CDC: Prevention and control of meningococcal disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP): MMWR; 2005;54(RR07):1-21.
Cases of meningococcal disease occur in the United States at a rate of 0.5 to 1.1/100,000 population with a case-fatality rate of 10% to 14%. Up to 20% of survivors experience serious sequelae such as neurologic disability, loss of hearing, or loss of a limb. In 2005, a tetravalent meningococcal polysaccharide-protein conjugate vaccine (MCV4) was licensed for use among persons 11 to 55 years of age. Previously, MPSV4 meningococcal vaccine was available, and it continues to be recommended for use among children 2 to 10 years of age and persons older than 55 years. Use of the new MCV4 vaccine is preferred among persons 11 to 55 years of age. The Advisory Committee on Immunization Practices advises routine vaccination of persons ages 11 and 12 with MCV4. Persons who have not received MCV4 should be vaccinated at entry to high school. Vaccination is also advised for members of populations at increased risk, including college freshman living in dormitories, military recruits, travelers to areas in which meningococcal disease is hyperendemic or epidemic, patients with anatomic or functional asplenia, and patients with terminal complement deficiency. Among healthy adults, the incidence of meningococcal disease is so low that vaccination is not routinely advised but may be used. It is expected, but has not been proven, that MCV4 protection will last longer than protection from MPSV4 vaccine. Since both vaccines are inactivated, they may be administered to persons who are immuno-suppressed. Vaccination with MPSV4 during pregnancy has not been associated with adverse effects, but there are no data on the safety of MCV4 during pregnancy. Systemic side effects are similar for either vaccine, with over one-half reporting at least one systemic adverse reaction. Serious adverse effects over 6 months are < 1% and similar to unvaccinated persons. Local adverse reactions are more common among those who receive MCV4 compared to MPSV4 (e.g. 13% reported arm pain compared to 3%). Routine vaccination of adolescents is expected to reduce cases and disability from meningococcal disease not only in vaccinated individuals, but also because it will protect those not vaccinated by reducing asymptomatic carriage of bacteria.