The Advisory Committee forward Immu...

The Advisory Committee forward Immunization Practices (ACIP) of the Center for Disease check and Prevention (CDC) has released updated recommendations in succession the management of meningococcal disease. The ACIP recommendations appear in the May 27 2005 issue of Morbidity and Mortality Weekly Report. The sated report is available online at http://www.cdc.gov/mmwr/preview/ mmwrhtml/rr5407a1.htm.

Approximately 1400 to 2800 cases of meningococcal disease present itself annually in the United States. Although meningococcus suits to many widely available antibiotics, 10 to 14 percent of patients with the disease die, and 11 to 19 percent of survivors have sequelae. Previous ACIP guidelines have attract favor toed a meningococcal tetravalent polysaccharide vaccine (MPSV4; Menomune) for high-risk patients. Although the incidence of Streptococcus pneumoniae and Haemophilus influenzae model b infections has decreased dramatically, Neisseria meningitidis has become a leading cause of bacterial meningitis in the United States. This report includes ACIP's recommendations regarding the use of a recently made known tetravalent meningococcal polysaccharide-protein conjugate vaccine (MCV4; Menactra), and updated recommendations regarding MPSV4 and antimicrobial chemoprophylaxis to manage meningococcal disease.

Recommendations for Specific Groups

PREADOLESCENTS 11 TO 12 YEARS OF AGE

Routine vaccination with a single dose of MCV4 is praiseed at the preadolescent office visit (11 to 12 years of age). If the patient does not receive the vaccine at this time, vaccination at high academy entry (approximately 15 years of age) is also acceptable.

ADULTS 20 TO 55 YEARS OF AGE

Vaccination is not praiseed for this group. MCV4 is approved for this age clump however, and a patient may single out to receive the vaccine.

CHILDREN YOUNGER THAN 11 YEARS AND ADULTS OLDER THAN 55 YEARS

MCV4 is not approved for use in these age disposes Routine vaccination with MPSV4 is not attract favor toed for low-risk patients in these age groups

HIGH-RISK PATIENTS

Patients at high risk of contracting meningococcal disease include society freshmen living in dormitories, microbiologists who are routinely expos to isolates of N meningitidis, military recruits, individuals who travel to or live in countries in which N meningitidis is endemic, bodily forms who have terminal complement ingredient deficiencies, and persons who have anatomic or functional asplenia.

High-risk patients younger than sum of two units years should not be vaccinated routinely with MPSV4 or MCV4 However, MPSV4 may be considered for short-term protection against serogroup A disease in patients three to 18 month of age (two doses, three month apart) and for patients 19 to 23 month of age (single dose). High-risk patients who are sum of two units to 10 years of age or who are older than 55 years should receive a single dose of MPSV4 High-risk patients 11 to 55 years of age should receive MCV4 still MPSV4 is an acceptable alternative.

ADMINISTRATION

MCV4 should be administered intramuscularly as a single 05-mL dose. MPSV4 should be administered subcutaneously as a single 05-mL dose. one as well as the other vaccines may be administered concomitantly with other vaccines, still at different anatomic sites.

REVACCINATION

High-risk patients vaccinated with MPSV4 may ne revaccination. High-risk children who were vaccinated when they were younger than four years should be revaccinated after brace to three years if they are still at a high risk.

The ne for revaccination after receiving MPSV4 is unclear, although antibodies decline rapidly sum of two units to three years after vaccination. If vaccination is indicated, a patient may be revaccinated after five years. MCV4 is praiseed for revaccination of patients 11 to 55 years of age, unless MPSV4 is an acceptable alternative.

CONTRAINDICATIONS

Patients with moderate to hard illness should not be vaccinated until their condition improves. MCV4 or MPSV4 should not be administered if a patient has known allergies to any constitutings of the vaccines. Patients who are immunosuppressed may receive vaccination, although it may be les effective. Patients who are pregnant may receive MPSV4 if indicated, yet no data exist on the safety of MCV4

ANTIMICROBIAL CHEMOPROPHYLAXIS

Antimicrobial chemoprophylaxis should be used to treat somebodys who are in close contact with patients who have invasive meningococcal disease (eg household members, child care contacts, and anyone directly expos to the patient's oral secretions). Ideally, antimicrobial chemoprophylaxis should be administered les than 24 hours after the index patient not absents Administration after 14 days principally likely is ineffective.

COPYRIGHT 2005 American Academy of Family Physicians

COPYRIGHT 2005 Gale Group