Meningitec (Meningococcal Serogroup C Oligosaccharide Diphtheria Toxoid Conjugate Vaccine) is used to protect high-risk patients from developing invasive meningococcal illness.

Uses :

Note: Not approved in the US.

• Meningococcal disease prevention:

  • People under the age of two months develop an active immunity against the invasive meningococcal illness caused by N. meningitidis serogroup C.
  • The National Advisory Committee on Immunization (NACI) has advised regular immunisation for young children, adolescents, and adults as well as healthy babies under two months old (per provincial/local schedules). Based on serogroups, meningococcal vaccine candidates are chosen (s). NACI guidelines for people thought to be at a higher risk of meningococcal disease:
    • Chemoprophylaxis and immunoprophylaxis:
    • Serogroup(s) should be considered when choosing meningococcal vaccine candidates: 
      • Should be carried out in those who share sleeping quarters, live in the same home, or come into close contact with an infected patient (such as by kissing, sharing smokes, or sharing eating or drinking utensils). 
    • employees and students in childcare centres or nursery schools
    • Immunoprophylaxis:
      • Serogroup(s) should be considered when choosing meningococcal vaccine candidates: 
    • Young adults and adolescents 
      • technicians who often handle isolates of N. meningitidis in laboratories 
        military enlistees 
      • individuals who reside in or are visiting nations where N. meningitidis is hyperendemic or epidemic, especially if extended interaction with the local population is anticipated. Based on the serogroup prevalence in the travel location, a monovalent vaccination may not be suitable for usage. 
      • terminal complement component deficits in humans 
      • individuals with functional or anatomic asplenia, including those with sickle cell disease
    • Note: Can also be used during meningococcal outbreaks caused by serogroup C.
    • Chemoprophylaxis:
      • Health care workers that encounter intensive unprotected contact with infected patients
      • Passengers travelling in an airline have to sit directly next to an infected patient for a duration of at least 8 hours
      • Individuals who were in close proximity to a person who had invasive meningococcal illness from seven days before symptoms appeared to one day after the start of effective treatment
      • People who have remained in close contact of invasive meningococcal disease caused by the serogroups not present in meningococcal vaccines, or when the serogroup has not been determined in the index case
      • Close contacts that have been vaccinated previously vaccinated or who do not meet re-vaccination criteria (refer to NACI guidelines)
      • See NACI guidelines for specific drug treatment at http://www.phac-aspc.gc.ca/publicat/ciggci/p04-meni-eng.php#a4.

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Uses for Adults

Dosage for the primary vaccination:

• IM: A stat dosage of 0.5 mL per dose is administered.

Note: The need for a booster dose is yet to be established in individuals who received a single primary dose

Dose for epidemic control (off-label) or post-exposure management (close contacts): IM:

• Unvaccinated:

  • 5 mL each dosage needs to be given right once postexposure (monovalent or quadrivalent vaccine may be used)

• Previously vaccinated:

  • Re-vaccination should be performed with 0.5 mL/dose if less than four weeks have passed since the last dose if the vaccine was given before the age of one or if the risk for invasive meningococcal disease is high. If at least 12 months have passed since the last dose, re-vaccination should be performed (monovalent or quadrivalent vaccine may be used)

Dose in Children:

 According to the manufacturer's label:

• Primary immunization:

  • Infants 2 to 12 months: IM:

    • Menjugate, Menjugate Liquid: 0.5 mL each dosage; a total of 3 doses should be given at least one month apart from one another.
    • Meningitec: 0.5 mL each dosage; two doses should be given, separated by at least two months.

  • Children and Adolescents (previously unvaccinated):

    • IM: See adult dosing.

• Booster immunization:

  • IM: Infants who have finished the primary vaccination series may receive 0.5 mL per dosage as a single dose at age 1; the need for a booster dose has not yet been determined in those who got a single dose at or before the age of 12 months.

Dose in the Post-exposure management (close contacts) or outbreak control (off-label) (NACI 2012):

• Infants 2 to <12 months: IM:

  • Unvaccinated: 5 mL per dose should be given immediately after postexposure; routine series should then be completed afterwards
  • Previously vaccinated: If 4 weeks have gone by since the last dosage, a booster immunisation with 0.5 mL per dose should be given; if required, the standard series should then be finished.

• Children and Adolescents: IM:

  • Unvaccinated:5 mL per dose should be given immediately after exposure (monovalent vaccine recommended for children 1 to 10 years; may use the monovalent or quadrivalent vaccine in individuals ≥11 years)
  • Previously vaccinated: Re-vaccination should be performed with 0.5 mL/dose if 4 weeks have passed since the last dose if the vaccine was given before the age of one year or if the risk for invasive meningococcal disease is high; otherwise, re-vaccination should be performed if at least 12 months have passed since the last dose (monovalent vaccine recommended for children ages one to ten; may use the monovalent or quadrivalent vaccine in individuals 11 years).

Pregnancy Risk Category: N

• It is unknown if the vaccine crosses the placenta.
• The National Advisory Committee on Immunization advises pregnant women to think about receiving conjugated meningococcal vaccines during pregnancy if they are going to high-risk locations, travelling during an epidemic, or if it is necessary for postexposure prophylaxis.

Use during breastfeeding:

• It is unknown whether breast milk contains the vaccine.
• According to the manufacturer, when deciding whether to discontinue or continue breastfeeding, it is important to consider the risks to infants, the benefits to the mother and the benefits to the mother.
• The National Advisory Committee on Immunization states that women may be given inactivated vaccines during breastfeeding, such as multicomponent or conjugate meningococcal vaccines.

Dose in Kidney Disease:

No dosage adjustments provided in the manufacturer's labeling.

Dose in Liver disease:

No dosage adjustments provided in the manufacturer's labeling.

Reports have shown the incidence for all indicated age groups unless otherwise specified. Infants received concurrent childhood vaccines.

Common Side Effects 

• Central nervous system:

  • Irritability
  • Decreased body temperature
  • Malaise
  • Drowsiness

• Dermatologic:

  • Erythema

• Gastrointestinal:

  • Diarrhea
  • Change in appetite
  • Nausea

• Local:

  • Pain at injection site
  • Tenderness at injection site Induration at injection site

• Neuromuscular & skeletal:

  • Myalgia
  • Arthralgia

Less Common Side Effects :

• Central nervous system:

  • Sleep disorder
  • Fever

• Dermatologic:

  • Skin rash

• Gastrointestinal:

  • Anorexia
  • Vomiting
  • Dyspepsia
  • Abdominal pain

• Infection:

  • Infection

• Respiratory:

  • Bronchospasm
  • Pharyngitis
  • Rhinitis
  • Upper respiratory tract infection
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• Otic:

  • Otitis media

• Local:

  • Swelling at injection site
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  Miscellaneous:

  • Crying
  • Trauma

Contraindications:

• Hypersensitivity to meningococcal group (C-CRM197 conjugate vaccination or any component)
• Acute severe febrile illness (Menjugate; Menjugate Liquid)
• Meningitec (Meningococcal Serogroup C): Significant neurological signs and symptoms after a previous dose

Warnings and precautions

• Anaphylactoid reactions and hypersensitivity reactions

  • The availability of rapid treatment (including epinephrine) for anaphylactoid and/or hypersensitive responses should be guaranteed when delivering the vaccination.

• Anxiety-related reactions

  • Injectable vaccines may cause vasovagal reactions, such as syncope, hyperventilation or stress-related reactions. 
  • Young adults and teenagers are more likely to have syncope, which can result in significant secondary injuries (such as a skull fracture or brain haemorrhage).
  • It usually occurs within 15 minutes of receiving the vaccine. 
  • It is crucial to carry out treatments in a way that avoids damage from falling or restores cerebral perfusion if syncope does occur.

• Acute illness:

  • Whether or whether vaccination should be administered sooner rather than later depends on the severity of the symptoms and the cause.
  • Vaccine administration should be postponed for healthy patients.
  • Use of vaccines during severe febrile illness (as per Menjugate liquid labeling) is contraindicated. 
  • Patients should get their vaccinations right away if they have a moderate acute sickness, fever or not.

• Bleeding disorders:

  • Avoid bleeding disorders, including thrombocytopenia. IM administration can cause bleeding/hematoma.
  • If the patient has received antihemophilic therapy or another similar therapy, IM injection should be given shortly after.

 Drug Interaction

Monitoring parameters:

• Monitor for 15 minutes after injection if you have syncope. If a patient has syncopal seizure-like activity, he or she should be kept in the supine or Trendelenburg position to restore appropriate cerebral perfusion.

How to administer?

IM:

• Deep intramuscular injection should be given only into the deltoid area.
• If multiple vaccines are given in a single day, separate injection sites should be used.
• IV, SubQ, or intradermal routes should not be used.
• Use different needles and syringes for each injection; do not combine with other injections or immunizations.
• The vaccine should be given while the patient is in a seated or lying down position for the prevention of syncope-related injuries.

Mechanism of action:

• The formation of bactericidal antibodies is directed towards the Neisseria meningitidis serogroup B polysaccharide capsular component. This provides immunity against meningococcal diseases.

International Brand Names:

• Meningitec
• Menjugate

Brand Names in Pakistan:

No Brands Available in Pakistan.