Updated guidance on use of meningococcal A conjugate vaccines in routine immunization of infants and young children

Source: WHO website

Mothers and babies in a waiting room prior to vaccinating their childrenWHO/AFRO
GENEVA, 20 FEBRUARY 2015 - In an updated position paper published in today’s edition of the Weekly Epidemiological Record, WHO emphasizes the importance of completing mass vaccination campaigns in individuals aged 1 to 29 years in all countries in the African meningitis belt, and the need to conduct high quality surveillance and vaccine programme evaluation in those countries. The meningitis belt stretches from Senegal in the west to Ethiopia in the east. As of January 2015, over 217 million persons have received meningococcal A conjugate vaccine in 15 countries of the meningitis belt.

WHO recommends that countries completing mass vaccination campaigns introduce meningococcal A conjugate vaccine into the routine childhood immunization programme within 1 to 5 years following campaign completion, along with a one-time catch-up campaign for children born since the initial mass vaccination campaign and which would not be within the age range targeted by the routine immunization programme.

In areas where routine childhood vaccination coverage with meningococcal A conjugate vaccine is below 60%, periodic vaccination campaigns could be considered to complement routine vaccination, as herd protection may not be sufficient to protect those who are not immunized.

The 15 African meningitis belt countries; illustration by PATH

WHO recommends a 1-dose schedule at 9 to 18 months of age based on local programmatic and epidemiologic considerations. This recommendation for routine immunization programmes is based on the high level of herd immunity following mass campaigns, epidemiologic evidence on the age distribution of disease, and programmatic and economic considerations. Any children who miss vaccination at the recommended age should be vaccinated as soon as possible thereafter.

Data on co-administration with other vaccines has been evaluated and found to be acceptable for diphtheria toxoid, tetanus toxoid, whole cell pertussis, hepatitis B, Haemophilus influenzae type b, oral poliovirus, yellow fever, measles and rubella vaccines. No evidence exists for co-administration with rotavirus vaccine, pneumococcal conjugate vaccine or inactivated polio vaccine. As there is no reason to expect vaccine interference, absence of data should not discourage co-administration and its related further evaluation.

Vaccination of pregnant women is safe, as assessed in a well-conducted observational study. Therefore pregnant women should be included if in the age range targeted by the mass vaccination campaigns.

A position paper on meningococcal vaccines was published in 2011 and its recommendations remain valid. The updated guidance adds to the previous recommendations specifically concerning routine immunization of infants and young children in the meningitis belt with meningococcal A conjugate vaccine, following discussions at the October 2014 meeting of the Strategic Advisory Group of Experts (SAGE) on immunization.