ACIP: Booster Dose for Meningococcal Vaccines?

ATLANTA — A limited number of studies suggest that immunity following meningococcal vaccination may wane earlier than initially expected, leaving those who are vaccinated at ages 11-12 years vulnerable to the disease at an age when they are at increased risk of contracting the disease, according to information from the Centers for Disease Control and Prevention.

As a result of these findings, a CDC working group on meningococcal disease is developing proposed revisions to the current recommendations, and will likely present its proposals to the CDC's Advisory Committee on Immunization Practices (ACIP) at its October meeting.

Dr. Amanda Cohn of the working group outlined the options currently under consideration to the committee at the June meeting. They are:

▸ Adding a booster dose at age 17 years, either for those who are or those who will be living in college dorms—a group at increased risk of meningococcal disease.

▸ Adding a booster dose for all adolescents.

▸ Moving the first dose closer to the period of risk by shifting the recommended vaccination age from 11-12 years to 14-15 years, for example.

The recommendations initially made for adolescents were made with the assumption that the vaccine would provide protection for 10 years or more. One study, however, showed that at 3 years of follow-up, protective levels of circulating antibody were present in only 35% of nearly 100 children vaccinated at ages 11-18 years. Another study showed that at 5 years, only 54% had protective titers, which was only 12% higher than the proportion in vaccine-naive individuals with naturally occurring protective antibodies, said Dr. Cohn, a medical epidemiologist with the CDC's meningitis and vaccine preventable diseases branch.

“These limited data do not support that children vaccinated at age 11-12 years will maintain protective antibody levels through college,” she said, adding that data coming available in the near future will “not likely change this picture.”

Based on these findings, it appears that the current vaccination program does not meet the CDC's prevention goals for meningococcal disease, Dr. Cohn said.

That is, vaccination of 11- to 12-year-olds at their preteen vaccination visit and vaccination of 13- to 18-year-olds not previously vaccinated, is not likely to provide adequate protection in late adolescence.

Although the program has had early success in terms of improving vaccination coverage and reducing disease burden, the working group feels compelled to address the matter of waning immunity, Dr. Cohn told ACIP.

When asked to weigh in on the pros and cons of adding a booster dose or moving back the recommended age for vaccination, ACIP members urged the working group to consider how any changes might affect other adolescent vaccination needs and recommendations to ensure overall vaccination goals are not adversely affected. Concerns also were raised about insurance coverage for vaccination, which might end for some individuals at the age of 18.

Disclosures: Dr. Cohn said she had no conflicts of interest to disclose.

ATLANTA — A limited number of studies suggest that immunity following meningococcal vaccination may wane earlier than initially expected, leaving those who are vaccinated at ages 11-12 years vulnerable to the disease at an age when they are at increased risk of contracting the disease, according to information from the Centers for Disease Control and Prevention.

As a result of these findings, a CDC working group on meningococcal disease is developing proposed revisions to the current recommendations, and will likely present its proposals to the CDC's Advisory Committee on Immunization Practices (ACIP) at its October meeting.

Dr. Amanda Cohn of the working group outlined the options currently under consideration to the committee at the June meeting. They are:

▸ Adding a booster dose at age 17 years, either for those who are or those who will be living in college dorms—a group at increased risk of meningococcal disease.

▸ Adding a booster dose for all adolescents.

▸ Moving the first dose closer to the period of risk by shifting the recommended vaccination age from 11-12 years to 14-15 years, for example.

The recommendations initially made for adolescents were made with the assumption that the vaccine would provide protection for 10 years or more. One study, however, showed that at 3 years of follow-up, protective levels of circulating antibody were present in only 35% of nearly 100 children vaccinated at ages 11-18 years. Another study showed that at 5 years, only 54% had protective titers, which was only 12% higher than the proportion in vaccine-naive individuals with naturally occurring protective antibodies, said Dr. Cohn, a medical epidemiologist with the CDC's meningitis and vaccine preventable diseases branch.

“These limited data do not support that children vaccinated at age 11-12 years will maintain protective antibody levels through college,” she said, adding that data coming available in the near future will “not likely change this picture.”

Based on these findings, it appears that the current vaccination program does not meet the CDC's prevention goals for meningococcal disease, Dr. Cohn said.

That is, vaccination of 11- to 12-year-olds at their preteen vaccination visit and vaccination of 13- to 18-year-olds not previously vaccinated, is not likely to provide adequate protection in late adolescence.

Although the program has had early success in terms of improving vaccination coverage and reducing disease burden, the working group feels compelled to address the matter of waning immunity, Dr. Cohn told ACIP.

When asked to weigh in on the pros and cons of adding a booster dose or moving back the recommended age for vaccination, ACIP members urged the working group to consider how any changes might affect other adolescent vaccination needs and recommendations to ensure overall vaccination goals are not adversely affected. Concerns also were raised about insurance coverage for vaccination, which might end for some individuals at the age of 18.

Disclosures: Dr. Cohn said she had no conflicts of interest to disclose.

ATLANTA — A limited number of studies suggest that immunity following meningococcal vaccination may wane earlier than initially expected, leaving those who are vaccinated at ages 11-12 years vulnerable to the disease at an age when they are at increased risk of contracting the disease, according to information from the Centers for Disease Control and Prevention.

As a result of these findings, a CDC working group on meningococcal disease is developing proposed revisions to the current recommendations, and will likely present its proposals to the CDC's Advisory Committee on Immunization Practices (ACIP) at its October meeting.

Dr. Amanda Cohn of the working group outlined the options currently under consideration to the committee at the June meeting. They are:

▸ Adding a booster dose at age 17 years, either for those who are or those who will be living in college dorms—a group at increased risk of meningococcal disease.

▸ Adding a booster dose for all adolescents.

▸ Moving the first dose closer to the period of risk by shifting the recommended vaccination age from 11-12 years to 14-15 years, for example.

The recommendations initially made for adolescents were made with the assumption that the vaccine would provide protection for 10 years or more. One study, however, showed that at 3 years of follow-up, protective levels of circulating antibody were present in only 35% of nearly 100 children vaccinated at ages 11-18 years. Another study showed that at 5 years, only 54% had protective titers, which was only 12% higher than the proportion in vaccine-naive individuals with naturally occurring protective antibodies, said Dr. Cohn, a medical epidemiologist with the CDC's meningitis and vaccine preventable diseases branch.

“These limited data do not support that children vaccinated at age 11-12 years will maintain protective antibody levels through college,” she said, adding that data coming available in the near future will “not likely change this picture.”

Based on these findings, it appears that the current vaccination program does not meet the CDC's prevention goals for meningococcal disease, Dr. Cohn said.

That is, vaccination of 11- to 12-year-olds at their preteen vaccination visit and vaccination of 13- to 18-year-olds not previously vaccinated, is not likely to provide adequate protection in late adolescence.

Although the program has had early success in terms of improving vaccination coverage and reducing disease burden, the working group feels compelled to address the matter of waning immunity, Dr. Cohn told ACIP.

When asked to weigh in on the pros and cons of adding a booster dose or moving back the recommended age for vaccination, ACIP members urged the working group to consider how any changes might affect other adolescent vaccination needs and recommendations to ensure overall vaccination goals are not adversely affected. Concerns also were raised about insurance coverage for vaccination, which might end for some individuals at the age of 18.

Disclosures: Dr. Cohn said she had no conflicts of interest to disclose.