Meningococcal Groups C and Y and Haemophilus b Conjugate Vaccine
Approximately 1,000 to 3,000 cases of meningococcal disease are diagnosed each year in the United States. Of the 13 indentified meningococcal serogroups, only six (A, B, C, W, X, and Y) are known to produce invasive disease. Over the past decade, serogroups B, C, and Y have predominated in the United States. Although there is still not a vaccine for serogroup B, vaccines against serogroups A, C, W-135, and Y have been part of the routine adolescent immunization series since 1981.
While the immunization of adolescents has had a significant impact on the incidence of meningococcal disease, until recently there have been no options for protecting the patients at highest risk for infection, children younger than 1 year of age. Over a 10-year period from 1998 to 2007, the incidence of meningococcal disease in infants was 5.38 cases per 100,000 population in the United States. In comparison, the incidence in adolescents and young adults (15–24 years of age) was only 0.78 per 100,000 population. Among the infants in this collaborative surveillance study, serogroup B was responsible for the greatest number of cases, 3.08 cases per 100,000 population, followed by serogroups C and Y, with 0.53 and 1.50 cases per 100,000 population respectively. The peak age of meningococcal infection has been suggested to be at 0–3 months for serogroup B, 4–5 months for serogroup C and 0–7 months for serogroup Y.
Invasive meningococcal disease is associated with significant morbidity and mortality in infants and young children. In a recent analysis using 2009 data, the adjusted mean length of stay for children with invasive meningococcal disease was 9 days with a cost per admission of $36,454. The mortality rate among the infants in the analysis who developed meningococcal sepsis was 11.6%.
The introduction of meningococcal conjugate vaccines, MenACWY-D (Menactra®) in 2005 and MenACWY-CRM (Menveo®) in 2010, was an important step in the development of vaccines that could provide effective seroconversion in infants and toddlers. While MenACWY-D is currently only approved by the Food and Drug Administration (FDA) for use in infants 9 months of age and older and MenACWY-CRM for patients 2 years of age and older, these vaccines have the potential to be of benefit in younger infants.
On June 14, 2012, the FDA approved the first combination meningococcal vaccine for use in infants and children from 6 weeks to 18 months of age. The Haemophilus influenzae type b (Hib) and meningococcal groups C and Y conjugate vaccine (HibMenCY-TT) is intended to be administered in a 4-dose series to be given at 2, 4, 6, and 12–15 months age. The Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (ACIP) is expected to consider the inclusion of the HibMenCY-TT vaccine into the recommended childhood immunization schedule at their February 2013 meeting.
Abstract and Introduction
Introduction
Approximately 1,000 to 3,000 cases of meningococcal disease are diagnosed each year in the United States. Of the 13 indentified meningococcal serogroups, only six (A, B, C, W, X, and Y) are known to produce invasive disease. Over the past decade, serogroups B, C, and Y have predominated in the United States. Although there is still not a vaccine for serogroup B, vaccines against serogroups A, C, W-135, and Y have been part of the routine adolescent immunization series since 1981.
While the immunization of adolescents has had a significant impact on the incidence of meningococcal disease, until recently there have been no options for protecting the patients at highest risk for infection, children younger than 1 year of age. Over a 10-year period from 1998 to 2007, the incidence of meningococcal disease in infants was 5.38 cases per 100,000 population in the United States. In comparison, the incidence in adolescents and young adults (15–24 years of age) was only 0.78 per 100,000 population. Among the infants in this collaborative surveillance study, serogroup B was responsible for the greatest number of cases, 3.08 cases per 100,000 population, followed by serogroups C and Y, with 0.53 and 1.50 cases per 100,000 population respectively. The peak age of meningococcal infection has been suggested to be at 0–3 months for serogroup B, 4–5 months for serogroup C and 0–7 months for serogroup Y.
Invasive meningococcal disease is associated with significant morbidity and mortality in infants and young children. In a recent analysis using 2009 data, the adjusted mean length of stay for children with invasive meningococcal disease was 9 days with a cost per admission of $36,454. The mortality rate among the infants in the analysis who developed meningococcal sepsis was 11.6%.
The introduction of meningococcal conjugate vaccines, MenACWY-D (Menactra®) in 2005 and MenACWY-CRM (Menveo®) in 2010, was an important step in the development of vaccines that could provide effective seroconversion in infants and toddlers. While MenACWY-D is currently only approved by the Food and Drug Administration (FDA) for use in infants 9 months of age and older and MenACWY-CRM for patients 2 years of age and older, these vaccines have the potential to be of benefit in younger infants.
On June 14, 2012, the FDA approved the first combination meningococcal vaccine for use in infants and children from 6 weeks to 18 months of age. The Haemophilus influenzae type b (Hib) and meningococcal groups C and Y conjugate vaccine (HibMenCY-TT) is intended to be administered in a 4-dose series to be given at 2, 4, 6, and 12–15 months age. The Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (ACIP) is expected to consider the inclusion of the HibMenCY-TT vaccine into the recommended childhood immunization schedule at their February 2013 meeting.
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