NeisVac (Meningococcal serogroup C polysaccharide tetanus toxoid combination vaccine) is used to protect patients with complement deficiencies and high-risk persons including recruits in the armed forces and pilgrims from invasive meningococcal illness.

NeisVac (Polysaccharide tetanus toxoid conjugate vaccination for meningococcal serogroup C) Uses:

Note: Not approved in the US

• Meningococcal disease prevention:

  • Infants 2 months, kids, teenagers, and adults develop active immunity against invasive meningococcal illness and/or septicemia brought on 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 taken into consideration while choosing meningococcal vaccines
      • • 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 centers or nursery schools
    • Immunoprophylaxis: Selection of meningococcal vaccination to be based upon serogroup(s):

      • 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

Key Point: Can also be used during serogroup C meningococcal epidemics.

• Health care workers that encounter intensive unprotected contact with infected patients
• Passengers traveling 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 an 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 with 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

• Meningococcal serogroup C polysaccharide tetanus toxoid combination vaccination for adults used outside of the recommended use:

  • Meningococcal disease management following exposure (close contacts) or outbreak prevention

NeisVac (Meningococcal serogroup C polysaccharide tetanus toxoid conjugate vaccine) Dose in Adults:

NeisVac (Meningococcal serogroup C polysaccharide tetanus toxoid conjugate vaccine) Dose as Primary immunization:

• IM: A stat dosage of 0.5 mL per dose is administered.
  Key point: In those primed with a single dosage at age 12 months, the requirement for a booster dose has not yet been determined.

NeisVac (Meningococcal serogroup C polysaccharide tetanus toxoid conjugate vaccine) for Post-exposure management of close contacts or outbreak control (off-label): IM:

• Unvaccinated:

  • 5 mL per dose should be administered immediately postexposure (monovalent or quadrivalent vaccine may be used)

• Previously vaccinated:

  • If the vaccine has been administered at <1 year of age or if the risk for invasive meningococcal disease is high, re-vaccination should be done with 0.5 mL/dose if ≥4 weeks have been passed since the last dose; otherwise re-vaccination should be done if at least 12 months have been passed since last dose (monovalent or quadrivalent vaccine may be used)

NeisVac (Meningococcal serogroup C polysaccharide tetanus toxoid conjugate vaccine) Dose in Children:

NeisVac (Meningococcal serogroup C polysaccharide tetanus toxoid conjugate vaccine) Dose:

• Primary immunization: IM:

  • Infants 2 to 4 months old: 5 mL each dosage; a total of 2 doses should be given at least 8 weeks apart (give the second dose when the infant is older than 5 months).
  • Infants under four months old, kids, and teenagers: See adult dosage.

• Booster immunization:

  • IM: Infants who have finished their primary immunization series are eligible for a single dosage of 0.5 mL/dose given between the ages of 12 and 13 months, at least six months following their last NeisVac-C shot. It has not been determined if those who only got a single primary dosage at 12 months of age require a booster dose.
  • Close contacts' post-exposure management or off-label use's outbreak control

    • Infants 2 to <12 months: IM:

      • Unvaccinated: 5 mL per dose should be given immediately after postexposure; routine series should then be completed afterward
      • Formerly vaccinated: Re-vaccination should be done with 0.5 mL per dose if ≥4 weeks have passed since the last dose; routine series should then be completed afterward if necessary

    • 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 if at least 12 months have passed since the last dose (monovalent vaccine recommended for children 1 to 10 years; may use the monovalent or quadrivalent vaccine in individuals 11 years) or if the risk for invasive meningococcal disease is high. Re-vaccination should be performed with 0.5 mL/dose if less than four weeks have passed since the last dose.

Pregnancy Risk Category: N

• It is not known if it has been used in pregnancy.
• The National Advisory Committee on Immunization recommends that pregnant women consider conjugated meningococcal vaccinations during pregnancy.
• Travel to high-risk locations, when it is necessary for postexposure prophylaxis, or during an outbreak are all examples of this.

Use during breastfeeding:

• It is unknown whether breast milk contains vaccines.
• According to the National Advisory Committee on Immunization, inactivated vaccinations like the conjugate or multi-component meningococcal vaccines may be administered to nursing mothers.

Dose in Kidney Disease:

No dosage adjustments are provided in the manufacturer's labeling.

Dose in Liver disease:

No dosage adjustments are provided in the manufacturer's labeling.

Side effects of NeisVac (Polysaccharide tetanus toxoid conjugate vaccination for meningococcal serogroup C):

• Central Nervous System:

  • Irritability
  • Disturbed Sleep
  • Drowsiness
  • Sleep Disorder
  • Headache

• Gastrointestinal:

  • Anorexia
  • Diarrhea
  • Nausea
  • Vomiting

• Hypersensitivity:

  • Severe Hypersensitivity

• Local:

  • Pain At Injection Site
  • Application Site Induration
  • Injection Site Reaction
  • Swelling At Injection Site

• Neuromuscular & Skeletal:

  • Limb Pain
  • Myalgia

• Miscellaneous:

  • Fever
  • Crying

Contraindications to NeisVac (Meningococcal serogroup C polysaccharide tetanus toxoid conjugate vaccine):

• Hypersensitivity to meningococcal group (C-tetanus toxoid) conjugate vaccine, or any component thereof including tetanus toxoid.

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.

• Syncope

  • Syncope may occur when injectable vaccines are administered. 
  • Syncope may result in detrimental secondary injuries (eg skull fracture, cerebral hemorrhage).
  • This is most common in young adults and adolescents.
  • It usually occurs within 15 minutes of receiving the vaccine. 
  • If syncope does occur, it is important to perform procedures in a way that prevents injuries from falling or restores cerebral perfusion.

• Acute illness:

  • Whether vaccination should be administered or delayed depends on the illness's severity and origin.
  • Vaccine administration should be postponed for healthy patients.
  • The use of vaccines during severe febrile illness (as per Menjugate liquid labeling) is contraindicated. 
  • Patients with mild acute illness (with fever or not) should be vaccinated immediately.

• 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.

Meningococcal serogroup C polysaccharide tetanus toxoid conjugate vaccine (United States: Not available): 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 NeisVac (Meningococcal serogroup C polysaccharide tetanus toxoid conjugate vaccine)?

IM:

• Only the deltoid region should get a deep intramuscular injection.
• Don't give anything intravenously or subcutaneously.
• The vaccine should be shaken before use. Should not be given if particulate matter or discoloration is noted.
• Use unique needles and syringes for each injection; do not combine this vaccination with other injections or vaccinations.
• 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 of NeisVac (Meningococcal serogroup C polysaccharide tetanus toxoid conjugate vaccine):

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

International Brand Names of Meningococcal serogroup C polysaccharide tetanus toxoid conjugate vaccine:

• NeisVac-C
• NeisVac

Meningococcal serogroup C polysaccharide tetanus toxoid conjugate vaccine Brand Names in Pakistan:

No Brands Available in Pakistan.