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Meningococcal vaccine

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Meningococcal vaccine
Vaccine description
TargetNeisseria meningitidis
Clinical data
ATC code
  (verify)

Meningococcal vaccine is a vaccine used against Meningococcus, a bacterium that causes meningitis, meningococcemia, septicemia, and rarely carditis, septic arthritis, or pneumonia.[1]

Types

Neisseria meningitidis has 13 clinically significant serogroups. These are classified according to the antigenic structure of their polysaccharide capsule. Six serogroups, A, B, C, Y, W135 and X are responsible for virtually all cases of the disease in humans.

Quadrivalent (Serogroups A, C, W-135 and Y)

There are currently three vaccines available in the US to prevent meningococcal disease, all quadrivalent in nature, targeting serogroups A, C, W-135 and Y:

Mencevax (GlaxoSmithKline) and NmVac4-A/C/Y/W-135 (JN-International Medical Corporation) are used worldwide, but have not been licensed in the United States.

The first meningococcal conjugate vaccine (MCV4), Menactra, was licensed in the U.S. in 2005 by Sanofi Pasteur; Menveo, was licensed in 2010 by Novartis. Both MCV4 vaccines have been approved by the Food and Drug Administration (FDA) for people 2 through 55 years of age. In April 2011, Menactra received FDA approval for use in children as young as 9 months, although the Centers for Disease Control and Prevention (CDC) has not made recommendations for or against it's use in children less than 2. [2]

Meningococcal polysaccharide vaccine (MPSV4), Menomune, has been available since the 1970s. It may be used if MCV4 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.[3]

Limitations

The duration of immunity mediated by Menomune (MPSV4) is three years or less in children aged under 5 because it does not generate memory T cells.[4][5] Attempting to overcome this problem by repeated immunization results in a diminished not increased antibody response, so boosters are not recommended with this vaccine.[6][7] As with all polysaccharide vaccines, Menomune does not produce mucosal immunity, so people can still become colonised with virulent strains of meningococcus, and no herd immunity can develop.[8][9] For this reason, Menomune is suitable for travelers 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 a diphtheria-toxoid polysaccharide–protein complex, resulting in anticipated enhanced duration of protection, increased immunity with booster vaccinations, and effective herd immunity.

Endurance

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% has passive protection after receiving MSPV-4 (31% protective compared with controls).[10] 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.[11] [12]

Serogroup A

Main article: MenAfriVac

In June 2011 the media widely reported that a vaccine called MenAfriVac had been developed through a program called the Meningitis Vaccine Project and that it was a good option for preventing meningitis group A infections.

Serogroup B

A vaccine for serogroup B was developed in Cuba in response to a large outbreak of meningitis B during the 1980s. The VA-MENGOC-BC vaccine proved safe and effective in randomized double-blind studies[13][14][15], but it was granted a license only for research purposes in the United States[16] as political differences limited cooperation between the two countries.[17]

Due to a similarly high prevalence of B-serotype meningitis in Norway between 1975 and 1985, Norwegian health authorities developed a vaccine specifically designed for Norwegian children and young adolescents. Clinical trials were discontinued after the vaccine was shown to cover only slightly more than 50% of all cases. 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 were subsequently passed on to Chiron (now a Novartis subsidiary), who developed a similar vaccine, MeNZB, for New Zealand.

Serogroup X

The occurrence of serogroup X was reported in North America, Europe, Australia, and West Africa.[18] Current meningoccocal meningitis vaccine is not known to protect from serogroup X N. meningitidis disease.

See also

References

  1. ^ Mascioni A, Bentley BE, Camarda R; et al. (2008). "Structural basis for the immunogenic properties of the meningococcal vaccine candidate LP2086". J. Biol. Chem. 284 (13): 8738–46. doi:10.1074/jbc.M808831200. PMC 2659232. PMID 19103601. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
  2. ^ April 22, 2011 Approval Letter - Menactra http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm252511.htm
  3. ^ "Menningococcal Vaccines - What You Need to Know" (2008). Center for Disease Control and Prevention. http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-mening.pdf
  4. ^ 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. PMID 2862316. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  5. ^ 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. PMID 411104.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  6. ^ 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/S0264447454-410X(00)00317-0. PMID 11137248. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  7. ^ 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. PMID 10462244. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  8. ^ Hassan-King MK, Wall RA, Greenwood BM. (1988). "Meningococcal carriage, meningococcal disease and vaccination". J Infect. 16 (1): 55–9. doi:10.1016/S0163-4453(88)96117-8. PMID 3130424.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  9. ^ 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. PMID 3184335.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  10. ^ Vu D, Welsch J, Zuno-Mitchell P, Dela Cruz J, Granoff D (2006). "Antibody persistence 3 years after immunization of adolescents with quadrivalent meningococcal conjugate vaccine". J Infect Dis. 193 (6): 821–8. doi:10.1086/500512. PMID 16479517.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  11. ^ "Updated Recommendations for Use of Meningococcal Conjugate Vaccines --- Advisory Committee on Immunization Practices (ACIP), 2010" MMRWJanuary 28, 2011 / 60(03);72-76 available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6003a3.htm
  12. ^ "Updated Recommendation from the Advisory Committee on Immunization Practices (ACIP) for Revaccination of Persons at Prolonged Increased Risk for Meningococcal Disease" MMWR September 25, 2009 / 58(37);1042-1043 available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5837a4.htm
  13. ^ http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=98525
  14. ^ http://cat.inist.fr/?aModele=afficheN&cpsidt=17825211
  15. ^ http://www.finlay.sld.cu/english/products/pregunvamengocbcenglish.htm
  16. ^ "World: Americas Cuba vaccine deal breaks embargo". BBC News. 29 July 1999. Retrieved 25 October 2009.
  17. ^ "Cuban scientist barred from receiving U.S. prize". MSNBC. 12 November 2005. Retrieved 25 October 2009.
  18. ^ Clonal Groupings in Serogroup X Neisseria meningitidis.
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