CDC urges meningitis vaccine for all adolescents.

ATLANTA -- The tetravalent meningococcal conjugate vaccine is now recommended for all 11- to 18-year-olds instead of select age groups, according to the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices.

The previous recommendations for meningococcal conjugate vaccine, MCV4 (Menactra), administration consisted of three cohorts: 11- to 12-year-olds, adolescents entering high school (or 15-year-olds), and anyone else at increased risk for meningococcal disease, such as incoming college freshman who would live in dormitories.

Dr. Amanda Cohn of the CDC's meningitis and vaccine preventable diseases branch, explained that the rationale for the new recommendations is twofold.

First, simplified recommendations for the use of MCV4 could improve coverage, said Dr. Cohn, who presented the draft of the recommendations at the ACIP meeting. Second, the current and future MCV4 supply is expected to be sufficient to meet the increased vaccine demand that would result from the expanded recommendations.

Ideally, the expanded recommendations, which came in a June 27 vote, will increase the number of adolescents who are vaccinated against meningococcal disease, which although rare, is more prevalent in adolescents than in younger children or adults. The newly approved recommendations will be published in an upcoming issue of the CDC's Morbidity and Mortality Weekly Report. In addition, vaccination information can be found at the ACIP Web site: cdc.gov/vaccines/recs/acip.

Because many adolescents don't see a doctor regularly, the expanded recommendations give physicians the freedom to vaccinate their teen patients whenever the opportunity arises.

"Overall it simplifies the approach to immunizing adolescents," said Dr. Joseph Bocchini Jr., the American Academy of Pediatrics' liaison to ACIP and chairman of pediatrics at Louisiana State University in Shreveport.

"This is a natural progression of the previous recommendations, which were originally made on the basis of supply and trying to get to those at highest risk," he said in an interview. "But now with increased supply we have the opportunity to make broader recommendations to include all adolescents."

"We like the idea of a broad target," said Dr. Jonathan Temte, the American Academy of Family Physicians' liaison to ACIP who is a family physician at the University of Wisconsin, Madison. "The AAFP would be very much in favor of a broader condition like this," he said during the open discussion period at the meeting.

The opportunity to vaccinate against meningococcal disease as part of any adolescent care visit speaks to the value of a medical home, where a teen's records would show whether he or she had received the MCV4 vaccine, he added in an interview. "The take-home message is to have a medical home and continuity."

Some members of the ACIP expressed concern over the increased risk of Guillain-Barre syndrome (GBS) that has been reported in adolescents who received the MCV4 vaccine, but they agreed that the opportunity to prevent meningococcal disease in more teens trumps the limited data that suggest an association between MCV4 and GBS. But individuals with a history of GBS may be at increased risk and should discuss their risk of meningococcal disease with their doctors, Dr. Cohn said.

The revised recommendations continue to emphasize that 11- to 12-year-olds should receive the MCV4 vaccination at the 11- to 12-year-old preventive care visit, along with other routine adolescent vaccinations.

"The ACIP goal is routine vaccination of all adolescents beginning at age 11 years," said Dr. Cohn. She quoted from the draft of the recommendations to add that the ACIP and partner organizations, including the AAP, AAFP, and American Medical Association, recommend a health care visit for all 11- to 12-year-olds to receive recommended immunizations and other preventive medicine services.

Supply problems with the MCV4 vaccine in 2006 prompted ACIP to recommend a deferral of vaccinating 11- to 12-year-olds in favor of older adolescents (starting high school) who were deemed at greater risk for meningococcal disease. But representatives from Menactra manufacturer Sanofi Pasteur assured the committee that the company's total vaccine supply from January 2007 to September 2007 is on track to exceed 6 million doses resulting from surplus carried over from 2006 when the vaccine was deferred in the younger adolescents. In addition, the company representatives projected a supply of at least 9 million doses (including the previous year's surplus) to be available for the remainder of 2007 and into 2008 to meet and exceed demand.

Real demand for new vaccines is unpredictable, noted Dr. Gregory Wallace, chief of the CDC's vaccine supply and insurance branch. Adolescents in the public sector are difficult to reach after age 11-12 years, and demand for MCV4 has yet to pick up after the deferral for 11-to 12-year-olds was lifted, he said in a presentation at the meeting.

But the ACIP working group anticipates that the expanded recommendations will improve adolescent coverage by simplifying health care providers' decisions to vaccinate, said Dr. Cohn.

Menactra was first licensed in January 2005, and it is indicated for use in persons aged 11 to 55 years to prevent invasive meningococcal disease caused by several Neisseria meningitis serogroups including A, C, and Y.

BY HEIDI SPLETE

Senior Writer