To confer active immunisation against meningococcal illness brought on by serogroups A, C, Y, and W-135, Nimenrix (Quadrivalent Meningococcal Polysaccharide Conjugate Vaccine) is employed.

Nimenrix (Quadrivalent meningococcal polysaccharide conjugate vaccine) Uses:

• Meningococcal disease prevention:

  • It offers protection against invasive meningococcal disease in people 6 weeks of age and older caused by Neisseria meningitidis serogroups A, C, Y, and W-135.
  • According to National Advisory Committee on Immunization (NACI) guidelines:
    • In healthy children or older than 12 years, teenagers, and young adults younger than 24 years old, a monovalent or quadrivalent conjugate meningococcal vaccine is administered as part of a standard vaccination schedule.
    • Vaccination of high-risk individuals:
      • Adolescents and young adults.
      • Laboratory workers routinely exposed to isolates of N. meningitidis.
      • Military recruits.
      • travellers going to regions where meningococcal sickness or transmission is widely prevalent. Based on the serogroup prevalence in the travel zone, the use of a monovalent vaccine may not be acceptable.
      • people who have acquired complement deficiencies as a result of taking the terminal complement inhibitor eculizumab or who have congenital defects in properdin, factor D, complement, or primary antibodies.
      • people who have HIV, especially if it was congenitally acquired.
      • those with sickle cell disease and those with anatomical or functional asplenia.
      • According to limited research, expert opinion, and data, NACI believes that vaccination with the quadrivalent conjugate meningococcal vaccine is appropriate for people older than 56 who are at a high risk of contracting the disease from travel to high-risk regions or from underlying medical conditions.
    • Postexposure management: NACI recommendations for persons considered to be at an increased risk for meningococcal disease:
      • Serogroup should be taken into consideration while choosing which meningococcal vaccine to provide (s):
        • living together, sharing a bed, or having close contact (such as kissing, sharing cigarettes, or using an infected patient's eating or drinking utensils)
        • Employees and children of nursery schools or daycare.

• Off Label Use of Adult

  • It is also used off-label for meningococcal disease outbreak prevention or post-exposure care of close contacts.

Nimenrix Dose in Adults

Nimenrix Dose in the prevention of Meningococcal disease:

• Manufacturer’s labeling:

  • Adults ≤55 years:
    • A single 0.5 mL intramuscular injection of it is administered.

The booster dose is still not recommended. According to the manufacturer's labelling, patients who received their first Nimenrix dose more than a year ago and are at a higher risk of contracting meningococcal serogroup A should think about receiving a second dose.

• Alternative recommendations:

It is significant to mention that its use in high-risk people older than 56 is regarded as suitable based on scant studies and expert opinion:

• Healthy individuals (≤24 years of age):
  • Even if the person has already received the vaccination as an infant or toddler, it is still administered as IM, 0.5 mL in a single dose.
  • Only people who were not immunised as children or adolescents older than 12 years should receive the dose.
• High-risk with underlying medical conditions and not previously immunized with quadrivalent conjugate meningococcal vaccine:
  • It is administered as an IM dosage of 0.5 mL.
  • When a more rapid immunisation is required, give a total of 2 doses at least 4 weeks apart and at least 8 weeks apart.
• Travel to high-risk areas and not previously immunized with quadrivalent conjugate meningococcal vaccine:
  • IM: 0.5 mL dose
• Postexposure management (close contacts) or outbreak control (off-label use):
  • The meningococcal serogroup involved determines the recommended doses:

• Serogroup C:

  • Previously unvaccinated:
    • Immediately following exposure, 0.5 mL/dose is administered intramuscularly (monovalent or quadrivalent vaccine may be used).
  • Previously vaccinated:
    • If more than 4 weeks have passed since the last dose, re-vaccinate with 0.5 mL/dose if given intramuscularly when younger than 1 year of age or if at high risk for invasive meningococcal illness due to underlying medical condition.
    • Otherwise, re-vaccinate with either a monovalent or quadrivalent vaccine if it has been at least a year since the prior dose.

• Serogroup A, Y, or W-135:

  • Previously unvaccinated:
    • It is administered IM as 0.5 mL/dose right away following exposure. When a more fast immunisation is required, high-risk patients with underlying medical issues usually need a total of 2 doses that are provided at least 8 weeks apart, or at least 4 weeks apart.

  • Previously vaccinated: IM:

    • Give 0.5 mL/dose of a quadrivalent vaccine immediately following exposure if a candidate has previously received only monovalent conjugate meningococcal group C vaccine (Men C-C), regardless of when Men C-C was given.
    • Revaccinate with 0.5 mL/dose of a quadrivalent vaccination if it has been more than 4 weeks since the last dose if you were previously immunised with the quadrivalent vaccine at a young age or if you are at high risk for invasive meningococcal illness because of an underlying medical condition. If at least a year has passed since the last dosage, re-vaccinate.

Nimenrix Dose in Childrens

Nimenrix Dose in the prevention of meningococcal disease:

• The Manufacturer’s recommendations:

  • Dose for Primary immunization:

    • Infants 6 - 12 weeks of age:

      • 0.5 ml intramuscularly at ages 2 and 4.
      • Starting vaccinations as early as 6 weeks of age is possible.

    • Children 1 year of age or older and Adolescents:

      • Refer to adult dosing

  • Booster immunization:

    • At the age of 12 months, babies who have finished a 2-dose primary vaccination series are advised to receive a booster dose of 0.5 ml intramuscularly.

Note: In those who have had one dosage at 12 months of age or older, the requirement for a booster dose has not yet been determined. According to the research, it is preferable to give patients who have had their first Nimenrix dosage more than a year ago and who are at an elevated risk of exposure to meningococcal serogroup A a booster dose.

• The NACI (National Advisory Committee of Immunization) recommendations:

  • Children 12 years of age or older and Adolescents:

    • Healthy individuals:

      • IM: Even if the person has already received the vaccination as an infant or toddler, it is still given as 0.5 mL in a single dose that is regularly delivered at the age of 12.

  • Children ≥2 years of age and Adolescents:

    • High-risk individuals who have untreated medical issues and have not received the quadrivalent conjugate meningococcal vaccine:
      • Refer to adult dosing.
    • travel to high-risk regions without having had the quadrivalent conjugate meningococcal vaccination in the past:
      • Refer to adult dosing.
    • Postexposure management (close contacts) or outbreak control (off-label use) (NACI 2012):
      • Recommendations are dependent on the meningococcal serogroup involved:

  • Serogroup C:

    • Children ≥11 years of age and Adolescents: Refer to adult dosing.

  • Serogroup A, Y, or W-135:

    • Children ≥2 years of age and Adolescents: Refer to adult dosing.

Pregnancy Risk Factor: B

• No adverse outcomes were reported in animal reproduction studies.
• The NACI (National Advisory Committee of Immunizations) recommends that pregnant women who are at high risk of contracting the disease should be administered conjugated meningococcal vaccinations during an outbreak and post-exposure prophylaxis.

Use of Nimenrix (Quadrivalent Meningococcal Polysaccharide Conjugate Vaccine) during breastfeeding

• It is unknown whether breast milk secretes it.
• Manufacturers prefer to weigh the benefits and risks of vaccines in infants and mothers.
• NACI states that Nimenrix can be administered to nursing mothers if necessary.

Nimenrix dose in kidney disease:

• No dose adjustment is indicated in renal disease.

Nimenrix Dose in Liver disease:

• No dose adjustment is required in liver disease

Common Side Effects of Nimenrix (Quadrivalent meningococcal polysaccharide conjugate vaccine):

• Central Nervous System:

  • Irritability
  • Drowsiness
  • Fatigue
  • Headache

• Gastrointestinal:

  • Anorexia
  • Gastrointestinal Symptoms

• Local:

  • Pain at the Injection Site
  • Erythema at the injection Site
  • Swelling at the injection Site

• Miscellaneous:

  • Fever

Less Common Side Effects of Nimenrix Include:

• Local:

  • Hematoma at the injection site

Contraindication to Nimenrix (Quadrivalent meningococcal polysaccharide conjugate vaccine):

Hypersensitivity to products is a contraindication.

Warnings and precautions

• Anaphylactoid reactions and hypersensitivity reactions

  • Patients who have received vaccines can experience severe allergic reactions and anaphylaxis.
  • At the vaccination facility, immediate care should be offered, including epinephrine 1 mg/mL.

• Syncope

  • Syncope and dizziness may occur in adolescents or young adults after the administration of the vaccine.
  • A fall or secondary injury such as a skull injury or intracranial bleeding may occur from syncope.
  • The patient should lie down while receiving the vaccine.

• Acute illness:

  • It should be delayed for 14 days following recovery from acute illness in cases of acute illness.
  • It can also be used in mild illnesses without fever.

• Bleeding disorders:

  • Patients with a history or low platelets or bleeding disorder should be cautious as bleeding could occur.
  • Patients suffering from hemophilia and other similar disorders should get the vaccine as soon as possible after receiving the appropriate clotting factor therapy.

Quadrivalent meningococcal polysaccharide conjugate vaccine (MenACWY-TT) (United States: Not available): Drug Interaction

Monitor:

• After the vaccination has been administered, keep an eye on the patient for syncope for at least 15 minutes.
• If the patient develops low blood pressures or seizure-like activity associated with syncope, the patient should be maintained in a supine or Trendelenburg position to reestablish adequate cerebral perfusion.

How to administer Nimenrix (Quadrivalent meningococcal polysaccharide conjugate vaccine)?

• It is for intramuscular use only.
• For newborns, the anterolateral thigh should be used, while for children, adolescents, and adults, the deltoid or anterolateral thigh should be used.
• Intravascular, intradermal, or subcutaneous administration should be avoided.
• The vaccines should not be administered with other vaccines or medicines. A separate injection should be used to administer the vaccine.
• While the vaccine is administered and at least for 15 minutes following the administration of the vaccine, ask the patient to get seated or lie down in a semi-recumbent position to avoid vaccine-related syncope.

Mechanism of action of Nimenrix (Quadrivalent meningococcal polysaccharide conjugate vaccine):

• Nimenrix is a quadrivalent meningococcal polysaccharide conjugate vaccine that stimulates bactericidal antibody production against the meningococcal bacteria.
• These antibodies target the serogroups C, C, Y, and W135 of Neisseria meningitidis. It defends against Neisseria Meningitidis serogroups C, Y, and W135-induced meningitis as well as other severe diseases.

International Brand Names of Quadrivalent meningococcal polysaccharide conjugate vaccine:

• Nimenrix

Brands of Quadrivalent meningococcal polysaccharide conjugate vaccine in Pakistan:

No Brands Available in Pakistan.