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Nimenrix

Common name:

MCV4-T, 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, X, Y and W (previously called W-135). The pattern of disease caused by each group varies by time and country or geographical areas. In New Zealand over 2014–2017, meningococcal group B caused around two-thirds of meningococcal disease each year, group C almost one-third and groups Y or W the remaining few cases. However, in 2018 group B decreased as the cause of around half of cases. Group C also decreased significantly and disease caused by meningococcal groups Y and W increased to cause almost half the number of cases. Group W disease included cases caused by a very virulent sequence type of meningococcal group W (ST-11). Meningococcal group A rarely causes disease in NZ.

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.

Nimenrix is a meningococcal conjugate vaccine to protect against meningococcal groups A, C, W and Y. In New Zealand, Nimenrix is only available as a purchased vaccine for individuals from 6 weeks of age through your family doctor.

For individuals with a medical condition that increases their risk of invasive meningococcal disease AND is listed on the Pharmaceutical Schedule, the meningococcal vaccines NeisVac-C® and/or Menactra® are available as funded vaccines.

Responses to vaccine

Nimenrix (MCV4-T)

Common responses

  • Mild pain, redness and swelling around injection site
  • Fever
  • Children:
    • Irritability
    • Drowsiness
    • Decreased appetite
  • Adults:
    • Headache
    • Fatigue
    • Nausea, vomiting and/or diarrhoea

Rare responses

  • Extensive limb swelling

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

References

 

In Depth

Other brands:

Meningococcal A, C, W, Y conjugate vaccine:

  • Menactra®

Meningococcal C only conjugate vaccine:

  • NeisVac-C®

Meningococcal group B only recombinant vaccine

  • Bexsero®

Vaccine type: subunit conjugate

Schedule and administration

Nimenrix® is not funded in New Zealand but is available for purchase.

Conjugated meninigococcal 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 (eg, in a hostel or at boarding school, in military accommodation, in correctional facilities or in other long-term institutions).

Special groups

Nimenrix is not funded for any special groups.

Catch-up doses

Not relevant

Storage and preparation

Store the lyophilised vaccine as per cold chain between 2°C to 8°C. Protect from light. The sterile 0.9% saline diluent may be refrigerated or stored at room temperature, but must not be frozen.

Nimenrix must be reconstituted by adding the entire contents of the pre-filled syringe of solvent to the vial containing the powder. After the addition of the solvent to the powder, the mixture should be well shaken until the powder is completely dissolved. The reconstituted vaccine is a clear colourless solution. After reconstitution, the vaccine should be used promptly. Although delay is not recommended, stability has been demonstrated for 8 hours at 30°C after reconstitution. If not used within the 8 hours, do not administer the vaccine.

Administration

Infants aged under 12 months: Administer two doses 8 weeks apart followed by a booster dose after the age of 12 months (minimum interval between second and booster dose to be advised).

Children, adolescents and adults: Administer one dose. A booster dose may be indicated in some individuals.

  • Protection against meningococcal group A disease wanes quickly over the first year after immunisation with Nimenrix. Where protection against meningococcal A disease is most important a booster dose of Nimenrix could be considered one year after the previous dose
  • Protection against meningococcal groups C, Y, and W135, wanes more slowly than protection against meningococcal group A disease after immunisation with Nimenrix. A booster dose of Nimenrix could be considered for children vaccinated as toddlers, five years after the previous dose if they continue to be at increased risk of meningococcal disease

Nimenrix can be administered at the same visit as other vaccines including all vaccines on the national immunisation schedule. Separate syringes and different injection sites should be used.

The vaccine is for intramuscular injection only, preferably in the deltoid muscle. In children aged 6 weeks to 23 months of age, the vaccine should be administered in the vastus lateralis. Under no circumstances should Nimenrix be administered intravascularly, intradermally or subcutaneously. Advice regarding administration of booster vaccinations is limited.

Vaccine safety

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

Nimenrix should not be given to:

  • Anyone with severe allergy (anaphylaxis) to a previous dose of a meningococcal vaccine or a component of the vaccine
  • Administration of Nimenrix 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

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.

Nimenrix generates long term memory cells and a booster immunisation will rapidly generate more circulating protection years later.

In children, adolescents and adults:

  • Protection against disease caused by meningococcal group A decreases quickly over the first year after immunisation
  • Protection against disease caused by meningococcal groups C, Y, and W135 is expected to last at least five years after immunisation

The following table shows the percentage of individuals with protective levels of circulating antibodies against meningococcal groups A, C, Y and W-135 one month after receipt of two infant doses of Nimenrix (at 2 months and 4 months of age), two infant doses plus a booster dose of Nimenrix at 12 months of age, and a single dose of Nimenrix when aged 12 months or older. 

 

Meningococcal group

Nimenrix

Infants
<12 months
A Two infant doses 96%.
Two infant doses plus a booster dose at 12 months of age 99%.
  C Two infant doses 98%.
Two infant doses plus a booster dose at 12 months of age 99%.
  Y Two infant doses 97%.
Two infant doses plus a booster dose at 12 months of age 100%.
  W Two infant doses 100%.
Two infant doses plus a booster dose at 12 months of age 100%.

12—23 months

A, C, Y, W

98, 97, 97,98%

2—10 years

A, C, Y, W

89, 96, 92, 97%

11—17 years

A, C, Y, W

85, 97, 93, 96%

18—55 years

A, C, Y, W

80, 91, 87, 90%

56—65 years A, C, Y, W 78, 82, 80, 80%
>65 years A, C, Y, W 73, 75, 85, 71%

 

 

    Last updated: Jun 2019