This MVEC guideline details our recommendations regarding meningococcal vaccines in special risk groups, specifically detailing the optimal schedule in the setting of adolescents who are immunosuppressed.

The epidemiology of invasive meningococcal disease (IMD) is detailed in our MVEC guidelines.[see Resources] One of the main serogroups still circulating is Meningococcal B. Since 2014 there has been an increase in Meningococcal disease type W, noted in Victoria and around Australia. This has led to the announcement of a Victorian state-wide program for MenACWY vaccines to be administered in schools. It is targeting the adolescent age group (15-19 year olds) and is a fully funded program starting in 2017.[see Resources]

This guideline is for patients 13-19 years on immune suppression.[see Table 1]

The immune suppressive medications may be for a number of underlying medical conditions, for example: Inflammatory Bowel Disease (IBD) and Paediatric Rheumatology patients. These patients are at higher risk of invasive infections due to their current immune suppression and as adolescents, should be protected from IMD.

We recommend two vaccines that cover both all of the IMD circulating serogroups (see Table 2). At RCH these vaccine have Drug Utilisation Committee (DUC) approval and funding.

 

Table 1: Immunosuppressive medications

Mechanism of action Examples*
Anti-TNF Etanercept Infliximab Adalimumab
IL-1 inhibition Anakinra
Costimulation blockade Abatacept
B-cell depletion/inhibition Rituximab
Immunomodulators (antimetabolites) Azathioprine  6-Mercaptopurine  Methotrexate
Corticosteroids Prednisone
T-cell activation/inhibition Tacrolimus Cyclosporine

*Note prednisolone doses considered immunosuppressive is >2mg/kg (or 20mg) for 2-weeks, or 1mg/kg for >1-month

 

Table 2: Meningococcal Vaccines

Meningococcal vaccines

 

Brand(s)

 

Dose

Meningococcal ACWY conjugate vaccine

 

Menveo, Menactra, Nimenrix

 

2 doses; 2-months apart
Meningococcal B Bexsero 2-doses; 2-months apart

 

Summary

The changing epidemiology of meningococcal disease has led to this updating of our:

‘Special Risk guidelines: meningococcal vaccines in immune-suppressed adolescents’.

For any clinical queries, please discuss them with your treating doctor. Immunisation queries can also be discussed at the RCH Immunisation Drop-in Centre or the Immunisation Hotline [1300 882 824] (open business hours).

 

Resources

MVEC Meningococcal 

Victorian Program Men ACWY program [2017: 15-19 year olds]

https://www2.health.vic.gov.au/about/news-and-events/news/free-meningococcal-vaccination-program

 

Reviewed by: Nigel Crawford (Paediatrician, The Royal Children’s Hospital, Melbourne)
Date: April 2017
Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.
You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.


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Welcome to MVEC

The Melbourne Vaccine Education Centre (MVEC) is a new web-based initiative, providing up-to-date immunisation information for healthcare professionals, parents and the public.

It is a collaboration between The Royal Children’s Hospital (RCH) and its Melbourne Children’s campus partners (Murdoch Children's Research Institute and The University of Melbourne) and Monash Health.

MVEC aims to address common queries around vaccines and to promote the benefits of immunisation for both children and adults.