 2019. Retrieved27 May 2019.A Cuban scientist who helped develop a low-cost synthetic vaccine that prevents meningitis and pneumonia in small children says he was offended the U.S. government denied his request to travel to the United States to receive an award.
^"Vaccines: Vac-Gen/Side Effects".Centers for Disease Control and Prevention. National Center for Immunization and Respiratory Diseases.Archived from the original on 17 March 2017. Retrieved27 March 2017.
^Yih WK, Weintraub E, Kulldorff M (December 2012). "No risk of Guillain-Barré syndrome found after meningococcal conjugate vaccination in two large cohort studies".Pharmacoepidemiology and Drug Safety.21 (12):1359–1360.doi:10.1002/pds.3353.PMID23225672.S2CID43096082.
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The Gambia
Indonesia
Lebanon
Libya
Philippines
Saudi Arabia
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