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AMERICAN ACADEMY OF PEDIATRICS

POLICY STATEMENT

Organizational Principles to Guide and Define the Child Health Care System and/or Improve the

Health of All Children

Committee on Infectious Diseases

Prevention and Control of Meningococcal Disease: Recoendations for

!se of Meningococcal "accines in Pediatric Patients

achmadian ir!anda ""#$%##"$%"&

'C() has *een licensed on the *asis of 

safety andshort+term immunogenicity data inadolescents$ Several postmar,eting studies

are planned- including astudy to evaluate theduration of anti*ody responses in

 participants !ho received a single dose of 'C()vaccine or 'PS() vaccine & and "#

years earlier and a study to evaluate safety

and immunogenicity !hen 'C() is givenconcomitantly !ith tetanus to.oid- reduced

diphtheria to.oid- and a cellular pertussis

vaccine$ Ho!ever- vaccine effectiveness andherd immunity *ased on the a*ility of 

'C() to alter transmission patterns cannot

 *e predicted from immunogenicity dataalone$ Information on 'C() effectiveness-duration of protection- and herd+immunity

effects o*tained from 'C() evaluation

studies !ill *e indispensa*le in guiding prevention policies and formulating

recommendations for immunization in other 

age groups$ 'C() and other meningococcalconugate vaccines may *e licensed in the

0nited States in the near future for use in

other age groups- including children% to "#

years of age and infants$ Such vaccines areundergoing clinical trials and are li,ely to *e

more immunogenic in infants and young

children compared !ith 'PS()- !hichcurrently is the only meningococcal vaccine

licensed in the 0nited States for use in

young children$ 1ecause meningococcalserogroup 1 capsular polysaccharide is

 poorly immunogenic in humans- vaccine

development has focused on commonsurface proteins- including the outer 

mem*rane proteins 2O'Ps3 of specificepidemic strains$45 O'P vaccines have

sho!n good efficacy in older children andadults- *ut efficacy in infants and young

children- in !hom rates of disease are

highest- has not *een demonstrated$ Inaddition- the varia*ility in O'P strains

causing endemic disease li,ely !ill limit

their usefulness in the 0nited States$1ecause of the potential limitations of these

vaccines- other ne! approaches to

meningococcal serogroup1 vaccines are *eing pursued$ 6ith the recent se7uencingof the serogroup 1 meningococcal ge+nome-

several ne! genes encoding putative

mem*rane proteins have *een identified-suggesting potential ne! targets for 

serogroup 1 vaccines$ 8he availa*ility of 

ne! meningococcal conugate vaccines as!ell as the pursuit of ne! vaccine strategies

should lead to su*stantial improvements in

control and prevention of meningococcal

disease in the 0nited States and glo*ally$Although the signs and symptoms of I'D

fre7uently are nonspecific- increasing

a!areness of meningococcal disease canresult in people see,ing medical care earlier 

and improved clinical out come$ In addition-

educating adolescents and their parentsa*out the *enefits of receiving 'C() is

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critical to prevention of a su*stantial num*er 

of cases of I'D$ Ho! ever- parents and

adolescents must understand that 'C()!ill not prevent all meningococcal disease-

and at least %&9 of cases in adolescents are

caused *y serogroup 1$" :ducating thegeneral pu*lic a*out the *enefits of *eing

immunized !ith 'C()may foster increased

immunization coverage rates for adolescentsand su*stantially decrease the *urden of 

meningococcal disease in the 0nited States$

RATIONALEFOR MENIN#OCOCCAL

"ACCINERECOMMENDATIONS

'C() offers advantages over 'PS()$

;irst- it demonstrates a 8+cell

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services can *e addressed$ Su*se7uent

annual visits throughout adolescence also

are recommended$4$ :ntering college students !ho plan to live

in dormitories should *e immunized !ith

'C()routinely 2evidence grade II+%3$)$ People at increased ris, of meningococcal

disease should *e immunized !ith 'C() if 

they are at least "" years of age- including adolescents !ho have a terminal

complement deficiency or adolescents !ho

have anatomic or functional a splenia

2evidence grade II+43@ or  adolescents !ho travel to or reside in

countries in !hich  N meningitidis is

hyperendemic or epidemic 2CDC 8ravelers

Health Hotline ?EE+;FI+8IP or online at!!!$cdc$gov/travel3 2evidence grade II+43$

&$ 1ecause people !ith HI( infection areli,ely to *eat higher ris, of meningococcal

disease- although not to the e.tent that they

are at ris, of invasive S pneumoniaeinfection- they may elect to *e immunized

!ith 'C() if they are at least "" years of 

age$

5$ Children % to "# years of age at increasedris, of meningococcal disease 2see

recommendations 4and )3 should *e

immunized !ith 'PS()- *ecause'C() isnot yet licensed for use in these children$

E$ People !ho !ish to decrease their ris, of 

meningococcal disease may elect to receive'C() if they are "" years or older$

?$ ;or control of meningococcal out*rea,s

caused *y vaccine+preventa*le serogroups

2A- C- F- or6+"4&3- 'PS() or 'C()should *e used for people

"" years or older 2evidence grade II+%3$

'C() is preferred- *ut 'PS() isaccepta*le$ ;or children %to "# years of age-

'PS() should *e used$

$ Immunization !ith 'C() may *eindicated for adolescents previously

immunized !ith 'PS()$8hese people

should *e considered for reimmuni+zation 4

to & years after receiving 'PS() if they

remain at increased ris, of meningococcal

disease$

"#$ Pu*lic and private insurers should *eresponsi*le for payment of costs of 'C()-

its administration to adolescents for !hom

'C() is recommended- and administrativecosts involved in providing vaccines to high+

ris, people$

APPENDI$% 0S Preventive Services 8as, 

;orce ating System of uality of Scientific

:vidence4?I :vidence o*tained from at least " properly

designed- randomized- controlled trial

II+" :vidence o*tained from !ell+designedcontrolled trials !ithout randomization

II+% :vidence o*tained from !ell+designed

cohort or case+control analytic studies- preferentially from" center or group

II+4 :vidence o*tained from multiple time

series !ith or !ithout the intervention or dramatic results in uncontrolled e.periments

2such as the results of the introduction of 

 penicillin treatment in the")#s3

III Opinions of respected authorities- *asedon clinical e.perience- descriptive studies-

or reports of e.pert committees