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Menactra

Common name:

MCV4-D, quadrivalent meningococcal conjugate vaccine

Protects against meningococcal disease caused by Neisseria meningitidis groups A, C, Y and W (previously called W-135).

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Overview

Meningococcal disease is caused by the bacterium Neisseria meningitidis. At least 12 groups have been identified, including groups A, B, C, Y and W (previously called W-135). On average in New Zealand, around two-thirds of meningococcal disease is caused by group B each year. Meningococcal group A rarely causes disease in New Zealand. There has been a decrease in disease caused by group C and an increase in disease caused by meningococcal groups Y and W in 2016 and 2017, including cases caused by a very virulent sequence type of meningococcal group W (ST-11).

Other countries, Canada (2014–2016), and Australia and the United Kingdom (2016–2017), have also seen an increase in disease caused by the very virulent group W sequence type ST-11.

In New Zealand, conjugate vaccines protect against groups A, C, Y and W (Menactra® or Nimenrix®) or group C only (NeisVac-C®), and the multicomponent recombinant vaccine protects against group B only (Bexsero® from mid-October). For best protection against all meningococcal disease in New Zealand, separate vaccinations against group B disease and groups A, C, Y and W disease are recommended.

The MeNZB™ vaccine used in New Zealand between 2004 and 2011 was designed to target a specific type of meningococcal group B bacteria that caused a prolonged epidemic here in New Zealand.

Menactra is a meningococcal conjugate vaccine to protect against meningococcal groups A, C, Y and W. The vaccine is funded for children and adults with a medical condition that increases their risk of invasive meningococcal disease AND is listed on the Pharmaceutical Schedule. Menactra is also available as a purchased vaccine through your family doctor.

Responses to vaccine

Menactra (MCV4-D)

Common responses

  • Mild pain, redness and swelling around injection site

In infants and children:

  • Mild fever
  • Decreased appetite
  • Irritability
  • Malaise / tiredness

In adolescents and adults

  • Headache
  • Fatigue
  • Mild fever

Rare responses

 

As with any medicine, very rarely a severe allergic reaction (anaphylaxis) can occur following immunisation.

References

  • Cohn AC, et al. Prevention and Control of Meningococcal Disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMRW 2013; 62(RR02); 1-22 22 March [accessed October 2016] Available from: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6202a1.htm.
  • MacNeil et al. Use of MenACWY-CRM Vaccine in Children Aged 2 Through 23 Months at Increased Risk for Meningococcal Disease: Recommendations of the Advisory Committee on Immunization Practices, 2013. MMRW 2014 63:27 p527-530.
  • Ministry of Health. Immunisation Handbook 2017. Ministry of Health: Wellington. Available from http://www.health.govt.nz/publication/immunisation-handbook-2017
In Depth

Other brands

Meningococcal A, C, Y, W conjugate vaccine:

  • Nimenrix®

Meningococcal C only conjugate vaccine:

  • NeisVac-C®

Meningococcal group B only recombinant vaccine (from late 2018)

  • Bexsero®

Vaccine type: subunit conjugate

Schedule and administration

Menactra® is funded for children and adults with a medical condition that increases their risk of invasive pneumococcal disease AND is listed on the Pharmaceutical Schedule. The vaccine is available for purchase by people with a medical condition that is not listed on the Pharmaceutical Schedule.

    Special groups

    Menactra is recommended and funded from 2 years of age for any of the following:

    • One dose for a close contacts of meningococcal disease case
    • Two doses for individuals post-haematopoietic stem cell transplantation; or following immunosuppression due to steroid or other immunosuppressive therapy longer than 28 days
    • Up to three doses plus booster doses (as appropriate) for individuals pre- or post-splenectomy; pre- or post-solid organ transplantation; with functional asplenia; complement deficiency (acquired or inherited); or who are HIV-positive

    Conjugated meningococcal vaccine is recommended, but not funded, for individuals:

    • Who are laboratory workers regularly handling meningococcal cultures
    • Who are travelling to high-risk countries or before the Hajj
    • Who are adolescents and young adults living in communal accommodation (e.g. in a hostel or at boarding school, in military accommodation, in correctional facilities or in other long-term institutions)

    Catch-up doses

    Not relevant.

    Storage and preparation

    Store as per cold chain between 2°C to 8°C. Protect from light.

    Administration

    Menactra can be administered at the same visit as other vaccines including vaccines on the national immunisation schedule except PCV13 (Prevenar 13). Where both Prevenar 13 and Menactra are to be given, administration of Menactra must be at least 4 weeks before or after a dose of Prevenar 13.

    For:

    Healthy infants and children aged 9–23 months

    • Two doses three months apart
    • If still at risk 3 years later - offer a booster dose

    Healthy children aged 2 years to under 7 years

    • One dose
    • If still at risk 3 years later – offer a booster dose

    Healthy children aged 7 years or over and adults

    • One dose
    • If still at risk 5 years later – offer a booster dose

    Children aged 2 years to under 7 years with a medical condition that increases their risk of meningococcal disease

    • Two doses eight weeks apart
    • If still at risk 3 years later – offer a booster dose

    Children aged 7 years or over and adults with a medical condition that increases their risk of meningococcal disease:

    • Two doses eight weeks apart
    • If still at risk 5 years later - offer a booster dose

    Vaccine safety

    More than 20 years of studies and safety monitoring have shown that the conjugate meningococcal vaccines have excellent safely profiles.

    Menactra should not be given to:

    • Anyone with severe allergy (anaphylaxis) to a previous dose of this vaccine or other meningococcal vaccine, or a component of the vaccine
    • Administration of Menactra should be postponed in individuals suffering from a fever over 38°C. The presence of a minor infection is not a reason to delay immunisation

    Specialist advice should be sought for the following groups:

    • Those with bleeding disorders, such as haemophilia. The vaccine should be administered in accordance with the haematologist’s instructions. It may, in this situation only, be given subcutaneously
    • Those with a history of Guillain-Barré Syndrome

    Vaccine effectiveness

    Protection against meningococcal disease is dependent on an individual having adequate existing circulating protection provided by antibodies because the bacteria cause disease more quickly than the immune system can generate new protection. Immunisation generates circulating antibodies. Over time the antibody levels decrease. The number and quality of antibodies and how long they last depend on what type of vaccine is used, the meningococcal group(s) covered by the vaccine, and the age of the person receiving the vaccine.

    As there are generally low numbers of meningococcal disease cases in countries such as Australia, England, Germany, New Zealand and the United States it is not possible to determine exactly how many cases of disease are prevented by vaccination and how long protection after vaccination lasts. Instead, the immune system response and antibody levels are used as an alternative measure of how well and how long meningococcal vaccines can protect from disease.

    A case-control study in the US found that the overall vaccine effectiveness in adolescents was 69% up to 6 years after one dose of vaccine. Less than one year after vaccination, vaccine effectiveness was around 82% and at 3–6 years post vaccination, the vaccine was 59% effective in adolescents. Around 71-95% of adolescents, who received one dose Menactra between ages 11–18 years, had protective antibody levels three years later.

    After two doses of Menactra, 96–100% of infants aged 9–12 months have protective antibodies against meningococcal groups A, C and Y and 86% have antibodies against group W-135.

    Older children, adolescents and adults are expected to have at least five years protection after immunisation. Children aged 9–23 months at the time of their last Menactra immunisation are likely to have fewer years of protection but the exact period of time is not known.

    A booster vaccination should be considered for individuals who remain at increased risk of meningococcal disease:

    • For children aged 9–23 months when they received their second Menactra dose consider a booster vaccination after three years
    • For children aged 2 years to under 7 years consider a booster vaccination after three years
    • For children aged 7 years or older and adults consider a booster vaccination after five years

     

    Last updated: Sep 2018