AAP: Meningitis shots recommended for vulnerable children

Dr Brady

For selected infants and children with increased risk for meningococcal disease, there will be a new recommended vaccine in their immunization schedule, according to updated recommendations from the American Academy of Pediatrics (AAP). 

Meningococcal disease can be life-threatening or cause considerable morbidity. 

For younger children, the recommendation for receipt of the meningococcal vaccine is limited to infants and young children who are at increased risk for infection with meningococcus, ie, children with specific immunodeficiencies (eg, complement deficiencies, Properdin deficiency, Factor D deficiency and Factor H deficiency), children without spleens (eg, born without spleens, spleens surgically-removed  or sickle cell disease) and children who will travel to areas with high rates of meningococcal infection (eg, “meningitis belt” in sub-Saharan Africa or the Hajj). 

The AAP Policy Statement on the meningococcal vaccines in 2011 provided recommendations for immunization of adolescents with the meningococcal vaccine and for appropriate intervals for booster doses of meningococcal vaccines in children and adolescents who are at increased risk for meningococcal infections.

The new AAP Policy Statement reiterates the prior recommendations for adolescents and booster doses with some minor modifications.  However, the major update related to recommendations for the 3 vaccines that were recently licensed down into infancy.

“Because the burden of disease that would be prevented in children less than 11 years by receipt of any of the 3 vaccines was low, there is no routine recommendation until age 11 years,” said Michael Brady MD, associate medical director, Nationwide Children’s Hospital, Columbus, Ohio.  “However, the recommendations are designed to target the most vulnerable.”

A modification for booster doses was needed since the interval between doses is shorter in younger children, ie, for children whose last dose was at < aged 7 years of age, a booster is needed after aged 3 years; for children was last dose was at > aged 7 years of age the interval between doses would be aged 5 years, Dr Brady explained. 

The meningococcal vaccines currently licensed in the United States contain 4 of the 5 most common serogroups of the meningococcus. The licensed vaccines contain serogroups A, C, W and Y.  Serogroup B is not present in the vaccines licensed in the United States, explained Dr Brady. 

“[Serogroups] C, W and Y cause the majority of disease in adolescents,” he said.  “That is why it is appropriate to have a recommendation for the vaccine for adolescents.  Serogroup B causes the majority of disease in infants.  That is why we don’t have a routine recommendation in infants.”

Dr Brady recommends that healthcare providers for children at increased risk for meningococcal disease should familiarize themselves with the specific situations in which their patients would be eligible to receive the meningococcal vaccine.

The disease associated with meningococcal disease has both financial and health costs.  The actual number of children at increased risk and the actual number of cases of meningococcal disease in the selected high-risk groups are not known for certain, according to Dr Brady. 

“So we don’t know how to be specific about the number of doses that would be administered and the number of children who would develop disease,” he said. “It is likely that both numbers will be small.”