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Meningococcal vaccination |
Meningococcal is still in the news and with the recent case close to home, discussions in playgrounds, in the street and over back fences are creating much misinformation and a desire for more facts. You will probably be aware of the fear that many patients are feeling by the amount of answers and reassurance that they are seeking from you. While details of the future vaccination program are still sketchy, there are some definites the public needs to hear.
In August the Health Minister Kay Patterson announced the free national meningococcal vaccination program. Starting early next year, all Australian children aged 12 months and 15 to 17 years will be eligible for free vaccination with a meningococcal group C conjugate vaccine. After the first year, the 12 month and 15 year olds will continue to be eligible: not the 16 and 17 year olds. This program will be maintained for the next 14 years and then it is proposed that only the 12 month vaccination will need to continue. Implementation of this program is estimated to cost $41 million in the first year. The whole press release can be viewed at the website listed at the end of the article.
Many of the logistics of this program have not been finalised at the time of writing this article. The start date has not been published. Two important considerations are the ability to supply the vaccine and the start of the influenza vaccination season: vaccine fridges (and staff) may not be able to cope with the influx of both vaccines and the start of both programs at the same time. The roll out of the teenage component of the program may be instigated through high schools but at this stage, no definite plans have been made in this area. Three drug companies now have type C conjugate vaccines registered in Australia and tenders are being considered as to the supplier/s for the government program.
The three meningococcal group C conjugate vaccines are Menjugate (CSL), Meningitec (Wyeth) and NeisVac-C (Baxter).
Site: The vaccines are given as a deep intramuscular injection into the anterolateral thigh in infants (12 month olds and younger) and into the deltoid for older children, teen and adults.
Dosage: Volume given is 0.5 ml. For patients over 12 months, a single dose is required. For those younger than 12 months and older than 6 weeks, a series of 3 doses is needed not less than 1 month apart.
Storage: The vaccine must be kept between 2 and 8 degrees, away from sunlight. Shelf life is approx 18 to 24 months depending on vaccine.
Efficacy: These vaccines can be given at the same time (different sites) as other vaccines without affecting the efficacy of any of the vaccines. The figures quoted here are derived from the UK Meningococcal C Immunisation Campaign (England, December 2001). The data in Table 1 is courtesy of the Menjugate Product Information sheet, CSL.
The ‘Meningococcal disease and Vaccination’ fact sheet from the Australian DoHA reports a coverage of 92% in toddlers and 97% in teenagers.
Table 1
| Age Groups |
No. of Doses |
Vaccine Efficacy (95% CI) |
| Under 1 year |
3 |
89% (69 - 96) |
| 1 - 2 years |
1 |
87% (69 - 94) |
| 5 - 14 years |
1 |
95% (87 - 97) |
| 15 - 17 years |
1 |
94% (79 - 99)
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Effectiveness: Meningitec had been assessed to produce an effective immunological memory lasting 20 years. (Meningitec information sheet: www.thebabyregistry.co.uk/immun/meningitec.htm )
Side effects: It seems that these vaccines have similar side effects to those already in the childhood immunisation schedule. As the vaccines may be administered at the same time, it will be difficult to differentiate the systemic side effects as to which vaccine may have caused the symptoms. The available literature lists redness, swelling and tenderness or pain at the injection site as common side effects for all ages. Toddlers and infants may also experience fever, crying, irritability, drowsiness, im-paired sleeping, loss of appetite, diarrhoea and vomiting. Table 2 is also to be found in CSL’s patient information leaflet comparing the systemic changes that may occur with Menjugate to the effects that may be experienced with hep B vaccine. The study was conducted in Canada in three centres, monitoring infants for reactions within seven days following immunisation.
Table 2
| Systemic Changes |
MENJUGATE group N=175 |
Hep B Vaccine N=176 |
P Value* |
| Change in eating habits |
68 (39%) |
63 (36%) |
0.55 |
| Sleepiness |
94 (54%) |
98 (56%) |
0.71 |
| Persistent crying |
7 (4%) |
4 (2%) |
0.35 |
| Irritability |
119 (68%) |
124 (70%) |
0.62 |
| Vomiting |
34 (19%) |
69 (22%) |
0.53 |
| Diarrhoea |
49 (28%) |
44 (25%) |
0.52 |
| Rectal temp >38C |
37 (21%) |
47 (27%) |
0.22 |
| Analgesic/antipyretic medication required |
96 (55%) |
105 (60%) |
0.36
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* P Value > 0.05 = non significant difference between the two listed columns of data. As all the P Values are all above 0.05, the difference of the listed side effects between Menjugate and Hep B vaccine is not significant.
Some of the very rare (<0.01%) effects are listed here: lymphadenopathy, anaphylaxis, hypersensitivity reactions including brochospasm, dizziness, convulsions including febrile convulsions, faints, hyptonia, urticaria, purpura, myalgia and arthralgia. Please see product information sheet for complete list of very rare side effects.
Contraindications: include severe acute febrile illness, known hypersensitivity to the components of the vaccine or patients who have shown signs of hypersensitivity after previous administration of this vaccine. If using NeisVac-C, the patients who are hypersensitive to tetanus toxoid should not receive this vaccine.
Benefits of vaccination are the reduction in the number of meningococcal strain C infections. Last year the total number of meningococcal infections in Australia was 679. It is estimated that 32% of cases are strain C (about 217 cases). With every year there has been a small increase in cases of neisseria meningitis. The UK experience post vaccination (since November 1999) has been a dramatic decrease in the number of people contracting the strain C.
Local availability and price
A Lismore pharmacy was kind enough to ring her suppliers to find out the information listed in Table 3. The supply should be the same for all pharmacies in the area where the retail price may vary.
Table 3
| Vaccine |
Company |
Coverage |
Availability |
Cost (retail) |
| Menjugate |
CSL |
C |
Early Oct |
$72.65 |
| NeisVac-C |
Baxter |
C |
Now |
$75.00 |
| Meningitec |
Wyeth |
C |
Mid Sept (but not in stock 25.09.02) |
$72.65 |
| Mencevax |
GSK |
ACWY |
End Sept |
$44.45 |
| Menomune |
CSL |
ACWY |
Mid Oct |
$49.50
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Patient education
One of the fears about the vaccine program that many hold is the thought that once a child has been vaccinated, the parents may believe that the child is immune against all meningitis producing diseases and thus ignore early symptoms. Please ensure that your patients are educated to the early signs and inform them that their child is still at risk of contracting meningitis, particularly where strain B is the most common. Please make use of the excellent patient information material listed below.
Resources and references
For more information about the following:
Meningitec: http://www.wyeth.co.uk/products/prod1.htm
Menjugate: http://www.csl.com.au/
NeisVac-C: A hard copy of the product information can be obtained from the division (Gae) or the public health unit (Marianne).
Free Meningococcal Vaccine Program Press Release: http://www.health.gov.au/mediarel/yr2002/kp/kp02077.htm
Meningitis Foundation: www.meningitis-foundation.org
Fact Sheet: http://www.health.gov.au/pubhlth/strateg/communic/factsheets/mening.htm
Communicable Disease stats: http://www.health.gov.au/pubhlth/cdi/nndss/year022.htm
An excellent patient information brochure can be obtained by ringing the Meningitis Foundation – 02 9960 0051. They can supply other educational tools as well. Large orders may incur a cost. Their help line is 1800 129 068.
A handy fridge magnet detailing symptom and a call line can be obtained from Wyeth – 1800 250 223 (which is also their help line).
This article is in no way to be viewed as a substitute to reading the product information sheets supplied with the vaccine, but aims to give an overview of the different meningococcal conjugate vaccines available.
Gae McDonald is the division’s immunisation project officer.
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