Menactra (Quadrivalent meningococcal conjugate vaccine) is a polysaccharide conjugate vaccine that is used to induce active immunity against meningococcal infections serotypes A, C, Y, W-135.

Quadrivalent meningococcal conjugate vaccine Uses:

• Meningococcal disease prevention:

  • The active immunisation provided by this vaccine protects against N-invasive meningococcal illness. serogroups A, C, Y, and W-135 of meningitidis.
  • It is recommended by The Advisory Committee on Immunization Practices:

  • ACIP recommends routine vaccination of the following:

    • Children and adolescents 11 to 18 years of age.
    • those who are older than 2 months and who have a higher chance of contracting meningococcal illness
    • In outbreaks brought on by serogroups that can be prevented by vaccination, people in all recommended age groups are at a higher risk.

  • Those at increased risk of meningococcal disease include the following:

    • Patients receiving eculizumab who are older than 2 months old and have a condition like anatomical or functional asplenia, such as sickle cell disease, HIV, or persistent complement component deficits like C3 & C4, properdin, factor H, or factor D.
    • individuals older than 2 months who go to or live in nations where meningococcal illness is hyperendemic or epidemic, particularly if prolonged contact with the local population is anticipated.
    • First-year college students living in dorms who are unvaccinated or have received insufficient vaccinations.
      military enlistees
    • High-risk microbiologists are exposed to dangerous environments.
  • The Canadian National Advisory Committee on Immunization (NACI):
    • A routine immunisation is advised by NACI for children around the age of 12, but booster shots are not advised unless there is an ongoing high risk of exposure.
    • You can use either of the two quadrivalent vaccines.
    • NACI makes no preference clear.
    • For high-risk individuals 2 months to 2 years of age, NACI advises the use of Menveo for off-label usage if vaccination with a quadrivalent vaccine is required.
    • Additionally, anyone older than 56 years old may utilise it.

Menactra (Quadrivalent meningococcal conjugate vaccine) Dose in Adults

Menactra (Quadrivalent meningococcal conjugate vaccine) Dose in the treatment of Immunization:

• ACIP recommendations:

  • MenACWY is an acronym for either meningococcal quadrivalent conjugate vaccination. Menveo is particularly mentioned in MenACWY-CRM, while Menactra is specifically mentioned in MenACWY-D.

  • Primary vaccination: IM:

    • Adults 19 to 21 years:
      • If no dose was given beyond the age of sixteen, one can receive one 0.5 mL dose as a catch-up immunisation, though it is not typically advised.
    • Adults ≥22 years:
      • It is not typically advised. There should be guidelines.

• Primary vaccination in Persons at increased risk for meningococcal disease:

Note: Administer MenACWY-D (Menactra) 4 weeks after finishing all PCV doses if using.

• Adults under the age of 55 who have never received a vaccination, persistent complement deficits (including those caused by the use of eculizumab), functional or anatomic asplenia, or HIV infection: MenACWY-CRM (Menveo) or MenACWY-D (Menactra):

  • Two 0.5 mL doses are administered intramuscularly, more than two months apart.

• Other adults ≤55 years not previously vaccinated and who are either:

  • residents of residential housing who are first-year college students;
  • During a community epidemic, those who are moving to or living in locations where meningococcal illness is endemic or hyperendemic are at risk;
  • Those joining the military; or microbiologists who frequently encounter Neisseria meningitidis:
  • MenACWY-CRM (Menveo) or MenACWY-D (Menactra):
    • 0.5 mL of it is administered intramuscularly in one dose. College students should show proof of immunisation, preferably from a dose given on or after their sixteenth birthday and no more than five years before to enrolment.

• Adults ≥56 years:

  • For individuals in this age group who need a single dose of the meningococcal polysaccharide vaccine (MPSV4, Menomune), it was advised. Menactra or Menveo might be adequate in the absence of Menomune.

• Booster dose: Persons NOT at increased risk for meningococcal disease:

  • Adults ≤21 years: MenACWY-CRM (Menveo) or MenACWY-D (Menactra):
    • If the first dose was administered before the patient turned sixteen, it is administered intramuscularly (IM) in one 0.5 mL dose. If the primary dose was administered after the age of sixteen, a booster dose is not necessary unless the patient develops a higher risk of meningococcal illness.

• Booster vaccination: Persons at increased risk for meningococcal disease:

  • Recurring dose every five years if the person is still at high risk is advised by ACIP.

Menactra (Quadrivalent meningococcal conjugate vaccine) Dose in Childrens

It is crucial to understand that when an acronym like MenACWY is used, it refers to either the meningococcal quadrivalent conjugate vaccine or the meningitis. Menveo is notably mentioned in MenACWY-CRM. Menactra is notably mentioned in MenACWY-D. For further information, including specific, detailed recommendations for catch-up scenarios and care of patients in high-risk environments, consult the CDC/ACIP yearly immunisation schedules. The ACIP considers dosages given fewer than 4 days prior to the minimum interval or age to be legitimate. However, this timeframe could be trumped by municipal or national regulations.

Menactra (Quadrivalent meningococcal conjugate vaccine) Dose in the treatment of Primary immunization:

Note: Although the FDA has allowed its use in children under the age of 11, only individuals at higher risk should use it. It is not advised to use it frequently.

• CDC (ACIP) recommendations:

  • Primary vaccination for patients NOT at increased risk for meningococcal disease:

    • Infants and Children <11 years:
      • Although it is not usually recommended, recommendations should be consulted if a clinical evaluation calls for it.
    • Children 11 to 12 years: MenACWY-CRM (Menveo) or MenACWY-D (Menactra):
      • A single dose of 0.5 mL is administered IM.
      • Children who may have previously had the Hib-MenCY-TT (Menhibrix) or MenACWY (Menactra or Menveo) vaccine before turning 10 should still receive the recommended dose of MenACWY at 11 to 12 years old even if they are not at a higher risk for meningococcal disease.
    • Adolescents:
      • If not previously immunised, it is administered as 0.5 mL IM in a single dose.

  • Primary vaccination for patients at increased risk for meningococcal disease:

Note: If MenACWY-D (Menactra) is to be administered, give it before or concurrently with DTaP and provide it 4 weeks after the age-appropriate completion of all PCV doses.

• Infants ≥2 months and Children <2 years:
  • Patients with anatomical or functional asplenia, including sickle cell disease, should take it. The first dosage is determined on age.
• Infants 8 weeks to 6 months: MenACWY-CRM (Menveo):
  • It is delivered intramuscularly (IM) in dosages of 0.5 mL each at ages 2, 4, 6, and 12 months.
• Children 7 to 23 months (incomplete vaccination): MenACWY-CRM (Menveo):
  • It is delivered IM in two doses of 0.5 mL each, spaced at least 12 weeks apart. At least 12 weeks should pass after the first dose before giving the second one.

• If you have a chronic complement component shortage or you have HIV exposure or infection, you should adjust your dosage based on your age:

  • Infants 8 weeks to 6 months:
    • MenACWY-CRM (Menveo) is given intramuscularly in doses of 0.5 mL each over the course of four administrations, one each at 2, 4, 6, and 12 months of age.
  • Infants and Children 7 to 23 months:
  • MenACWY-CRM (Menveo): Infants and Children 7 to 23 months:
    • It is given twice, with a dose size of 0.5 mL each. At least 12 weeks after the first dose and when the patient is older than 12 months, the second dose should be administered.
  • MenACWY-D (Menactra): In Infants and Children 9 to 23 months:
    • It is administered intramuscularly in two dosages of 0.5 mL each.
    • At least 12 weeks should pass between the first and second doses.
    • If necessary, it can be administered eight weeks apart before a trip. It should be given 4 weeks after the last PCV dose was taken, either before or concurrently with DTaP.

• Community outbreak (due to vaccine serogroup):

  • Infants ≥2 months to Children 23 months of age:
    • For MenACWY-CRM (Menveo) or MenACWY-D, it must be offered in accordance with age-dependent recommendations, and the course must be finished (Menactra).

• Travel to or residence in countries with hyperendemic or epidemic meningococcal disease:

  • Infants 2 months to children 23 months of age:
    • Start or finish an age-appropriate MenACWY-CRM (Menveo) or MenACWY-D series (Menactra). For more information on dosage, refer to the prior primary vaccination.
  • Children under the age of two and adolescents who have never received a vaccination and who have chronic complement deficiencies (including using eculizumab), functional or anatomic asplenia, or HIV infection should receive:
    • MenACWY-CRM (Menveo) or MenACWY-D (Menactra) in two doses at least eight weeks apart.
  • Other children ≥2 years and Adolescents at increased risk not previously vaccinated and who are either:
    • Those who are at risk during a community outbreak, first-year college students under the age of 21, dorm occupants, travellers to or locals of locations where meningococcal illness is endemic or hyperendemic, or microbiologists frequently exposed to Neisseria meningitidis.
    • MenACWY-CRM (Menveo) or MenACWY-D (Menactra) should be administered as a 0.5 mL IM dose in a single injection.
    • College students who are younger than 21 years old should provide proof of immunizations, preferably from the time they were 16 years old and no more than 5 years before to admission.

• Booster dose: 

  • Booster vaccination for patients NOT at increased risk for meningococcal disease:
    • It is administered as a single 0.5 mL intramuscular injection. The booster dosage should be administered at age 16 if the initial vaccine was given between the ages of 11 and 12.
    • If the initial immunisation was given between the ages of 13 and 15, the booster dose should be administered between 16 and 18.
    • A minimum of 8 weeks must pass between MenACWY (Menveo or Menactra) dosages.
    • If the primary dose was administered after the age of 16, a booster dose is not advised until the patient's meningococcal disease risk increases.

• Booster vaccination for patients at increased risk for meningococcal disease:

  • If the person is still at elevated risk after the first dose, given between the ages of 2 months and 6 years, the dose should be given again three years after the original immunisation and then every five years after that.
  • If the initial dosage was given at a younger age than 7 years old, a second dose should be given 5 years after the original vaccine and then every 5 years after that if the risk is still present.

Pregnancy Risk Factor B

• Its effect on pregnancy is not known.
• If you become pregnant, or are aware that you were pregnant at Menactra vaccination, please contact Sanofi Pasteur Inc. at 1-800-822-2463.
• The inadvertent administration of Menveo to pregnant women is not well documented. 
• GlaxoSmithKline should be contacted at 1-877-413-44759 if a patient becomes pregnant or is aware that they were pregnant at Menveo vaccination.
• There have been no increased risks for fetal health from inactivated bacterial vaccinations.
• If the patient meets all requirements for the vaccine, pregnancy should not be considered a contraindication.

Use of quadrivalent meningococcal conjugate vaccinations during breastfeeding

• It is not yet known if it is secreted into milk.
• Breastfeeding patients should be cautious.
• Studies have shown that breastfeeding doesn't affect the health or well-being of either the mother and the infant.
• The guidelines for breastfeeding infants are to be vaccinated in accordance with the recommendations.

Dose in Kidney Disease:

• TNo specific dose adjustments are required in renal impairment.

Dose in Liver disease:

• No specific dose adjustments are required in liver diseases.

Depending on the product and age category, actual percentages may change. Unless otherwise stated, adverse effects happen in children, adolescents, and adults.

Common Side Effects of Menactra (Quadrivalent meningococcal conjugate vaccine):

• Central Nervous System:

  • Headache
  • Irritability
  • Fatigue
  • Drowsiness
  • Excessive Crying
  • Malaise
  • Pain

• Gastrointestinal:

  • Change In Appetite
  • Nausea
  • Diarrhea
  • Vomiting
  • Anorexia

• Local:

  • Tenderness At Injection Site
  • Induration At Injection Site
  • Erythema At Injection Site
  • Swelling At Injection Site
  • Pain At Injection Site

• Neuromuscular & Skeletal:

  • Arthralgia
  • Myalgia

• Miscellaneous:

  • Fever
  • Crying

Less Common Side Effects of Menactra (Quadrivalent meningococcal conjugate vaccine):

• Central Nervous System:

  • Chills

• Dermatologic:

  • Skin Rash

Contraindications to Menactra (Quadrivalent meningococcal conjugate vaccine):

Hypersensitivity to meningococcal-containing vaccines or any of its components used in its manufacturing including diphtheria toxin carrier protein constitutes an absolute contraindication.

Warnings and precautions

• Anaphylactoid reactions and hypersensitivity reactions

  • Its immediate treatment is epinephrine 1 mg/mL for anaphylactoid and hypersensitivity reactions which should be available during vaccine use.

• Syncope

  • Syncope can be caused by injectable vaccines. It can lead to serious secondary injuries like skull fractures or cerebral hemorhage. 
  • This happens in young adults and adolescents, and usually occurs within 15 minutes of vaccination.
  • To avoid injuries from falling and to restore cerebral circulation in the event of syncope, guidelines and procedures should be defined.

• Acute illness:

  • The severity of symptoms and the cause of the disease will determine whether or not vaccination is administered.
  • Patients with severe or moderate acute illness should be withheld from receiving the vaccine, with or without fever. 
  • Patients with mild acute illnesses should be vaccinated immediately.

• Bleeding disorders:

  • Patients with bleeding disorders, such as thrombocytopenia, should be cautious. IM administration can cause hemorhage. 
  • If antihemophilic therapy has been completed, IM injections can be scheduled within a few hours.

• Meningococcal Infections:

  • It is not advised for the treatment of meningococcal infection, N. meningitidis serogroup A prevention, or diphtheria prevention.

Monitoring parameters:

• After injection, observe for syncope for at least 15 minutes.
• Keep the patient in a supine or Trendelenburg position if seizure-like activity associated with syncope develops in order to restore appropriate cerebral perfusion.

How to administer Menactra (Quadrivalent meningococcal conjugate vaccine)?

IM:

• Use the IM method to administer, preferably into the middle deltoid area.
• Don't use the IV, SubQ, or intradermal routes of administration.
• Use different needles and syringes for each injection; do not mix vaccines or injections.
• Patients should receive their shots while seated or lying down to reduce the risk of harm caused by syncope.
• According to US law, the patient's permanent medical record must include the date of administration, the vaccine manufacturer, the lot number of the administered vaccines, as well as the name, position, and address of the person who administered the vaccine.
• If, in the opinion of a doctor knowledgeable with the patient's bleeding risk, the vaccine can be provided by this route with reasonable safety, it should be given intramuscularly to patients at risk of haemorrhaging.
• A vaccination administered intramuscularly can be scheduled soon after an antihemophilic or other comparable therapy is given to the patient.
• For the immunisation, a fine needle (23 gauge or smaller) may be used, and for at least two minutes, the location may be subjected to firm pressure (without rubbing).
• The danger of hematoma from the injection should be explained to the patient or family.
• Anticoagulant therapy patients should be handled similarly to people with clotting factor abnormalities and should be thought of as having the same bleeding risks.
• It is only for managing IM. Inadvertent SubQ treatment results in a lesser serologic response, according to the limited evidence.
• The reaction is still regarded as protective, though.
• Revaccination is not required if the SubQ method was accidentally used to administer the vaccine.

Mechanism of action of Menactra (Quadrivalent meningococcal conjugate vaccine):

• Promotes immunity to meningococcal infections by causing the production of bactericidal antibodies against the polysaccharide capsule parts of Neisseria Meningitidis serogroups C, Y, and W135

International Brands of Quadrivalent meningococcal conjugate vaccine:

• Menactra
• Menveo
• Menacttra

Quadrivalent meningococcal conjugate vaccine Brands Names in Pakistan:

• Menactra