Meningococcal disease can refer to any illness caused by the bacteria Neisseria meningitidis, also known as meningococcus. There are five serogroups — or variations — of Neisseria meningitidis that cause most meningococcal disease in the world. They are serogroups A, B, C, W and Y.
Meningococcal disease often afflicts otherwise healthy people. It can be unexpected and devastating. The disease can include meningitis, which is inflammation of the membranes covering the brain and the spinal cord. Meningitis is a serious and potentially life-threatening illness.
“Having meningitis doesn’t always mean you have meningococcal disease, And having meningococcal disease doesn’t necessarily mean you have meningitis.”
- according to the Centers for Disease Control and Prevention
Meningococcal disease can also include life-threatening blood infection. It can lead to amputation of limbs, hearing loss, nervous system problems, mental retardation, seizures, strokes and even death.
Meningococcal disease is at a historic low in the U.S. Still, teens and young adults 16 through 23 years old are at increased risk of meningococcal disease. The bacteria are spread from person to person through infected droplets of respiratory and throat secretions. This can happen with kissing, sneezing or coughing on someone. It can also occur as a result of living in close quarters with an infected person such as in a dormitory or sharing eating or drinking utensils. Close or prolonged contact with an infected person increases the risk. The period between exposure to an infection and the onset of the first symptoms ranges from two to 10 days, with the average being four days. Neisseria meningitidis only infects humans.
Available Meningococcal Vaccines
No meningococcal vaccine currently licensed in the U.S. offers protection against all variations of the Neisseria meningitidis bacteria in one shot. Some meningococcal vaccines for preteens and teens are designed to protect against meningococcal types A, C, W and Y. Others help protect against meningococcal type B. The U.S. Food and Drug Administration (FDA) has approved six meningococcal vaccines since the 1980s.
Vaccines protecting against bacteria types A, C, W, and Y:
Menomune — FDA approved Menomune in 1981 for use in people 2 years of age and older. It is the only meningococcal vaccine licensed for people older than 55 years of age.
Menactra — FDA approved Menactra in 2005 for use in people aged 9 months through 55 years.
Menveo— FDA approved Menveo vaccine in 2010 for use in people aged 2 months through 55 years of age.
Vaccines protecting against bacteria types C and Y:
MenHibrix — FDA approved MenHibrix in 2012, specifically for infants and toddlers. It is approved for use in children aged 6 weeks through 18 months and provides protection against meningococcal types C and Y as well as Haemophilus influenzaetype b (Hib).
Vaccines protecting against bacteria type B.
Meningococcal Conjugate Vaccines (MCV4)
Menactra and Menveo are meningococcal conjugate vaccines approved for use in children and adults to protect against meningococcal types A, C, W and Y. The CDC defines conjugate vaccines as vaccines that “join a protein to part of the bacteria to improve the protection the vaccine provides.” MenHibrix is also a conjugate vaccine but is indicated for use only in babies and toddlers ages 6 weeks through 18 months to protect against meningococcal types C and Y.
The CDC recommends that all 11- to 12-year-olds receive a meningococcal conjugate vaccine (Menactra or Menveo) to help protect against bacteria types A, C, W and Y. Protection from meningococcal vaccines decreases in many teens within five years, so the CDC recommends all teens vaccinated before their 16th birthday get a booster dose at age 16. This helps teens continue to have protection during the ages when they are at highest risk of meningococcal disease. Teens do not need a booster dose if they get their first dose of a quadrivalent meningococcal conjugate vaccine at or after age 16. Quadrivalent means the vaccine protects against four strains.
The agency does not have a preference as to which brand — Menactra or Menveo — of a quadrivalent meningococcal conjugate vaccine preteens and teens receive, though the agency prefers they receive the same vaccine brand for both doses.
The CDC also recommends meningococcal conjugate vaccines for children who are between 2 months and 10 years old and for certain adults.
Meningococcal conjugate vaccines are recommended for certain people who:
- Have a rare type of disorder called “persistent complement component deficiency”
- Are taking the medicine called Soliris (also called eculizumab)
- Have a damaged spleen or have had their spleen removed
- Have HIV
- Are traveling to or residing in countries in which the disease is common
- Are part of a population identified to be at increased risk because of a serogroup A, C, W or Y meningococcal disease outbreak
Adults should also get a meningococcal conjugate vaccine if they are a military recruit or a microbiologist who is routinely exposed to Neisseria meningitidis or if they are not up to date with this vaccine and are a first-year college student living in a residence hall, according to the CDC. Many colleges require students to provide proof of quadrivalent meningococcal conjugate vaccination within five years of their starting school. States such as Iowa and Nevada are requiring the vaccines for middle and high school students.
Although meningococcal conjugate vaccination works well to protect against meningococcal disease, it cannot prevent all cases. According to studies, out of every 10 preteens and teens who received Menactra, eight or nine had signs of immunity one month after completing the series. And between seven and nine adults out of every 10 vaccinated with Menactra were protected. Menveo showed similar results: Between seven and nine people out of every 10 vaccinated were protected one month after completing the series. Efficacy of MenHibrix in children was slightly higher — about nine children out of every 10 vaccinated had signs of immunity against types C and Y one month after completing the series.
Meningococcal Polysaccharide Vaccine (MPSV4)
Menomune is the only meningococcal polysaccharide vaccine licensed in the U.S. It is also the only meningococcal vaccine approved for people older than 55 years of age. The CDC defines a polysaccharide vaccine as “a type of vaccine that is made to look like the surface of certain bacteria in order to help the body build protection against that germ.”
These vaccines are made of long chains of sugar molecules that make up the surface capsule of certain bacteria. Young children do not respond consistently to polysaccharide antigens, and repeat doses of polysaccharide vaccines usually do not cause a booster response, according to the CDC.
CDC recommends adults 56 years or older get MPSV4 vaccine if they only need one dose and are:
- Traveling to or residing in countries in which the disease is common
- Part of a population identified to be at increased risk because of a serogroup A, C, W or Y meningococcal disease outbreak
- Have not previously been vaccinated with a meningococcal conjugate vaccine (Menactra or Menveo)
Studies show Menomune resulted in a short-term protective immune response against meningococcal types A and C in 85 to 100 percent of vaccinated older children and adults. Estimates are not available for the efficacy of Menomune in children starting at age 2 years, but studies show a protective immune response against meningococcal types Y and W, according to the CDC.
Serogroup B (Recombinant) Meningococcal Vaccines
Bexsero and Trumenba are FDA-approved serogroup B meningococcal vaccines, which mean they are intended to help prevent meningococcal disease caused by serogroup B. They are also categorized as recombinant vaccines. The CDC defines recombinant as “a type of vaccine where proteins from certain bacteria are used to help the body build protection against that germ.”
The CDC recommends serogroup B vaccines for people 10 years or older who are at an increased risk for serogroup B meningococcal infections.
Serogroup B Meningococcal Vaccines are recommended for:
- People at risk because of a serogroup B meningococcal disease outbreak
- Anyone whose spleen is damaged or has been removed
- Anyone with “persistent complement component deficiency,” a rare immune system condition
- Anyone taking a drug called eculizumab (also called Soliris)
- Microbiologists who routinely work with isolates of meningitidis
Teens and young adults ages 16 through 23 years also may get a serogroup B meningococcal vaccine to provide short-term protection against most strains of serogroup B meningococcal disease. Sixteen through 18 years are the preferred ages for this vaccine.
Between 60 and 90 percent of preteens, teens and young adults vaccinated with Bexsero and 80 percent of preteen, teens and young adults vaccinated with Trumenba had a protective immune response one month after completing the series.
Depending on the brand, two or three doses of serogroup B meningococcal vaccine are needed for the best protection. The CDC says the same vaccine brand should be used for all doses.
Things to Consider Before Getting Meningococcal Vaccines
According to the CDC, people of a certain age or with certain health conditions should not get meningococcal vaccines or should wait before getting them. For example, anyone who has had a life-threatening allergic reaction after a previous dose of a meningococcal vaccine should not get another dose of that vaccine.
Anyone who is severely allergic to any component of meningococcal vaccines should not get a dose of these vaccines.
Women who are pregnant and are at an increased risk for serogroup A, C, W or Y meningococcal disease may get meningococcal conjugate and polysaccharide vaccines. Pregnant or breastfeeding women that are at an increased risk for serogroup B meningococcal disease should only get serogroup B vaccines after talking with a doctor and deciding that the benefits of getting the vaccine outweigh the risks. If a pregnant or breastfeeding mother is not at risk for serogroup B meningococcal disease, she should defer this type of vaccination, according to the CDC.
Another reason to consider deferring vaccination is if the person scheduled to receive the vaccination is moderately or severely ill. People who have a cold or other slight illness may be able to still get the vaccine. It is up to them and their health care professional to decide.
Potential Complications After Vaccination
About 50 percent of the people vaccinated with quadrivalent meningococcal conjugate vaccines experience mild problems following vaccination. Reactions usually last for one or two days and include redness or pain at the injection site or a slight fever. The same reactions can also occur after meningococcal polysaccharide vaccine but are more common after meningococcal conjugate vaccines.
If mild problems occur after serogroup B meningococcal vaccines, they can last up to two or three days.
Mild Problems After Vaccination Can Include:
- Redness and swelling where the shot was given
- Muscle or joint pain
- Fever or chills
- Nausea or diarrhea.
The CDC also warns that people sometimes faint after vaccination, and some people get severe pain in the shoulder and have difficulty moving the arm where a shot was given. There is also potential for severe, life-threatening allergic reaction and a very small chance of a serious injury or even death. People who believe meningococcal vaccination resulted in injury or death can seek compensation through the National Vaccination Injury Compensation Program (VICP). Conditions for which people may currently receive compensation include anaphylaxis (serious life-threatening allergic reaction), shoulder injury related to vaccine administration and vasovagal syncope (a sudden drop in heart rate and blood pressure leading to fainting).
Meningococcal Vaccines and Guillain-Barré Syndrome
Within nine months of Menactra hitting the market, the Vaccine Adverse Event Reporting System (VAERS) received reports of five confirmed cases of Guillain-Barré syndrome (GBS) in people who received the vaccine. The FDA and the CDC co-manage VAERS, which allows doctors to report adverse reactions that occur after vaccination. The reported GBS cases occurred in people 17 and 18 years old who were vaccinated between June 10, 2005, and July 25, 2005, and first experienced symptoms about two weeks to one month after receiving Menactra.
GBS is a serious neurological disorder that involves inflammation of the peripheral nerves and can lead to paralysis and death.
In October 2005, the FDA and the CDC said that evidence was not sufficient to conclude that Menactra causes GBS. However, the FDA required an update to Menactra’s package insert to reflect that GBS has been reported in association with the vaccine. In the four months that followed, VAERS received three additional confirmed cases of GBS occurring after Menactra vaccination. The CDC said “available evidence neither proves nor disproves a causal relation” between Menactra and GBS. The agency continued to recommend the vaccinations.
Between March 2006 and September 2006, VAERS received nine additional reports of GBS occurring after Menactra vaccination. Although the CDC concluded that “these data suggest a small increased risk for GBS” after Menactra vaccination, it continued to recommend routine vaccination with Menactra for adolescents, college freshmen living in dormitories and other populations at increased risk.
In 2008, reports to VAERS again suggested a potential for an increased risk of GBS following Menactra vaccination. The package inserts for two of the meningococcal vaccines were changed to identify a history of GBS as a precaution to vaccination. However, two large studies showed there was no link between Menactra and GBS, according to the CDC. “Based on these large studies, the Advisory Committee on Immunization Practices (ACIP) no longer considers a history of GBS to be a contraindication nor precaution for meningococcal vaccination,” the CDC said. Still, the most recent package inserts for Menactra and Menveo include GBS warnings.