Meningitis Vaccine For All Aged 11–18

ATLANTA — The tetravalent meningococcal conjugate vaccine is now recommended for all 11- to 18-year-olds instead of select age groups, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices voted at its June meeting.

The previous recommendations for meningococcal conjugate vaccine, MCV4 (Menactra), administration consisted of three cohorts: 11- to 12-year-olds, adolescents entering high school (or 15-year-olds), and anyone else at increased risk for meningococcal disease, such as incoming college freshman who would live in dormitories.

Dr. Amanda Cohn of the CDC's meningitis and vaccine preventable diseases branch, explained that the rationale for the new recommendations is twofold.

First, simplified recommendations for the use of MCV4 could improve coverage, said Dr. Cohn, who presented the draft of the recommendations at the ACIP meeting. Second, the current and future MCV4 supply is expected to be sufficient to meet the increased vaccine demand that would result from the expanded recommendations.

“We like the idea of a broad target,” said Dr. Jonathan Temte, the American Academy of Family Physicians' liaison to ACIP who is a family physician at the University of Wisconsin, Madison. “The AAFP would be very much in favor of a broader condition like this,” he said during the open discussion period at the meeting.

Because many adolescents don't see a doctor regularly, the expanded recommendations give physicians the freedom to vaccinate their teen patients whenever the opportunity arises.

The opportunity to vaccinate against meningococcal disease as part of any adolescent care visit speaks to the value of a medical home, where a teen's records would show whether he or she had received the MCV4 vaccine, Dr. Temte added in an interview. “The take-home message is to have a medical home and continuity.”

Ideally, the expanded recommendations will increase the number of adolescents who are vaccinated against meningococcal disease, which although rare, is more prevalent in adolescents than in younger children or adults. The newly approved recommendations will be published in an upcoming issue of the CDC's Morbidity and Mortality Weekly Report. In addition, vaccination information can be found at the ACIP Web site: cdc.gov/vaccines/recs/acip.

Some members of the ACIP expressed concern over the increased risk of Guillain-Barré syndrome (GBS) that has been reported in adolescents who received the MCV4 vaccine, but they agreed that the opportunity to prevent meningococcal disease in more teens trumps the limited data that suggest an association between MCV4 and GBS. But individuals with a history of GBS may be at increased risk and should discuss their risk of meningococcal disease with their doctors, Dr. Cohn said in her presentation.

The revised recommendations continue to emphasize that 11- to 12-year-olds should receive the MCV4 vaccination at the 11- to 12-year-old preventive care visit, along with other routine adolescent vaccinations.

“The ACIP goal is routine vaccination of all adolescents beginning at age 11 years,” said Dr. Cohn. She quoted from the draft of the recommendations to add that the ACIP and partner organizations, including the AAP, AAFP, and American Medical Association, recommend a health care visit for all 11- to 12-year-olds to receive recommended immunizations and other preventive medicine services.