American Academy of Pediatrics.doc 2 Kolom
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8/20/2019 American Academy of Pediatrics.doc 2 Kolom
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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