Meningococcal Vaccination Guide PDF

Meningococcus Jennifer Girotto, PharmD, BCPPS, BCIDP   Centers for Disease Control and Prevention. Epidemiology and prevention of vaccine preventable diseases. (The Pink Book) Focus on Chapter 14 Meningococcal Disease Resources  Collins JP...

Meningococcus Jennifer Girotto, PharmD, BCPPS, BCIDP   Centers for Disease Control and Prevention. Epidemiology and prevention of vaccine preventable diseases. (The Pink Book) Focus on Chapter 14 Meningococcal Disease Resources  Collins JP, Crowe SJ, Ortega-Sanchez IR, et al. Use of the Pfizer Pentavalent Meningococcal Vaccine Among Persons Aged ≥10 Years: Recommendations of the Advisory Committee on Immunization Practices ― United States, 2023. MMWR Morb Mortal Wkly Rep 2024;73:345–350. DOI: http://dx.doi.org/10.15585/mmwr.mm7315a4.  Mbaeyi SA, Bozio CH, Duffy J, et al. Meningococcal Vaccination: Recommendations of the Advisory Committee on Immunization Practices, United States, 2020. MMWR Recomm Rep. 2020 Sep 25;69(9):1-41. Objectives For each vaccine preventable disease ◦ Recall the disease epidemiology and characterize pathogenesis of vaccine preventable diseases ◦ Define the categorization of the vaccine (e.g., live, inactivated, subunit, recombinant, mRNA, conjugated vs pure polysaccharide) ◦ Explain mechanism of action of the available vaccine(s) ◦ Identify appropriate vaccines (brand and generic) by age and indication ◦ List the dose, route, and schedule recommended for the vaccine(s) based upon the schedule ◦ Summarize vaccine storage and handling ◦ Name common and severe adverse reactions related to vaccine(s) ◦ Determine if precautions or contraindications to vaccination exist ◦ Evaluate drug-vaccine interactions Create a recommendation for immunizations provided a patient scenario and current Centers for Disease Control and Prevention pediatric and/or adult immunization schedules Meningococcal Disease Pathogenesis - transmission : · Respiratory Bacteria: Neisseria meningitidis ◦ Polysaccharide capsule, 12 important serotypes ◦ Most associated with clinical disease A, B, C, W, X, Y Transmission: respiratory ◦ 50% of patients with bloodstream infection bacteria cross the blood brain barrier causing meningitis Incubation period: 2 – 10 days Seasonality: most common late winter early spring N. meningitidis Clinical Presentations Meningitis Bacteremia Pneumonia Arthritis Otitis media Epiglotitis 0% 20% 40% 60% 80% Meningococcemia ~ 30% of meningococcal disease Clinically presents ◦ High fever ◦ Rash petechial or purpuric ◦ Shock: including hypotension and multi-organ failure ◦ Acute adrenal hemorrhage ◦ Death can occur within hours of symptom onset Meningococcal Meningitis ~70% of patients with meningococcal disease Clinically presents similar to other types of bacterial meningitis Headache, fever, neck stiffness/pain, photophobia, nausea/vomiting, confusion Meningococcal Epidemiology Cases of meningococcal disease in the US per 100,000 population 1st MenACWY MenACWY expanded age and HR Revaccination for HR; booster for adolescents; 2nd MenACWY approved 2 MenB vaccines approved 14-15  Meningococcal Epidemiology US Incidence of meningococcal infection by age and serotype 2009 - 2018 1 o 0.87 man race years in 0.75 0.5 0.38 0.25 0.14 0.15 0.1 0.12 0.1 0.09 0.09 0.07 0.06 0.06 0.03 0.03 0.03 0.02 0.03 0.03 0 - every MenB Storage and Administration Storage: refrigerator temperature between 2°C and 8°C (36°F and 46°F) Administration: 0.5 ml IM MenB Vaccine Adverse Effects Local: Injection site pain, redness, swelling, or induration at the injection site Systemic: Headache, fatigue, myalgia, arthralgia  No > - promancy MenB Vaccine Contraindications and Precautions Contraindications: ◦ Severe allergic reaction to a vaccine component or to a prior dose of vaccine is a contraindication ◦ Note that Bexsero tip-cap contains latex Precautions: ◦ Patients with moderate to severe illness should not be vaccinated until the illness resolves ◦ Pregnancy PENBRAYA MenACWY-TT/ MenB-FHbp (Penbraya) Pentalvalent- covers 5 ◦ Contains a MenACWY polysaccharides individually conjugated to tetanus toxoid and Trumenba component for MenB ◦ Approved 10-25 years, ◦ ACIP CDC Recommended for 10 years+ if both MenACWY & MenB indicated at that visit. If it is used, it is a Trumenba dose for MenB (remember can not interchange Bexsero and Trumenba) ◦ Effectiveness inferred from immunogenicity studies ◦ Dosing: 2 dose (0.5 ml IM) series at times 0 and 6 months. ◦ Storage: Store in the refrigerator between 36°F and 46°F. After reconstitution use immediately or store between 36 °F – 86 °F for up to 4 hours.  Summary of CDC’s MenACWY and MenB Recommendations for Those with High-Risk Conditions Risk group MenACWY vaccine MenB vaccine Persons with complement component Aged ≥2 mos Aged ≥10 yrs deficiency including patients using a complement inhibitor (e.g., eculizumab) Persons with functional or anatomic asplenia Aged ≥2 mos Aged ≥10 yrs (including sickle cell disease) Persons with HIV infection Aged ≥2 mos No recommendation Microbiologists routinely exposed to Neisseria Age appropriate Age appropriate meningitidis Persons exposed during an outbreak of Aged ≥2 mos Aged ≥10 yrs meningococcal disease due to a vaccine- preventable serogroup Persons who travel to or live in countries where Aged ≥2 mos No recommendation meningococcal disease is hyperendemic or epidemic College freshmen living in residence halls Age appropriate No recommendation Military recruits Age appropriate No recommendation https://www.cdc.gov/mmwr/volumes/69/rr/rr6909a1.htm Learning A 1-year-old living with Sickle cell Disease, is here for his 12-month Assessment vaccinations. Which of the vaccines is appropriate to administer? A. Menveo B. Menquadfi C. Bexsero D. Trumenba  A 37-year-old patient who you have not seen in a while tells you she had her spleen removed last month due to an Learning injury. She does not remember Assessment receiving any vaccines in the past year. You call her doctor to confirm. What vaccine(s) should be administered? A. Men ACWY B. Men B C. Men ACWY & MenB D. None, she should have received any needed vaccines before splenectomy Learning How should the MenB vaccine(s) be Assessment stored? A. Room temperature B. Refrigerator C. Freezer Learning What dose and route should the Assessment MenB be administered? A. 1 ml SC B. 0.5 ml SC C. 1 ml IM D. 0.5 ml IM