수막구균백신 [메낙트라 (Menactra), 멘비오 (Menveo), 멘쿼디피 (MenQuadfi)]

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수막구균백신으로 현재 멘비오와 메낙트라를 사용 중입니다. 멘비오 (MenACWY-CRM, Menveo)는 글락소스미스클라인, 메낙트라는 (MenACWY-D, Menactra)는 사노피파스퇴르 회사의 백신입니다.

 

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2020.04월 멘쿼디피 (MenACWY-TT, MenQuadfi) FDA 승인에 대한 내용이 있었고

ACIP는 최근 멘쿼디피 (MenQuadfi)에 대한 내용을 update하였습니다.

What's New Updated ACIP guidelines for meningococcal vaccine (December 2020) Updated guidelines from the United States Advisory Committee on Immunization Practices (ACIP) recommend a booster dose of serogroup B meningococcal vaccine (MenB) one year after the primary series and every two to three years thereafter for persons age 10 and older with anatomic or functional asplenia (including sickle cell disease), complement component deficiency, use of C5 inhibitors (eg, eculizumab, ravulizumab), and microbiologists who routinely work with meningococcus). The same formulation of MenB should be used for all doses. For persons age 2 and older, recommendations for MenQuadfi, the recently licensed quadrivalent meningococcal conjugate vaccine (MenACWY), are the same as for the other licensed MenACWY. We agree with the updated recommendations.

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용어정리

MenACWY은 모든 meningococcal quadrivalent conjugate vaccine을 지징합니다. MenACWY-CRM은 Menveo를 지칭합니다. MenACWY-D는 Menactra를 지칭합니다. MenACWY-TT는 MenQuadfi를 지칭합니다.

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Labeled indications은 다음과 같습니다.

멘비오 (Menveo) ≥2 months to ≤ 55 years of age ​ 메낙트라 (Menactra) ≥9 months to ≤ 55 years of age ​ 멘쿼디피 (MenQuadfi) ≥2 years of age

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Routine meningococcal vaccination recommendations for healthy adolescents and young adults age 11 through 23 years in the United States

Meningococcal vaccine	Primary dose(s)	Booster dose(s)
MenACWY (for those age 11 through 21 years)*	MenACWY (any licensed vaccine): ■ 1 dose, at age 11 through 18 years; preferred age: 11 through 12 years	MenACWY (any licensed vaccine): 1 dose at age ≥16 years; the minimum interval between doses is 8 weeks. If first dose given after age 16 years, then booster is not needed unless the person is at increased risk for meningococcal disease. College freshmen living in residence halls should receive ≥1 dose of MenACWY ≤5 years before college entry.
MenB (for those age 16 through 23 years based on shared decision-making)¶	Preferred age: 16 through 18 years ■ Either: ● MenB-4C: 2 doses, ≥1 month apart, or ● MenB-FHbp: 2 doses, ≥6 months apart	Not routinely recommended unless the person becomes at risk (eg, exposed during an outbreak, occupational risk).

This table is meant for use with UpToDate content on meningococcal vaccination. Refer to UpToDate content for additional details, including meningococcal vaccination of persons at increased risk of meningococcal disease and details of shared decision-making.

■ Three MenACWY are licensed in the United States:

● MenACWY-CRM (Menveo)

● MenACWY-D (Menactra)

● MenACWY-TT (MenQuadfi)

Although each of the MenACWY vaccine formulations uses a different protein conjugate, the products are considered interchangeable in persons ≥2 years of age. The same vaccine product is recommended, but not required, for all doses.

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■ Two MenB vaccines are licensed in the United States:

● MenB-4C (Bexsero)

● MenB-FHbp (Trumenba)

MenB vaccines are not interchangeable; the same brand must be used for each dose of the primary series and all booster doses (if indicated).

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MenACWY: meningococcal groups A, C, W, and Y conjugate vaccine; MenB: serogroup B meningococcal vaccine; ACIP: Advisory Committee on Immunization Practices.

* Although the ACIP recommends routine MenACWY vaccination only for adolescents age 11 through 18 years, MenACWY may be given to persons age 19 through 21 years who have not received a dose.

¶ Given the seriousness of meningococcal disease and efficacy and safety of available formulations, we suggest MenB for persons age 16 through 23 years.

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Meningococcal vaccination recommendations for children age 2 through 23 months who are at increased risk of meningococcal disease in the United States

Targeted group by risk factor and current age	Primary dose(s) of MenACWY	Future booster dose(s) of MenACWY if increased risk persists
Children with anatomic or functional asplenia* (including sickle cell disease) or HIV infection
Age 2 through 6 months	Initiate series with MenACWY-CRM as soon as possible: ■ 3 doses, ≥8 weeks apart ■ 4th dose at age 12 months	■ Primary series completed at age <7 years: 3 years after completion of primary series and every 5 years thereafter ■ Primary series completed at age ≥7 years: every 5 years
Age 7 through 23 months	2 doses of MenACWY-CRM¶, ≥12 weeks apart
Children with complement component deficiency* (eg, C3, C5-C9, properdin, factor H, factor D) or using complement inhibitors (eg, eculizumab, ravulizumab)*
Age 2 through 6 months	Initiate series with MenACWY-CRM as soon as possible: ■ 3 doses, ≥8 weeks apart ■ 4th dose at age 12 months	■ Primary series completed at age <7 years: 3 years after completion of primary series and every 5 years thereafter ■ Primary series complete at age ≥7 years: every 5 years
Age 7 through 8 months	2 doses of MenACWY-CRM¶, ≥12 weeks apart
Age 9 through 23 months	2 doses of either MenACWY-CRM¶ or MenACWY-DΔ, ≥12 weeks apart
Children who travel to or are residents of countries where meningococcal disease is hyperendemic or epidemic◊
Age 2 through 6 months	Initiate series with MenACWY-CRM as soon as possible: ■ 3 doses, ≥8 weeks apart ■ 4th dose at age 12 months	Not applicable
Age 7 through 8 months	2 doses of MenACWY-CRM¶, 12 weeks apart§
Age 9 through 23 months	2 doses of either MenACWY-CRM¶ or MenACWY-DΔ, 12 weeks apart§

This table is meant for use with UpToDate content on meningococcal vaccination. Refer to UpToDate content for additional details, including information about immunizations during meningococcal outbreaks. For children ≥9 months of age, if available, the same MenACWY product should be used for all doses of the primary series. Some of the recommendations are considered off-label (eg, administration of a 2-dose primary series, repeated booster doses).

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MenACWY: meningococcal groups A, C, W, and Y conjugate vaccine; MenACWY-CRM (Menveo), MenACWY-D (Menactra), MenACWY-TT (MenQuadfi); PCV13: 13-valent pneumococcal conjugate vaccine; DTaP: diphtheria and tetanus toxoids and acellular pertussis vaccine; CDC: United States Centers for Disease Control and Prevention.

* Children with these conditions should also receive serogroup B meningococcal vaccine at age ≥10 years.

¶ For children age 7 through 23 months, the second dose of MenACWY-CRM should be given at age ≥12 months.

Δ When given to children at increased risk of meningococcal disease, MenACWY-D should be given before, at the same visit as, or ≥6 months after DTaP, unless the child is at increased risk because of travel, in which case it may be given at any time in relation to DTaP.

◊ Vaccination is recommended for international travelers visiting the parts of sub-Saharan Africa known as the meningitis belt during the dry season (December to June). The CDC issues advisories for other countries during epidemics of vaccine-preventable serogroups. Additional travelers' health information is available from the CDC.

§ The interval may be shortened to ≥2 months if the travel is scheduled in <3 months.

 

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Meningococcal vaccination recommendations for persons age ≥2 years who are at increased risk of meningococcal disease in the United States

Risk factor	MenACWY		MenB for those ≥10 years of age
	Primary dose(s)	Booster dose(s) if increased risk persists	Primary dose(s)	Booster dose(s) if increased risk persists
Immunodeficiency that increases the risk of meningococcal disease
Complement component deficiency (eg, C3, C5-C9, properdin, factor H, factor D) or use of complement inhibitors (eg, eculizumab, ravulizumab)*	2 doses of any MenACWY¶, ≥8 weeks apart	■ Age <7 years: 3 years after completion of primary series and every 5 years thereafter ■ Age ≥7 years: every 5 years	Either: ■ MenB-4C: 2 doses, ≥4 weeks apart, or ■ MenB-FHbp: 3 doses on a 0-, 1- to 2-, and 6-month schedule	1 year after completion of primary series and every 2 to 3 years thereafter.
Anatomic or functional asplenia including sickle cell disease	2 doses of any MenACWY¶Δ, ≥8 weeks apart	■ Age <7 years: 3 years after completion of primary series and every 5 years thereafter ■ Age ≥7 years: every 5 years	Either: ■ MenB-4C: 2 doses, ≥4 weeks apart, or ■ MenB-FHbp: 3 doses on a 0-, 1- to 2-, and 6-month schedule	1 year after completion of primary series and every 2 to 3 years thereafter.
Persons with HIV	2 doses of any MenACWY¶Δ, ≥8 weeks apart	■ Age <7 years: 3 years after completion of primary series and every 5 years thereafter ■ Age ≥7 years: every 5 years	MenB is not recommended unless it is otherwise indicated (eg, age 16 through 23 years based on shared decision-making).
Increased risk of exposure to meningococcal disease
Microbiologists routinely exposed to meningococcus	1 dose of any MenACWY◊	■ Every 5 years	Either: ■ MenB-4C: 2 doses, ≥4 weeks apart, or ■ MenB-FHbp: 3 doses on a 0-, 1- to 2-, and 6-month schedule	1 year after completion of primary series and every 2 to 3 years thereafter.
Persons who travel to or are residents of countries where meningococcal disease is hyperendemic or epidemic§	1 dose of any MenACWY¶◊	■ Age <7 years: 3 years after completion of primary series and every 5 years thereafter ■ Age ≥7 years: every 5 years	MenB is not recommended unless it is otherwise indicated (eg, age 16 through 23 years based on shared decision-making).
Unvaccinated or undervaccinated college freshmen living in residence halls¥	1 dose of any MenACWY◊	■ No recommendation unless otherwise indicated
Unvaccinated or undervaccinated military recruits	1 dose of any MenACWY◊	■ Every 5 years depending on assignment‡

This table is meant for use with UpToDate content on meningococcal vaccination. Refer to UpToDate content for additional details, including meningococcal vaccination of persons at risk who are <2 years of age, routine meningococcal vaccination of adolescents and young adults, and information about immunizations during meningococcal outbreaks. Some of the recommendations above are considered off-label (eg, administration of a 2-dose primary series for MenACWY, repeated booster doses of MenACWY or MenB).

■ Three MenACWY are licensed in the United States:

● MenACWY-CRM (Menveo)

● MenACWY-D (Menactra)

● MenACWY-TT (MenQuadfi)

Although each of the MenACWY vaccine formulations uses a different protein conjugate, the products are considered interchangeable in persons ≥2 years of age. The same vaccine product is recommended, but not required, for all doses.

■ Two MenB vaccines are licensed in the United States:

● MenB-4C (Bexsero)

● MenB-FHbp (Trumenba)

MenB vaccines are not interchangeable; the same brand must be used for each dose of the primary series and all booster doses.

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MenACWY: meningococcal groups A, C, W, and Y conjugate vaccine; MenB: serogroup B meningococcal vaccine; DTaP: diphtheria and tetanus toxoids and acellular pertussis vaccine; PCV13: 13-valent pneumococcal conjugate vaccine; CDC: United States Centers for Disease Control and Prevention.

* Meningococcal vaccines should be administered ≥2 weeks before the first dose of complement inhibitor, unless the risk for delaying complement therapy outweighs the risk for developing meningococcal disease.

¶ When given to children <7 years of age, MenACWY-D should be given before, at the same visit as, or ≥6 months after DTaP, unless the child is at risk because of travel or an outbreak, in which case it may be given at any time in relation to DTaP.

Δ If using MenACWY-D for this dose, give the first dose ≥4 weeks after final dose of PCV13.

◊ Patients at increased risk of exposure who also have an immunodeficiency that increases the risk of meningococcal disease should receive the 2-dose primary series.

§ Vaccination is recommended for international travelers visiting the parts of sub-Saharan Africa known as the meningitis belt during the dry season (December to June). The CDC issues advisories for other countries during epidemics of vaccine-preventable serogroups. Additional traveler's health information is available from the CDC.

¥ College freshmen living in residence halls should receive ≥1 dose of MenACWY ≤5 years before college entry (preferably at age ≥16 years). If only 1 dose of vaccine was administered before the 16th birthday, a booster dose should be administered before enrollment.

‡ Vaccination recommendations for military personnel are made by the United States Department of Defense on the basis of high-risk travel requirements.

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Meningococcal vaccination recommendations for persons age ≥2 years during an outbreak in the United States

Persons who are at risk during an outbreak attributable to a vaccine group	Individuals with exposure to group A, C, W, Y	Individuals with exposure to serogroup B*
Healthy persons with no immunizations against meningococcal disease
2 through 6 months old	MenACWY-CRM: ■ 3 doses, ≥8 weeks apart ■ 4th dose at age 12 months	No recommendations
7 through 8 months old	2 doses of MenACWY-CRM¶, 12 weeks apart	No recommendations
9 through 23 months old	2 doses of MenACWY-CRM¶ or MenACWY-D, 12 weeks apart	No recommendations
2 through 9 years old	1 dose of MenACWY	No recommendations
≥10 years old	1 dose of MenACWY	Either: ■ MenB-4C: 2 doses, ≥4 weeks apart, or ■ MenB-FHbp: 3 doses on a 0-, 1- to 2-, and 6-month schedule
Patients who have completed an age-appropriate primary series of meningococcal vaccine
2 through 6 years old	1 dose if ≥3 years since last dose of MenACWY vaccine	No recommendations
7 through 9 years old	1 dose if ≥5 years since last dose of MenACWY vaccine	No recommendations
≥10 years	1 dose if ≥5 years since last dose of MenACWY vaccine	1 dose if ≥1 year since completing primary MenB vaccineΔ

This table is meant for use with UpToDate content related to meningococcal vaccination. Refer to UpToDate content for additional details. Detailed recommendations for outbreak management are available from the CDC. Consult local public health authorities to identify persons who require vaccination.

■ Three MenACWY are licensed in the United States:

● MenACWY-CRM (Menveo)

● MenACWY-D (Menactra)

● MenACWY-TT (MenQuadfi)

Although each of the MenACWY vaccine formulations uses a different protein conjugate, the products are considered interchangeable in persons ≥2 years of age. The same vaccine product is recommended, but not required, for all doses.

■ Two MenB vaccines are licensed in the United States:

● MenB-4C (Bexsero)

● MenB-FHbp (Trumenba)

MenB vaccines are not interchangeable; the same brand must be used for each dose of the primary series and all booster doses.

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MenACWY: meningococcal groups A, C, W, and Y conjugate vaccine; MenB: serogroup B meningococcal vaccine; CDC: United States Centers for Disease Control and Prevention.

* For healthy persons ≥10 years of age with incomplete MenB immunization, the schedule varies with the vaccine formulation and number of doses received:

Single dose of MenB-4C: Give second dose of MenB-4C ≥1 month after the first dose.

Single dose of MenB-FHbp: Complete a 3-dose series (0-, 1-, and 6-month schedule).

Two doses of MenB-FHbp with second dose <6 months after the first: Give a third dose according to the recommended schedule. If the second dose was given at ≥6 months after the first dose, no additional doses are needed.

If the vaccine type of any previous doses received is not known, the primary series should be restarted and completed using either MenB-4C or MenB-FHbp, since the MenB vaccines are not interchangeable.

¶ For children age 7 through 23 months, the second dose of MenACWY-CRM should be given at age ≥12 months.

Δ A booster dose interval of ≥6 months may be considered by public health officials to avoid missed opportunities for vaccination. Similarly, if the formulation used for the primary series is unavailable or unknown and cannot be quickly determined, any type of MenB vaccine may be administered. However, if possible, the same formulation of MenB vaccine that was used for the primary series should be used, since there are no data on the efficacy of using a different formulation for the booster dose.

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REF. UpToDate 2020.12.19