Vaccine Information

Entry last updated: May 27, 2004

- Understanding the Disease
- Available Vaccines
- History of the Vaccine
- Who Should and Should Not Receive the Vaccine
- Dose Schedule
- Effectiveness of the Vaccine
- Known Side Effects
- Related Issues
- Key References and Sources of Additional Information
- State Vaccine Requirements
- Important Facts for Parents to Know
- Frequently Asked Questions
- CDC Vaccine Information Statement

Understanding the Disease

Neisseria meningitidis, or the meningococcus, is a bacterium that can cause a life-threatening infection of the bloodstream, meningitis (infection of the brain and spinal cord coverings), or both. Symptoms may include fever, stiff neck, sore throat, headache, muscle aches, joint pain and swelling, shock, and seizures. Complications may include deafness and other neurologic impairment, and impaired circulation leading to gangrene and amputation of limbs. Death occurs in 10% to 15% of people with meningococcal disease, and is highest in infants and adolescents.

There are approximately 2,600 cases of meningococcal meningitis in the U.S. each year, mostly in children less than five years old. Children younger than two years old have the highest incidence, with a second peak incidence between 15 to 24 years of age. Studies report that first-year college students living in dormitories have an elevated risk for meningococcal disease when compared with other undergraduate students (See Related Issues). Close contacts of a person with meningococcal disease have a higher rate of infection and are at greatest risk in the first week of contact.

Large outbreaks of the disease are rare in the United States, but not in some countries. It is recommended that travelers to certain areas, particularly sub-Saharan Africa during the dry season (December through June) receive the vaccine, especially if close contact with locals is anticipated.

Available Vaccines

Product: Menomune� A/C/Y/W-135
(Meningococcal polysaccharide vaccine, Groups A, C, Y and
W-135 combination)
Manufacturer: Aventis Pasteur
Year licensed: 1981

For information on the thimerosal content in this vaccine, see the Food and Drug Administration at www.fda.gov/cber/vaccine/thimerosal.htm#t3
or Johns Hopkins University's Institute for Vaccine Safety at
www.vaccinesafety.edu/thi-table.htm

History of the Vaccine

In the U.S., meningococcal disease is usually caused by groups A, B, C, Y, and W-135 of the meningococcus bacteria. In 1978, the first meningococcal vaccines were licensed in the United States and were effective against only two of the major groups of meningoccocus. Currently, licensed vaccines provide some protection against all groups except B; there is no licensed vaccine for group B in the U.S.

Originally, the vaccines were developed to control meningococcal disease in the armed forces. All U.S. military recruits are given meningococcal polysaccharide vaccine prior to induction.

Who Should and Should Not Receive this Vaccine

Who should receive the vaccine?

• U.S. military recruits
• People two years of age and older who might be affected during a meningococcal disease outbreak
• Travelers to certain parts of Africa and other locations where meningococcal disease is common
• People with immune system disorders (e.g., spleen has been removed or damaged, disorder known as terminal complement component deficiency, or properdin deficiencies)
• Laboratory personnel who are routinely exposed to the meningococcus
• It is recommended that those who provide medical care to freshmen college students give information to students and their parents about meningococcal disease and the benefits of vaccination, ideally two or more weeks before entering school. Vaccination should be provided or made easily available to those freshmen who wish to reduce their risk of disease, especially to those living in, or planning to live in, dormitories or similar housing arrangements. Other students wishing to reduce their risk of meningococcal disease can also choose to be vaccinated. Some states now require college students to be vaccinated against the meningococcus.
• The vaccine may be given to pregnant women.

Who should not receive the vaccine?

• People who had a serious reaction to a previous dose of the meningoccocal vaccine
• It is not recommended that children routinely receive the meningococcal vaccine because the infection rate among children is low, their immunity is short-lived, and if they receive the vaccine early, subsequent doses of the vaccine may not protect them as well.
• People who are moderately or severely ill should consult with their physician before receiving any vaccine.

Dose Schedule

When indicated, one dose of the vaccine is given to people who are at least two years of age.

For children 3 months to 2 years of age who need the vaccine, 2 doses are given, 3 months apart.

If needed, children may be revaccinated in two to three years if they were first vaccinated before four years of age. Older children and adults may need to be revaccinated in three to five years to continue to be protected against meningococcal disease.

Effectiveness of the Vaccine

In older children and adults, the vaccine is 85% to 100% effective at preventing infection from the strains of the meningococcus used in the vaccine, and protection lasts for at least three years. Children under two years of age respond poorly to the vaccine.

Known Side Effects

More than half of those immunized experience no adverse reactions. Mild reactions are experienced by up to 40% of those immunized and include pain and redness at the site of injection. Also, recipients may develop a fever after immunization.

In very rare cases (far less than 1 person out of 10,000 shots given), a more serious reaction, such as paresthesia (a burning, prickling, or sensation of numbness), or an allergic response that can cause difficulty breathing, can occur.

Related Issues

Studies report that first-year college students who live in dormitories have an elevated risk of meningococcal disease. One study found that among 18 to 23-year-olds who did not attend college, there were 1.4 cases of meningitis per 100,000 people; however, only half as many cases occurred among undergraduate students. Despite the overall low rate of meningococcal disease in college, freshmen living in dormitories had a much higher rate of the disease when compared with other students, 5.4 cases per 100,000. In addition, 68% of these freshmen cases were due to vaccine-preventable groups of the meningococcus (Bruce et al. 2001).

Maryland was the first state to require all college students residing in on-campus housing to receive the meningococcal vaccine. Similar laws that require all incoming full-time college students to be immunized against the meningococcus have been passed in Virginia, Connecticut, New York, Oklahoma, Pennsylvania, Delaware, Georgia and Florida.

States that require colleges and universities to provide either information or vaccinations for meningitis are California, Texas, Minnesota, Illinois, Indiana, Arkansas,�Mississippi, Nebraska,�North Carolina, South Carolina, Tennessee, Washington, New�Jersey, Rhode Island�and Wisconsin.

Key References and Sources of Additional Information

• American Academy of Pediatrics, Committee on Infectious Diseases. (2003). Meningococcal infections. In LK Pickering (Ed.), Red Book: Report of the Committee on Infectious Diseases (26th ed., pp. 430-436). Elk Grove Village, IL: Author.
• American College Health Association. (2000). Recommendations on meningococcal vaccination from ACHA, CDC, and AAP. 
• Bruce MG, Rosenstein NE, Capparella JM, Shutt KA, Perkins BA, and Collins M. (2001). Risk factors for meningococcal disease in college students. JAMA, 286(6), 688-693.
• Centers for Disease Control and Prevention (CDC). (1997). Control and prevention of serogroup C meningococcal disease: Evaluation and management of suspected outbreaks: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report, 46(RR-5), 13-21.
• CDC. (2000). Meningococcal disease and college students: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report, 49(RR-7), 13-20.
• CDC. (2000). Meningococcal vaccine: What you need to know [Vaccine Information Statement (VIS)].
• CDC. (2000). Prevention and control of meningococcal disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report, 49(RR-7), 1-10. 
• Food and Drug Administration, Vaccine Adverse Event Reporting System Working Group. (2001). Safety data on the meningoccocal polysaccharide vaccine from the vaccine adverse event reporting system. Clinical Infectious Diseases, 32(9), 1273-1280.
• Harrison LH. (2000). Preventing meningococcal infections in college students. Clinical Infectious Diseases, 30(4), 648-651.
• Humiston SG and Good C. (2000). Vaccinating your child: Questions and answers for the concerned parent. Atlanta: Peachtree Publishers.
• Offit PA and Bell LM. (1999). Vaccines: What every parent should know (Rev. ed.). New York: IDG Books.
• Plotkin SA and Orenstein WA (Eds.). (2004). Vaccines (4th ed.). Philadelphia: W. B. Saunders.
• Wang VJ, Kupperman N, Malley R, Barnett ED, Meissner HC, Schmidt EV, and Fleisher GR. (2001). Meningoccocal disease among children who live in a large metropolitan area, 1981-1996. Clinical Infectious Diseases, 32(7),1004-1009.

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