Meningococcal Vaccination

Meningococcal vaccination is a standard vaccination (regular vaccination) performed by means of an inactivated vaccine. Vaccination is possible against meningococci of serogroups A (MenA vaccine), B (MenB vaccine; quadvalent vaccine: first available since 12/2013), C, W135, and Y subgroups, which have been defined according to differences in the capsule surrounding the bacterium. Two vaccines against meningococcal serogroup B are licensed in Germany: Bexsero is licensed for persons 2 months of age and older, and Trumenba is licensed for persons 10 years of age and older. The bacterium Neisseria meningitidis – colloquially known as meningococcus – is responsible for many cases of meningitis (meningitis) or pneumonia (pneumonia) in otherwise healthy individuals, and can also lead to meningococcal sepsis (blood poisoning). The following are the recommendations of the Standing Commission on Vaccination (STIKO) at the Robert Koch Institute on meningococcal vaccination:

Indications (areas of application)

  • I: Vaccination with 4valent ACWY conjugate vaccine and a MenB vaccine (meningococcal serogroup B)Health-compromised individuals with congenital or acquired immunodeficiency or suppression with residual T and/or B cell function, especially:
    • Complement/properdeficiency,
    • Eculizumab therapy (monoclonal antibody against terminal complement component C5),
    • Hypogammaglobulinemia,
    • Functional or anatomic asplenia (absence of the spleen).

    In outbreaks or regional clusters on the recommendation of health authorities (vaccination as recommended by the health authority).

  • B: Vaccination with 4-valent ACWY conjugate vaccine and a MenB vaccine (meningococcal serogroup B)Laboratory personnel at risk (when working with the risk of N. meningitidis-containing aerosol).
  • R: Vaccination with 4valent ACWY conjugate vaccine Travelers to countries with epidemic/hyperendemic occurrence, especially in close contact with the local population (e.g., development workers, disaster relief workers, medical personnel, during long-term stays); this also applies to stays in regions with disease outbreaks and vaccination recommendation for the local population (follow WHO and country notes). Before pilgrimage to Mecca (Hajj, Umrah). Pupils / students before long-term stays in countries with recommended general vaccination for adolescents or selective vaccination for pupils / students.

Legend

  • I: Indication vaccinations for risk groups with individual (not occupational) increased risk of exposure, disease or complications and for the protection of third parties.
  • B: Vaccinations due to an increased occupational risk, e.g., after risk assessment in accordance with the Occupational Health and Safety Act / Biological Substances Ordinance / Ordinance on Occupational Medical Precautions (ArbMedVV) and / or for the protection of third parties in the context of occupational activities.
  • R: Vaccinations due to travel

Contraindications

  • Persons with acute diseases requiring treatment.
  • Individuals who showed intolerance to a previous vaccination with the vaccine in question
  • Allergy to vaccine components (see manufacturer’s supplements).

Implementation

  • For children in the first year of life, vaccination with meningococcal polysaccharide vaccine is given when serogroup A is present:
    • From the third month bivalent (A, C polysaccharide).
    • From the sixth month tetravalent (A-, C-, W135-, Y-polysaccharide).
  • Missing vaccination should be made up to the 18th birthday.
  • Vaccination against meningococcal serogroup B: two injections; the second injection is 6 months after the first injection.
  • Vaccination against meningococcal serogroup C (meningococcal C conjugate vaccine) [standard vaccination] for all children 12 months of age.
    • Basic immunization: from the age of 12 months.
    • Repeat vaccination: 2-17 years of age.

Effectiveness

  • Reliable efficacy
  • Vaccine protection from 2-3 weeks after vaccination with envelope polysaccharides of serogroups A, C (bivalent) and serogroups A, C, W 135, Y (tetravalent). Duration of vaccination protection here 3-5 years
  • Vaccine protection within one month after vaccination with oligosaccharides of serogroup C (monovalent), serogroups A, C, W 135, Y (tetravalent), serogroup B. Duration of vaccination protection here 4 years with 90% certainty, vaccination protection for 10 years likely.

Possible side effects / vaccination reactions

Possible side effects of Bexsero (4CMenB) and Trumenba (MenB-fHbp). (Data taken from the product information):

  • Infants and children (up to 10 years of age).
    • Gastrointestinal tract diseases (gastrointestinal tract)Very common: diarrhea, vomiting (occasionally after booster vaccination).
    • Metabolic and nutritional disordersVery common: eating disorders.
    • General disorders and administration site complaintsVery common: fever (≥ 38 °C), injection site tenderness (including significant injection site tenderness defined as crying/crying when the inoculated limb is moved), injection site erythema (redness), injection site swelling, injection site induration, irritability Occasional: fever (≥ 40 °C).
  • Adolescents (11 years and older) and adults
    • Gastrointestinal tract disorders Very common: nausea, vomitingVery common: chills, fatigue, injection site pain (including significant injection site pain, defined as inability to perform daily activities), injection site swelling, injection site induration, injection site erythema (areal redness of the skin), malaiseFrequent: fever (≥ 38 °C)