Vaccination for meningococcal disease

Key points

• Update gynecologists and obstetricians on the importance and need for vaccination against meningococcal meningitis, raising awareness of the risk of invasive meningococcal disease in adolescents and young adults, with positioning of the National Commission Specialized in Vaccines of the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo) about the subject.

• Show that meningococcal infection can result in serious diseases, such as meningitis and meningococcemia, and in Brazil, at least 2 out of 10 people with invasive meningococcal disease die from it. Furthermore, about 20% of survivors have permanent sequelae.

• Present the different vaccines available and their characteristics, as well as the official recommendations in Brazil.

• Emphasize that the protective efficacy of vaccines for ACWY serogroups declines over time when administered in childhood, and booster doses in adolescents and young adults are important.

• Inform that in the Brazilian National Immunization Program (PNI), the meningococcal ACWY conjugate vaccine is routinely available to 11- and 12-year-old adolescents.

• Inform that meningococcal ACWY and B vaccines are available for different age groups in private vaccination clinics, as indicated in the package insert and recommended by scientific societies.

• Present the best scientific evidence of vaccination against meningococcal meningitis in women and contribute to an up-to-date clinical practice.

• Emphasize the importance of gynecologists discussing vaccination against meningococcal disease with adolescents, parents and legal guardians.

The National Commission Specialized in Vaccines of the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo) endorses this document. The production of content is based on scientific evidence on the proposed theme and the results presented contribute to clinical practice.

Publication History

Article published online:
10 October 2022

• References

• 1 Centers for Disease Control and Prevention. Chapter 14: Meningococcal Disease. In: Hamborsky J. et al. (Eds). Epidemiology and Prevention of Vaccine-Preventable Diseases. 13th ed.. Washington, DC: Public Health Foundation; 2015: 231-46
• 2 Wang B, Santoreneos R, Giles L, Haji Ali Afzali H, Marshall H. Case fatality rates of invasive meningococcal disease by serogroup and age: a systematic review and meta-analysis. Vaccine 2019; 37 (21) 2768-82 DOI: 10.1016/j.vaccine.2019.04.020.
• 3 Olbrich KJ, Müller D, Schumacher S, Beck E, Meszaros K, Koerber F. Systematic review of invasive meningococcal disease: sequelae and quality of life impact on patients and their caregivers. Infect Dis Ther 2018; 7 (04) 421-38
• 4 Ministério da Saúde. Datasus. Meningite – casos confirmados notificados no sistema de informação de agravos de notificação – Brasil [Internet]. 2022 [cited 2022 Jun 12]. Available from: http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sinannet/cnv/meninbr.def
• 5 World Health Organization. Meningococcal [Internet]. 2021 [cited 2022 May 19]. Available from: https://www.who.int/news-room/fact-sheets/detail/meningitis
• 6 Secretaria de Estado da Saúde. Coordenadoria de Controle de Doenças. Instituto Adolfo Lutz. Informação da vigilância das pneumonias e meningites bacterianas [Internet]. 2017 [cited 2022 May 19]. Available from: https://www.saude.pr.gov.br/sites/default/arquivos_restritos/files/documento/2020-04/sireva_2017_2.pdf
• 7 Marshall HS, McMillan M, Koehler AP, Lawrence A, Sullivan TR, MacLennan JM. et al. Meningococcal B vaccine and meningococcal carriage in adolescents in Australia. N Engl J Med 2020; 382 (04) 318-27 DOI: 10.1056/NEJMoa1900236.
• 8 Christensen H, May M, Bowen L, Hickman M, Trotter CL. Meningococcal carriage by age: a systematic review and meta-analysis. Lancet Infect Dis 2010; 10 (12) 853-61 DOI: 10.1016/S1473-3099(10)70251-6.
• 9 Weckx LY, Puccini RF, Machado A, Gonçalves MG, Tuboi S, Barros E. et al. A cross-sectional study assessing the pharyngeal carriage of Neisseria meningitidis in subjects aged 1-24 years in the city of Embu das Artes, São Paulo, Brazil. Braz J Infect Dis 2017; 21 (06) 587-95 DOI: 10.1016/j.bjid.2017.06.005.
• 10 American Academy of Pediatrics. Meningococcal infections. In: Pickering LK, Baker CI, Kimberlin DW, Long SS. editors. Red Book: 2009 report of the Committee on Infectious Diseases. 28th ed.. Elk Grove Village: American Academy of Pediatrics; 2009: 455-63
• 11 Pace D, Pollard AJ. Meningococcal disease: clinical presentation and sequelae. Vaccine 2012; 30 (Suppl. 02) B3-9 DOI: 10.1016/j.vaccine.2011.12.062.
• 12 Estado de Santa Catarina. Diretoria de Vigilância Epidemiológica. Boletim Epidemiológico nº 07/2019 – Vigilância da Doença Meningocócica [cited 2022 May 19]. Available from: http://www.dive.sc.gov.br/conteudos/boletim2019/Boletim_DM_07_2019/Boletim%20DM%2007.2019.pdf
• 13 Dretler AW, Rouphael NG, Stephens DS. Progress toward the global control of Neisseria meningitidis: 21st century vaccines, current guidelines, and challenges for future vaccine development. Hum Vaccin Immunother 2018; 14 (05) 1146-60 DOI: 10.1080/21645515.2018.1451810.
• 14 Bröker M, Berti F, Costantino P. Factors contributing to the immunogenicity of meningococcal conjugate vaccines. Hum Vaccin Immunother 2016; 12 (07) 1808-24 DOI: 10.1080/21645515.2016.1153206.
• 15 Bröker M, Dull PM, Rappuoli R, Costantino P. Chemistry of a new investigational quadrivalent meningococcal conjugate vaccine that is immunogenic at all ages. Vaccine 2009; 27 (41) 5574-80 DOI: 10.1016/j.vaccine.2009.07.036.
• 16 Harrison LH. Prospects for Vaccine Prevention of Meningococcal Infection. Clin Microbiol Rev 2006; 19 (01) 142-64 DOI: 10.1128/CMR.19.1.142-164.2006.
• 17 Sáfadi MA, Barros AP. Meningococcal conjugate vaccines: efficacy and new combinations. J Pediatr (Rio J) 2006; 82 (3 Suppl): S35-44 DOI: 10.2223/JPED.1495. PMID: 16826310.
• 18 Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Introdução da vacina meningocócica C (conjugada) no calendário de vacinação da criança. Departamento de Vigilância Epidemiológica. Brasília (DF): Ministério da Saúde; 2010: 1-18
• 19 Sociedade Brasileira de Imunizações. Calendário de Vacinação SBIm Adolescente: 2021-2022 [cited 2022 Mar 10]. Available from: https://sbim.org.br/images/calendarios/calend-sbim-adolescente.pdf
• 20 Sociedade Brasileira de Imunizações. Calendários de vacinação [Internet]. 2022 [cited 2022 Jul 15]. Available from: https://sbim.org.br/calendarios-de-vacinacao
• 21 Federação Brasileira das Associações de Ginecologia e Obstetrícia (Febrasgo). Programa Vacinal para Mulheres. 2ª ed.. São Paulo: 2021. [cited 2022 May 10]. Available from: https://www.febrasgo.org.br/en/revistas/item/1261-programa-vacinal-das-mulheres
• 22 Brasil. Ministério da Saúde. Nota Informativa 149 de 2015. Informa as mudanças no calendário nacional de vacinação de 2016 [Internet]. Brasília (DF): Programa Nacional de Imunizações; 2015. [cited 2017 Jun 10]. Available from: http://www.aids.gov.br/sites/default/files/anexos/legislacao/2015/58563/nota_informativa_149_pdf_23535.pdf
• 23 Chang LJ, Hedrick J, Christensen S, Pan J, Jordanov E, Dhingra MS. A Phase II, randomized, immunogenicity and safety study of a quadrivalent meningococcal conjugate vaccine, MenACYW-TT, in healthy adolescents in the United States. Vaccine 2020; 38 (19) 3560-9 DOI: 10.1016/j.vaccine.2020.03.017. . Epub 2020 Mar 21
• 24 Calendário Nacional de Vacinação do PNI/MS. Available from: https://www.gov.br/saude/pt-br/assuntos/saude-de-a-a-z-1/c/calendario-de-vacinacao
• 25 Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Imunização e Doenças Transmissíveis. Manual dos Centros de Referência para Imunobiológicos Especiais [Internet]. 5ª ed.. Brasília (DF): Ministério da Saúde; 2019. [cited 2022 May 19]. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/manual_centros_imunobiologicos_especiais_5ed.pdf