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Menactra

Common name:

MenACWY-D, quadrivalent meningococcal conjugate vaccine

Protects against meningococcal disease caused by Neisseria meningitidis groups A, C, Y and W.

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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, X, Y and W. The pattern of disease caused by each group varies by time and country or geographical areas.groups have been identified, including groups A, B, C, Y and W. In New Zealand from 2015 to 2017, groups B and C were the most frequent causes of meningococcal disease. However, this has changed since 2018 with an increase in disease caused by groups W or Y. Over 2018–2019, just under half of cases were caused by meningococcal group B, and just under half by groups C, W or Y. Meningococcal group A rarely causes disease in New Zealand.

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®). 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 (MenACWY-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
  • Institute of Environmental Science and Research Ltd. Meningococcal disease quarterly report Jan - Dec 2019. Porirua: Institute of Environmental Science and Research Ltd (ESR); 2020.
  • Lopez L, Sherwood J. The epidemiology of meningococcal disease in New Zealand 2013. Wellington: Institute of Environmental Science and Research Ltd (ESR); 2014. Report No.: FW14023. 
  • 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.
  • Medsafe. New Zealand data sheet: Menactra [Internet]. Wellington: New Zealand Medicines and Medical Devices Safety Authority; 2012 [updated 2018 July 5; cited 2020 June 26]. Available from: https://www.medsafe.govt.nz/profs/Datasheet/m/menactrainj.pdf
  • Ministry of Health. Immunisation handbook [Internet]. Wellington: Ministry of Health; 2020 [updated 2020 September 25; cited 2020 September 28]. Available from: https://www.health.govt.nz/publication/immunisation-handbook-2020
  • Pharmaceutical Management Agency (PHARMAC). Online pharmaceutical schedule - November 2020 [Internet]. Wellington: Pharmaceutical Management Agency; [updated 2020 November 18; cited 2020 November 19]. Available from: https://schedule.pharmac.govt.nz/ScheduleOnline.php 
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

  • Bexsero®

Vaccine type: Subunit protein vaccine

Schedule and administration

Menactra® 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. 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 9 months of age for any of the following:

    • One dose for a close contact of meningococcal disease case
    • One dose for adolescents and young adults aged 13–25 years inclusively who are entering within the next 3 months, or in their first year of living in a boarding school hostel, tertiary education halls of residence, military barrack, or prison (see box)
      • CATCH-UP EXTENDED to 30 November 2021, one dose for individuals aged 13–25 years inclusively who are in their second, third or more years living in a boarding school hostel, tertiary education halls of residence, military barrack, or prison
    • 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:

    • Infants and young children aged under 5 years, adolescents and young adults who do not meet the eligibility crieria listed above
    • Adolescents and young adults living in close proximity to others, e.g. in a crowded household, at boarding school, in university halls of residence, group accommodation or long-term institutional care
    • Who are laboratory workers regularly handling meningococcal cultures
    • Who are travelling to high-risk countries or before the Hajj

    Catch-up doses

    Eligibility for adolescents and young adults aged 13–25 years inclusively who are in their second, third or more years of living in a boarding school hostel or university hall of residence, military barracks or prison HAS BEEN EXTENDED to 30 November 2021 to receive a funded catch-up Menactra vaccination.

    Menactra for adolescents and young people aged 13–25 years
    in a close-living situation

    Answers to frequently asked questions

    Who is be eligible?

    • Meningococcal ACWY vaccination will be funded for individuals aged 13–25 years in their first year of living in a boarding school hostel, tertiary education hall of residence, military barracks or prison.
    • The catch-up programme has been EXTENDED TO 30 November 2021 for those aged 13–25 years who are in their second, third or more years living in one these close-living situations.

    Are international students eligible?

    • All students aged under 18 years are eligible to receive funded vaccines as per the National Immunisation Schedule regardless of residency status.
    • Students aged 18 years or older must be eligible to receive publicly funded health and disability services in New Zealand to receive funded vaccines, including meningococcal ACWY vaccine.

    How do eligible individuals access the vaccine?

    • Those who qualify would be able to make an appointment with their primary care provider to receive the meningococcal ACWY vaccination up to 3 months before entering a boarding school hostel, tertiary education hall of residence, military barracks or prison close-living situation.

    How far in advance of moving into a close-living situation should people be vaccinated?

    • Eligible individuals will be able to receive the meningococcal ACWY vaccination up to 3 months before entering a boarding school hostel, tertiary education hall of residence, military barracks or prison close-living situation. Ideally, people would be vaccinated at least two weeks prior to moving into a close-living situation.

    How many doses are required?

    • One dose for individuals who are in their first year of living in a boarding school hostel, tertiary education hall of residence, military barracks or prison; or
    • One dose for individuals who are in their second, third or more years of living in a boarding school hostel, tertiary education hall of residence, military barracks, or prison, has been EXTENDED TO 30 November 2021.
    • Individuals who have previously received a dose of meningococcal ACWY vaccine (Menactra® or Nimenrix®) do not require a booster dose for 5 years.

     Are there any resources to explain the meningococcal vaccination to adolescents?

     Yes, HealthEd have produced the resource Immunise against meningococcal disease (code HE2596).
     The resource can be ordered through the HealthEd website.

     

     

    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: Nov 2020