Since the publication of the 2006 Canadian Immunization Guide:
For additional information, refer to the National Advisory Committee on Immunization (NACI) Statement/Update on the Use of Quadrivalent Conjugate Meningococcal Vaccines.
Meningococcal disease is caused by an aerobic encapsulated diplococcus, Neisseria meningitidis (meningococcus). Meningococcal serogroups are classified according to the immunologic reactivity of the polysaccharide capsule. Almost all invasive meningococcal disease (IMD) is associated with serogroups A, B, C, Y, and W-135. Meningococcal serogroups A, B, and C cause the majority of disease worldwide and are responsible for most sporadic cases and outbreaks.
Humans are the only reservoir for N. meningitidis.
Meningococci are transmitted person-to-person by mucosal contact with respiratory droplets from the nose and throat of infected persons. Most people who are colonized with meningococci are asymptomatic carriers. Meningococcal disease is characterized by a short incubation period (2 to 10 days, usually 3 to 4 days).
Risk factors for the development of IMD include: complement, properdin or factor D deficiencies; functional or anatomic asplenia (including sickle cell disease); certain genetic risk factors; household exposure to an infected person; concurrent respiratory tract infection; recent influenza; household crowding; and active and passive smoking. Persons with HIV infection may be at increased risk for meningococcal disease; especially if HIV is congenitally acquired.
Although disease occurs year-round, there is seasonal variation with the majority of cases occurring in the winter-spring period in temperate climates and in the dry season in tropical climates. Most noteworthy is the “meningitis belt” of sub-Saharan Africa where the majority of cases occur from December to June. For further information, refer to the Committee to Advise on Tropical Medicine and Travel (CATMAT) website at: About CATMAT
Spectrum of clinical illness
Invasive meningococcal disease usually presents as an acute febrile illness with rapid onset and features of meningitis or septicemia (meningococcemia), or both, and a characteristic non-blanching petechial or purpuric rash. Symptoms of meningococcal meningitis include intense headache, fever, nausea, vomiting, photophobia and stiff neck. Meningococcemia is characterized by circulatory collapse, haemorrhagic skin rash and a high fatality rate. Overall mortality is approximately 10%, and 10% to 20% of survivors have long term sequelae which include hearing loss, neurologic disabilities, and digit or limb amputations.
Invasive meningococcal disease occurs sporadically worldwide and in focal epidemics. The traditional endemic areas of the world include the savannah areas of sub-Saharan Africa (known as the meningitis belt) extending from Gambia and Senegal in the west to Ethiopia and Western Eritrea in the east. Serogroup A disease predominates in Africa and Asia, while serogroup B disease is predominant in Europe and most of the Americas. Meningococcal disease is also associated with the Hajj, an Islamic pilgrimage to Mecca, Saudi Arabia.
Invasive meningococcal disease is endemic in Canada, but rare. From 1985 to 2010, the overall incidence of IMD ranged between 0.4 to 1.6 cases per 100,000 population (refer to Figure 1). Incidence peaked in 1990 and again in 2001 due to localized outbreaks of serogroup C disease. Immunization campaigns using meningococcal serogroup C polysaccharide and conjugate vaccines were implemented in some regions during outbreaks from 1999 to 2001. Between 2002 and 2007, all Canadian provinces and territories implemented routine vaccination programs at various ages with monovalent meningococcal (serogroup C) conjugate vaccine, and since 2007 some have implemented routine adolescent quadrivalent meningococcal (serogroups A, C, Y, W-135) conjugate vaccination programs.
From 2005 to 2010, an average of 197 cases of IMD was reported annually in Canada, with an average incidence of 0.60 cases per 100,000 population. During this time period, incidence rates were highest among infants less than one year of age (average 7 cases per 100,000), followed by 1 to 4 year olds (1.81), and 15 to 19 year olds (1.18). As seen in Figure 2, the majority of cases with serogroup information from 2005 to 2010 were due to serogroup B (59%), which is not preventable by current vaccines. Serogroup C incidence has fallen dramatically to the extent that in 2010 its incidence fell to a level similar to that of serogroup W-135. Serogroup Y replaced C as the second most frequent serogroup by 2007. Cases caused by other serogroups were rare. The average number of cases caused by serogroups B, C, Y, and W-135 reported annually from 2005 to 2010 were 110, 29, 31, and 11, respectively. From 2005 to 2010, 6.7% of reported cases died. Case fatality ratios differed by serogroup, with serogroup C having the highest at 13% and serogroups B and W-135 having the lowest at around 4%.
Figure 1: Reported cases and incidence (per 100,000) of invasive meningococcal disease in Canada, 1995 to 2010Figure 1 - Footnote *
Figure 2: Incidence of invasive meningococcal disease per 100,000 population in Canada by serogroup and year, 1995 to 2010Figure 2 - Footnote *
Current meningococcal disease outbreak information is available from the World Health Organization (WHO) at: Global Alert and Response (GAR) - Meningococcal disease
Monovalent conjugate meningococcal vaccines (Men-C-C)
Quadrivalent conjugate meningococcal vaccines (Men-C-ACYW-135)
Quadrivalent polysaccharide meningococcal vaccine (Men-P-ACYW-135)
Vaccines against meningococcal serogroup B disease are under development.
For complete prescribing information, consult the product leaflet or information contained within Health Canada’s authorized product monographs available through the Drug Product Database. Refer to Table 1 in General Considerations in Part 1 for a list of all vaccines available for use in Canada and their contents.
A study of Men-C-C vaccine demonstrated effectiveness in infants of 97% within one year of vaccination, decreasing to 68% after 1 year. Longer term vaccine effectiveness requires receipt of a booster dose in the second year of life for those immunized in infancy. Vaccine effectiveness of Menactra® within 3 to 4 years of vaccination in adolescence is 80% to 85%; however, effectiveness wanes over time. There is no efficacy or effectiveness data available for Menveo™. Vaccine effectiveness measured at individual level may under-estimate the impact of the program on meningococcal disease burden in the community due to the additional benefit conferred by herd immunity.
Men-C-C and Men-C-ACYW-135 vaccines are immunogenic in infants and toddlers but those vaccinated in infancy show a waning immune response. Vaccination with conjugate meningococcal vaccine primes the immune system for memory and induces good anamnestic responses; however, anamnestic response may not be sufficient to prevent disease after exposure and circulating antibodies are thought to be essential. In comparison to polysaccharide meningococcal vaccine, conjugate meningococcal vaccines demonstrate greater immunogenicity and induce better immunologic memory. Conjugate meningococcal vaccines do not result in hyporesponsiveness and have been shown to overcome the hyporesponsiveness evident with polysaccharide meningococcal vaccine usage.
Infants may receive Men-C-C vaccine beginning at 2 months of age depending on the provincial/territorial schedule and the incidence of meningococcal serogroup C disease in their jurisdiction. Men-C-C vaccine is recommended for all children at 12 to 23 months of age regardless of any doses given at less than 12 months of age. It is routinely given at 12 months and is recommended in unimmunized children less than 5 years of age. Men-C-C vaccine may be considered for children 5 to 11 years of age if not previously immunized as infants or toddlers.
Either Men-C-C or Men-C-ACYW-135 vaccine (depending on local epidemiology and programmatic considerations) is recommended for adolescents (routinely at 12 years of age) and young adults, even if previously vaccinated as an infant or toddler.
Individuals with increased risk of meningococcal disease because of underlying medical conditions are as follows:
Table 3 outlines the recommended schedule for vaccination of individuals who are at high risk due to underlying medical conditions. For those 1 year of age or older, two doses of Men-C-ACYW-135 vaccine, 8 weeks apart, are recommended.
There is limited evidence on the need for boosters. Based on expert opinion and the evidence to date, a booster dose for individuals in high risk groups is recommended every 3 to 5 years if vaccinated at 6 years of age and younger, and every 5 years for those vaccinated at 7 years of age and older. If a one dose primary series was used, give the second dose at the next available opportunity and then begin the booster doses based on the above intervals after the second dose.
Men-C-ACYW-135 vaccine is recommended for individuals at increased risk of exposure to meningococcal disease as follows:
A booster dose is recommended every 5 years if individuals in these groups remain at ongoing risk (every 3 to 5 years in children vaccinated at 6 years of age or younger). Refer to Travellers or Workers sections for additional information.
Meningococcal vaccine is also recommended for most close contacts of a case of IMD and for outbreak control, if the disease is caused by a serogroup contained in the vaccine. Refer to Post-exposure management and Outbreak control for additional information.
to 23 months of age
Based on available published data in this age group, Menveo™ should be used because it has been found to be safe and immunogenic. Routine meningococcal C conjugate vaccine does not need to be administered in addition to Menveo™.
months to 55 years of age
Either Men-C-ACYW-135 vaccine may be used.
years of age and older
Either Men-C-ACYW-135 vaccine should be considered.
Refer to Schedule for additional information, Table 1 for recommended vaccination for certain travellers and Table 3 for recommended vaccination of high risk individuals with underlying medical conditions.
Children and adults lacking adequate documentation of immunization should be considered unimmunized and started on an immunization schedule appropriate for their age and risk factors. Conjugate meningococcal vaccine, as appropriate for age, may be given regardless of possible previous receipt of the vaccine as adverse events associated with repeated immunization have not been demonstrated. Refer to Immunization of Children and Adults with Inadequate Immunization Records in Part 3 for additional general information.
Conjugate meningococcal vaccines have not been studied in pregnancy; however, there is no theoretical reason to suspect adverse events will occur and, in circumstances in which the benefits outweigh the risks, the use of conjugate meningococcal vaccines in pregnancy may be considered. Inactivated vaccines, such as conjugate meningococcal vaccines, may be administered to women who are breastfeeding. Refer to Immunization in Pregnancy and Breastfeeding in Part 3 for additional general information.
Premature infants in stable clinical condition should be immunized with conjugate meningococcal vaccine at the same chronological age and according to the same schedule as full-term infants. Infants born prematurely (especially those weighing less than 1,500 grams at birth) are at higher risk of apnea and bradycardia following vaccination. Hospitalized premature infants should have continuous cardiac and respiratory monitoring for 48 hours after their first immunization. Refer to Immunization of Infants Born Prematurely in Part 3 for additional general information.
Residents of long-term care facilities should receive meningococcal vaccine as appropriate for their risk factors. Refer to Immunization of Patients in Health Care Institutions in Part 3 for additional general information.
Quadrivalent conjugate meningococcal vaccine is recommended for certain high risk individuals as outlined under High risk groups above. When considering immunization of an immunocompromised person, consultation with the individual’s attending physician may be of assistance in addition to the guidance provided below. For complex cases, referral to a physician with expertise in immunization and/or immunodeficiency is advised.
Persons with complement, properdin, factor D or primary antibody deficiencies should be vaccinated with Men-C-ACYW-135 vaccine. Refer to Table 3 for additional information.
stem cell transplantation (HSCT- autologous or allogeneic)
For children and adults, the effect of any previous meningococcal vaccine will be diminished following HSCT; therefore, HSCT recipients should be vaccinated as per recommendations for the previously unvaccinated based on their age or risk factors for IMD. If routinely indicated based on age or other risk factors, conjugate meningococcal vaccine can be given as early as 6 months after transplantation, unless needed earlier for management of a close contact or outbreak. However, if it is given earlier than 6 months after transplant the response may not be optimal and consideration should be given to repeating the dose at least 6 months after transplant (and at least 8 weeks after the previous dose) if ongoing protection is needed.
Solid organ transplantation
Conjugate meningococcal vaccine (type of vaccine as appropriate for age) is recommended to be given at least two weeks before transplantation if routinely indicated based on age or risk factors for IMD. If not given prior to transplant and routinely indicated based on age or other risk factors, meningococcal vaccine can be given any time after 6 months post-transplant and at least one month after discontinuation of treatment for acute rejection unless needed earlier for management of a close contact or outbreak. However, if it is given earlier than 6 months after transplant or earlier than 1 month after discontinuing treatment for acute rejection, the response may not be optimal and consideration should be given to repeating the dose at least 6 months after transplant and at least 1 month after discontinuing treatment for acute rejection (and at least 8 weeks after the previous dose) if ongoing protection is needed.
Two doses of Men-C-ACYW-135 vaccine should be considered for individuals with HIV infection. Refer to Table 3 for additional information.
Acquired complement deficiency
People with conditions such as paroxysmal nocturnal hemoglobinuria who are receiving the terminal complement inhibitor eculizumab (Soliris™) should receive two doses of Men-C-ACYW-135 vaccine. They must be vaccinated at least two weeks prior to receiving the first dose of eculizumab, if possible, and every 5 years thereafter if they continue to use the drug. Refer to Table 3 for additional information.
Two doses of Men-C-ACYW-135 vaccine are recommended for persons with anatomic or functional asplenia (including sickle cell disease). When elective splenectomy is planned, all recommended vaccines should ideally be completed at least 2 weeks before surgery; if only one dose can be given before surgery, the second dose should be given 8 weeks after the first dose (with a minimum interval of 4 weeks). In the case of an emergency splenectomy, two doses of vaccine should ideally be given beginning 2 weeks after surgery but can be given earlier, before discharge, if the person might not return for vaccination after discharge. Note that persons one year of age and older with asplenia who have not received Men-C-ACYW-135 vaccine should receive two doses administered 8 weeks apart (with a minimum interval of 4 weeks). Periodic booster doses are also recommended.
Refer to Table 3 for vaccination recommendations of high risk individuals due to underlying conditions based on age. Refer to Booster doses and re-immunization for additional information and Immunization of Persons with Chronic Diseases in Part 3 for additional general information.
Travellers going to destinations where risk of meningococcal transmission is high should be vaccinated with Men-C-ACYW-135 vaccine. Men-C-C vaccine alone is not appropriate for protection of travellers as it does not protect against serogroup A, which is endemic in selected regions of the world, or serogroup W-135 disease. Current meningococcal disease outbreak information is available from the WHO at: Global Alert and Response (GAR) - Meningococcal disease.
For travellers 2 months to 10 years of age, Men-C-ACYW-135 vaccine is indicated. For children 2 to 23 months, Menveo™ is recommended based on expert opinion and clinical trial data; however, Menveo™ is not authorized for use in this age group. For children 2 years to 10 years of age, Men-C-C vaccine should already have been administered. If Men-C-C vaccine has not been given previously, it should be administered to children at least 4 weeks after the Men-C-ACYW-135 vaccine. Refer to Table 1 for recommended immunization for travellers to destinations where risk of meningococcal transmission is high.
Refer to the Committee to Advise on Tropical Medicine and Travel (CATMAT) information on assessing a traveller’s need for pre-travel vaccination at: About CATMAT.
Proof of meningococcal immunization may be required by certain countries. For example, Saudi Arabia requires proof of meningococcal immunization for pilgrims to the Hajj in Mecca (refer to Ministry of Hajj - Kingdom of Saudi Arabia). For travel to the Hajj, re-immunization at an interval of less than 5 years from the last dose may be required. Refer to Immunization of Travellers in Part 3 for additional general information.
|2 to 11 months of age||Menveo™Table 1 - Footnote *2||2 or 3 doses given 8 weeks apart (with another dose between 12-23 months of age that is at least 8 weeks from the previous dose)Table 1 - Footnote *3 and booster dosesTable 1 - Footnote *4|
|12 to 23 months of age||Menveo™Table 1 - Footnote *2||2 doses at least 8 weeks apartTable 1 - Footnote *3 and booster dosesTable 1 - Footnote *4|
|24 months of age and olderTable 1 - Footnote *6||Men-C-ACYW-135Table 1 - Footnote *1||1 doseTable 1 - Footnote *5 and booster dosesTable 1 - Footnote *4|
Health care providers who see persons newly arrived in Canada should review the immunization status and update immunization for these individuals. Review of meningococcal vaccination status is particularly important for persons from areas of the world where sickle cell disease is present as persons with sickle cell disease are at risk of serious meningococcal infections. In many countries outside of Canada, conjugate meningococcal vaccines are in limited use. Information on vaccination schedules in other countries can be found on the following website: WHO Vaccine Preventable Diseases Monitoring System. Refer to Immunization of Persons New to Canada in Part 3 for additional general information.
Research, industrial and clinical laboratory personnel who are potentially routinely exposed to N. meningitidis should be offered one dose of Men-C-ACYW-135 vaccine. Re-vaccination is generally recommended every 5 years. Routine infection control precautions should be practiced at all times to minimize the risk of exposure in laboratory workers and post-exposure prophylaxis should be offered after recognized exposures. Refer to Booster doses and re-immunization for additional information.
Health care workers (HCW)
There is no evidence to recommend routine meningococcal immunization of HCW. Nosocomial transmission of IMD is very uncommon. HCW are considered as close contacts only if they have had intensive, unprotected contact (without wearing a mask) with infected patients (e.g., intubating, resuscitating or closely examining the oropharynx). It is recommended that HCW use barrier precautions to avoid direct contact with respiratory secretions of patients with meningococcal disease until the patient has completed 24 hours of effective antibiotic therapy.
Military personnel may be at increased risk when accommodated in close quarters or through deployment to endemic or epidemic countries.
Refer to Immunization of Workers in Part 3 for additional general information.
Contacts of cases
Close contacts of individuals with meningococcal infections have an increased risk of developing IMD; this risk is greatest for household contacts. The increased risk of disease for household contacts persists for up to 1 year after disease in the index case and beyond any protection from antibiotic chemoprophylaxis. In general, this prolonged risk is not seen in contacts who do not have ongoing exposure.
Chemoprophylaxis should be offered to all persons having close contact with a case of IMD from 7 days before onset of symptoms in the case to 24 hours after onset of effective treatment in the case, regardless of their immunization status. Refer to the Public Health Agency of Canada Guidelines for the Prevention and Control of Meningococcal Disease for information about chemoprophylaxis in the management of close contacts of individuals with meningococcal infection.
Vaccination or re-vaccination of certain close contacts should be considered in addition to chemoprophylaxis when the serogroup is vaccine preventable as it may further reduce the risk of subsequent meningococcal disease.
contacts requiring chemoprophylaxis and consideration for immunoprophylaxis
The following individuals (regardless of immunization status) should receive chemoprophylaxis and, if the meningococcal serogroup identified in the case of IMD is vaccine preventable, should also be considered for immunoprophylaxis:
Refer to Table 2 for specific recommendations for immunoprophylaxis of close contacts of IMD cases according to the serogroup in the index case and the age and underlying conditions of the contact.
Re-vaccination criteria for those previously vaccinated against IMD
The following provides criteria for the re-vaccination of previously vaccinated close contacts when the index case has a vaccine preventable IMD serogroup or there is a vaccine preventable outbreak of IMD:
contacts requiring chemoprophylaxis only
The following individuals should receive chemoprophylaxis only, immunoprophylaxis is not necessary:
Outbreaks of meningococcal disease
Consultation with public health officials and/or experts in communicable disease is important in the assessment and control of meningococcal disease outbreaks. Outbreaks may be controlled by the use of a conjugate meningococcal vaccine. The type of vaccine to use in an outbreak is dependent on the serogroup causing the outbreak and the age of those being vaccinated as outlined in Table 2. Re-vaccination criteria of previously vaccinated individuals are outlined above in Re-vaccination criteria for those previously vaccinated against IMD.
Close contacts and outbreak control of serogroup C invasive meningococcal disease
2 months to less than 12 months of age
Men-C-CTable 2 - Footnote *1
Unvaccinated: 1 dose immediately after exposure then complete the routine series of Men-C-C
Previously vaccinated: If previously vaccinated then re-vaccinate with Men-C-C if at least 4 weeks since last dose, then complete the routine series of Men-C-C if necessary
12 months – 10 years of age
Men-C-CTable 2 - Footnote *1
Unvaccinated: 1 dose immediately after exposure
Previously vaccinated: If previously vaccinated at less than 1 year of age OR person is at high risk for IMD due to underlying medical conditionsTable 2 - Footnote *2, then re-vaccinate with one dose of Men-C-C if at least 4 weeks since last dose; otherwise re-vaccinate if at least 1 year since last dose
11 years of age and older
Men-C-CTable 2 - Footnote *1
Men-C-ACYW-135Table 2 - Footnote *3
Unvaccinated: 1 dose immediately after exposure
Previously vaccinated: If previously vaccinated at less than 1 year of age OR person is at high risk for IMD due to underlying medical conditionsTable 2 - Footnote *2, then re-vaccinate with one dose of vaccine of choice if at least 4 weeks since last dose; otherwise re-vaccinate if at least 1 year since last dose
Close contacts and outbreak control of serogroup A, Y, or W-135 invasive meningococcal disease
2 months to less than 12 months of age
Menveo™Table 2 - Footnote *4
Unvaccinated: 2 or 3 doses given 8 weeks apart with another dose between 12 and 23 months and at least 8 weeks from the previous dose
12 to 23 months of age
Menveo™Table 2 - Footnote *4
Unvaccinated: 2 doses at least 8 weeks apart
2 years and older
Men-C-ACYW-135Table 2 - Footnote *3
Unvaccinated: 1 dose immediately after exposureTable 2 - Footnote *6
Each dose of meningococcal vaccine is 0.5 mL.
Route of administration
Conjugate meningococcal vaccine should be administered intramuscularly (IM). Refer to Vaccine Administration Practices in Part 1 for additional information.
Recommended meningococcal immunization schedules and products vary across provinces/territories depending upon the epidemiology of meningococcal disease in the jurisdiction and other programmatic factors.
Healthy infants and children (2 to 23 months of age)
The manufacturer-recommended infant schedule varies with the Men-C-C vaccine used. For routine infant immunization, three doses of Menjugate® may be administered separated by at least 4 weeks, from 2 months of age. Two doses of NeisVac-C® or Meningitec® may be administered at least 2 months apart, from 2 months of age. If Men-C-C vaccine is given to infants less than 12 months of age, a booster dose should be given between 12 to 23 months of age. If the booster dose is missed, it can be given at the next vaccination opportunity.
Healthy children, adolescents and young adults
One dose of Men-C-C vaccine is recommended for previously unimmunized children 12 months to less than 5 years of age and may be considered for children 5 to 11 years of age. In addition to routine Men-C-C vaccine for infants and young children, adolescents and young adults (12 to 24 years of age) should receive one dose of either Men-C-C or Men-C-ACYW-135 vaccine, based on local epidemiology and programmatic considerations, with around 12 years being the preferred age for the routine dose
High risk individuals due to underlying medical conditions
High risk individuals are those with underlying conditions that make them more likely to develop IMD. Schedule options for high risk individuals who have not previously received a quadrivalent conjugate meningococcal vaccine are included in Table 3. As noted in Table 3, previously unimmunized high risk persons 12 months of age and older should receive a two dose primary series administered 8 weeks apart (with a minimum interval of 4 weeks).
|2 to 11 months of age||Menveo™Table 3 - Footnote *3||2 or 3 doses given 8 weeks apart (with another dose between 12-23 months of age that is at least 8 weeks from the previous dose)Table 3 - Footnote *4 and booster dosesTable 3 - Footnote *5|
|12 to 23 months of age||Menveo™Table 3 - Footnote *3||2 doses at least 8 weeks apartTable 3 - Footnote *4 and booster dosesTable 3 - Footnote *5|
|24 months to 55 years of age||Men-C-ACYW-135||2 doses 8 weeks apartTable 3 - Footnote *4and booster dosesTable 3 - Footnote *5|
|56 years of age and older||Men-C-ACYW-135Table 3 - Footnote *6||2 doses 8 weeks apartTable 3 - Footnote *4 and booster dosesTable 3 - Footnote *5|
Circulating antibodies are considered necessary to protect an individual against IMD. Re-vaccination is recommended as follows:
People previously vaccinated with a polysaccharide meningococcal vaccine should be re-vaccinated with the appropriate conjugate meningococcal vaccine if they remain at ongoing risk for meningococcal disease, with at least a 6 month interval following vaccination with polysaccharide meningococcal vaccine.
Serologic testing is not recommended before or after receiving meningococcal vaccine.
Menactra®, Meningitec®, NeisVac-C®: Store in a refrigerator at +2ºC to +8ºC. Do not freeze.
Menjugate®, Menveo™: Store in a refrigerator at +2ºC to +8ºC. Do not freeze. Protect from light.
Refer to Storage and Handling of Immunizing Agents in Part 1 for additional general information.
Men-C-C vaccine may be administered concomitantly with routine childhood vaccines and Men-C-ACYW-135 vaccine may be administered concomitantly with adolescent and adult age appropriate vaccines at different injection sites using separate needles and syringes.
Menveo™ can be administered with routine paediatric vaccines; however, further studies are needed with regard to concomitant administration with pneumococcal 13-valent conjugate vaccine. Co-administration of Menveo™ and combined tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) may result in a lower immune response to the pertussis antigens than when Tdap vaccine is given alone; however, the clinical significance of this is unknown. Tdap vaccine given one month after Menveo™ induces the strongest immunologic response to pertussis antigens. Refer to Timing of Vaccine Administration in Part 1 for additional general information.
Refer to Vaccine Safety and Adverse Events Following Immunization Part 2 for additional general information.
Injection site reactions occur in up to 59% of vaccinees. Fever is reported in up to 5% of recipients and systemic reactions, such as headache and malaise, are reported in up to 60% of recipients.
Mild reactions, including injection site reactions (redness, tenderness, and swelling), occur in up to 50% of vaccinees. Irritability occurs in up to 80% of infants and fever in up to 9% when other vaccines were administered. Headaches and malaise occur in up to 10% of older children and adults. These reactions last no more than a few days.
Serious adverse events are rare following immunization and, in most cases, data are insufficient to determine a causal association. A concern regarding Guillain Barre Syndrome (GBS) following Menactra® was raised because of case reports to the United States Vaccine Adverse Event Reporting System (VAERS). Subsequently, two large epidemiologic studies were conducted. No cases of GBS were observed during the six weeks following over 2.2 million doses given to individuals aged 11 to 21 years. This evidence supports the conclusion that there is no increased risk of GBS following Menactra®.
Vaccine providers are asked to report, through local public health officials, any serious or unexpected adverse event felt to be temporally related to vaccination. An unexpected AEFI is an event that is not listed in available product information but may be due to the immunization, or a change in the frequency of a known AEFI. Refer to Box 1 in Vaccine Safety in Part 2 and Reporting Adverse Events Following Immunization (AEFI) in Canada for additional information about AEFI reporting.
Meningococcal vaccine is contraindicated in persons with a history of anaphylaxis after previous administration of the vaccine and in persons with proven immediate or anaphylactic hypersensitivity to any component of the vaccine or its container. Refer to Table 1 in General Considerations in Part 1 for lists of all vaccines available for use in Canada and their contents. For meningococcal vaccines, potential allergens include:
There are very few individuals who cannot receive meningococcal vaccines. In situations of suspected hypersensitivity or non-anaphylactic allergy to vaccine components, investigation is indicated which may involve immunization in a controlled setting. Consultation with an allergist is advised. Menomune® may be considered in the rare circumstance that someone is allergic to components (other than latex) in the conjugate meningococcal vaccines.
Administration of meningococcal vaccine should be postponed in persons with moderate or severe acute illness. Persons with minor acute illness (with or without fever) may be vaccinated.
Refer to General Contraindications and Precautions in Part 2 for additional general information.
There are no published data regarding the interchangeability of Men-C-C vaccines, but the vaccines have been safely interchanged without a noticeable decrease in efficacy. When possible, the infant series should be completed with the same vaccine. Either Men-C-ACYW-135 vaccine may be used for re-vaccination, regardless of which meningococcal vaccine was used for initial vaccination. Refer to Principles of Vaccine Interchangeability in Part 1 for additional general information.