Two types of Meningococcal vaccines are licensed for use in India. It is an optional vaccine and is not routinely recommended in India.
1) Capsular polysaccharide vaccines
Internationally available Meningococcal polysaccharide vaccines are based on purified, lyophilized and heat-stable capsular polysaccharides from Meningococci of the respective serogroup. Polysaccharide vaccines are used for persons above 2 years only, as they are not efficient to induce immunity in infants and toddlers below 2 years. Adults above 56 years should receive the polysaccharide vaccines only. Polysaccharide vaccines are used satisfactorily for mass immunization during outbreaks.
Currently available licensed Meningococcal polysaccharide vaccines are:
- Bivalent against serogroups A and C
- Trivalent against serogroup A, C and W135
- Quadrivalent against serogroup A, C, Y and W135
2) Conjugate vaccines
Conjugate vaccines are made by conjugating or attaching the Diptheria toxoid or a non-toxic mutant of Diptheria toxin (CRM 197) or a Tetanus toxoid protein to Meningitis serogroup antigens. Conjugate vaccines effectively induces higher and more persistent functional antibody titers against specific meningococcal serogroups than corresponding polysaccharide vaccines. Persons who have previously received a polysaccharide vaccine can be vaccinated with the conjugate vaccine. Conjugate vaccines are preferred over capsular polysaccharide vaccines due to the increased immunogenicity and potential for herd protection.
Currently available licensed Meningococcal conjugate vaccines are:
- Monovalent (A or C) licensed in 2010
- Quadrivalent (A, C, W135, Y) containing diphtheria toxin as carrier protein, licensed in 2005
- Combination vaccine HibMenC (based on Haemophilus influenza type b and Neisseria meningitidis serogroup C antigen conjugated to Tetanus toxoid), licensed in 2007
Recommended dosage and intervals:
Meningococcal polysaccharide vaccines
Bivalent (A, C), trivalent (A, C, W135), and quadrivalent (A, C, W135, Y) formulations of polysaccharide vaccines contain 50 μg of each of the individual polysaccharides. They are given subcutaneously in the deltoid region of the upper arm.
- They are given as a single dose to persons 2 years or older
- One booster dose 3-5 years after the primary dose is given to the people, who are at continued risk of Meningococcal disease, for e.g. Health workers
The Meningococcal polysaccharide vaccine is the recommended vaccine for travelers 56 years and older, as it is immunogenic, or produce an immune response, in older adults. A booster dose is recommended every 5 years if the adult remains at increased risk.
Immunization during outbreaks
Serogroups of Meningococcal bacteria are identified in each outbreak and mass vaccinations are carried out according to the serogroup prevalence.
- Bivalent A, C polysaccharide vaccines are used during serogroup A and C outbreaks in case of the limited supply of conjugate vaccines
- Trivalent A, C, W135 or quadrivalent A, C, W135, Y polysaccharide vaccines are used in case of W135 or Y serogroup outbreaks
- Children less than 2 years of age (2-24 months) are given conjugate vaccines in place of polysaccharide vaccines as PS vaccines are not efficient to produce a sufficient immune response in younger kids and infants
Meningococcal conjugate vaccines
Conjugate vaccines are administered intramuscularly in the deltoid area of the upper arm of adults and in the anterolateral aspect of the thigh in infants less than 1 year of age.
Men A conjugate vaccine
- It is mainly used in the African Meningitis belt since 2010
- It is given as a single dose to persons 1-29 years of age
- PsA-TT (MenAfrivac by serum institute of India) is the Men A conjugate vaccine available in India
Combined Hib plus MenC conjugate (HibMenC) vaccine (2007) MenHibrix®
- The primary series of 3 doses can be administered at 2,4 and 6 months of age
- One booster dose at 12-15 months of age
- Used for routine immunization of infants in some countries after the vaccine was introduced in 2007
- 3 dose series not used by many countries, including India, as not a very cost effective schedule
- Can be safely used for vaccination of young infants suffering from certain medical conditions which bring them under high risk category
- Additional 1 dose of quadrivalent conjugate vaccine is recommended for children who have previously received MenHibrix before traveling to meningococcal endemic areas
Quadrivalent meningococcal conjugate vaccines
Quadrivalent (A, C, W135, Y) Menveo® by Novartis
- The single dose can be given to persons 2-55 years of age
- Menveo can be given to children as young as 2 months till 10 years of age who are suffering from certain medical conditions which bring them under high risk category
- Four doses of Menveo® are recommended for infants who start getting this vaccine at 2 months of age before traveling
- Two doses of Menveo® are recommended for children ages 7 through 23 months of age before traveling
Quadrivalent (ACWY-D) Menactra® by Sanofi Pasteur
- The single dose can be given to persons 2-55 years of age
- Cannot be given to children below 2 years to avoid interference with the immunological response to Pneumococcal Conjugate infant Vaccines (PCV)
# Persons above 55 years of age should not be given conjugate vaccines, but the polysaccharide vaccines only.
# Conjugate vaccines are preferred over polysaccharide vaccines for immunizations in early childhood, as they have the capacity to provide herd protection and increased immunogenicity for children less than 2 years of age.
Side effects of polysaccharide meningococcal vaccines
Mild reactions like pain and redness at the site of injection for 2 days can occur. Less than 5 % of recipients can have a fever. Anaphylactic reactions like urticaria, wheezing and rash is very rare. Neurological reactions may be there in very rare cases. These vaccines are safe for use in pregnant women and immunodeficient individuals. In case of severe allergic reaction to any component of these vaccines, further doses of vaccine should not be given.
Side effects of Meningococcal conjugate vaccines
All meningococcal conjugate vaccines are known to be absolutely safe. No other adverse effects than redness, swelling and pain at the site of injection may occur in 1-2 days. Less commonly, the child may develop a mild fever or remain irritated for a short period.
Is Meningococcal vaccination recommended in India?
Meningococcal vaccines are optional vaccines, but recommended for the infants, young children and adults who are suffering from certain medical conditions. The vaccine becomes mandatory for people in close contact with the diseased person in the event of outbreaks. People traveling to Meningococcal epidemic prone areas need to get vaccinated. It is essential to show documentary proof of meningococcal vaccines administered to the person at least 2 weeks before traveling to Mecca (Saudi Arabia) for Hajj. International travelers to sub-Saharan Africa also require Meningococcal vaccine.
Infants as young as 3 months can be attacked by Meningococcal Meningitis. Children and adolescents are primarily affected by this endemic disease. However, cases in adolescents and young adults rise during the outbreak. An outbreak is defined as the substantial increase in invasive meningococcal disease, than normally expected, in a defined population at that place in that period of time. Outbreaks have happened in the past due to certain risk factors like high population density, tobacco smoke, asplenia, HIV infection and certain genetic factors of hosts predisposing them to a Meningococcal infection.
Parents can decide about meningococcal vaccination of children, according to the certain facts about the disease burden in India. The first outbreak of meningococcal disease was seen in 1883 in Rajasthan. This disease has stayed in every part of India as an endemic disease and major outbreaks have been recorded in 1966 (Delhi 616 cases), 1985 (Delhi, Faridabad, Gurgaon, Rohtak, Ghaziabad, Mathura and Bharatpur etc., 6133 cases with 799 deaths), 1989 (Andhra Pradesh 475 cases and Orissa 2951 cases), 2005 (Delhi and surrounding areas 527 cases), 2008 (Meghalaya 2100 cases), 2009 (Tripura 277 cases). The majority of cases during an outbreak or epidemic have been seen in adolescents and young adults.
Emergence of penicillin and other antibiotic resistant strains of meningococcal bacteria have posed a big challenge to chemical prophylaxis (prevention of disease by giving antibiotics in advance) and treatment of meningococcal cases during outbreaks. Vaccination is a safe bet to protect the young ones from this serious fatal disease. Parents should certainly discuss with the doctor about this vaccine.
Marketed Meningococcal Products
Here is the list of WHO pre-qualified vaccine products available in market. Click on name of the product to know more.