3 Facts About Meningococcal Vaccine Recommendations for Patients With HIV

DECEMBER 01, 2016
The CDC is now recommending the routine use of the meningococcal conjugate vaccine for patients with human immunodeficiency virus (HIV).

The CDC had previously recommended routine vaccination for all adolescents and individuals at risk for meningococcal disease.1 Meningococcal disease is considered any illness caused by the bacteria Neisseria meningitides.1 The 5 serogroups (strains) causing the most infections worldwide are A, B, C, W, and Y.1 Additionally, serogroups B, C, and Y cause the most illness in the United States.1 Individuals infected with meningococcal disease can develop severe infections including meningitis, bacteremia, or septicemia. These 3 facts will serve as counseling points to assist patients with HIV with important vaccine information.
  1. New recommendations include individuals > 2 months of age with HIV.2
The CDC's Advisory Committee on Immunization Practices recommended at its June 2016 meeting the routine use of the meningococcal conjugate vaccine (serogroups A, C, W, and Y) for individuals > 2 months of age with HIV infection. The same vaccine product should be used for all doses. However, if the product is unknown or unavailable for previous doses, then the series can be completed with any age and formulation appropriate vaccine. 
  1. The recommendations include a 2-dose primary series and booster dose recommendations2
Patients > 2 years of age with HIV infection who have not been previously vaccinated should receive a 2-dose primary series of MenACWY conjugate vaccine. Additionally, individuals > 2 years of age with HIV infection who have been previously vaccinated with one dose of the meningococcal conjugate vaccine should receive a booster dose at the earliest opportunity, separated by at least 8 weeks from the previous dose. If the most recent dose was administered before age 7 years, then a booster dose should be given 3 years later.  If the most recent dose was received at > 7 years of age, then a booster dose should be administered 5 years later and every 5 years throughout life.
  1. Evidence suggests there is an increased risk of meningococcal disease in patients with HIV.2
There is growing evidence suggesting that patients with HIV have an increased risk of developing meningococcal disease. Additionally, the risk increases in patients with a low CD4 count or high viral load. The CDC utilized the Grading of Recommendations, Assessment, Development, and Evaluation for the new recommendations. The risks and benefits were reviewed through 2 open-label observational studies. Even though these study designs provided a low level of evidence, the CDC evaluated the risks and benefits of the vaccine for this patient population.  It was determined that the meningococcal vaccine provides efficacy in the short term and is safe.  Since the efficacy wanes over time, the booster doses are recommended.  The most common adverse effect associated with the vaccine is pain at the injection site.  Other less common adverse events may include mild fever, sever pain at the injection site, and anaphylactic reactions.
  1. Meningococcal disease.  CDC website.  Accessed November 26, 2016.
  2. MacNeil JR, Rubin JL, Patton M, et al.  Recommendations for use of meningococcal conjugate vaccines in HIV-infected persons-Advisory Committee on Immunization Practices, 2016.  MMWR Morb Mortal Wkly Rep. 2016;65:1189-1194. Accessed November 26, 2016.

Jennifer Gershman, PharmD, CPh
Jennifer Gershman, PharmD, CPh
Jennifer Gershman, PharmD, CPh, received her PharmD degree from Nova Southeastern University (NSU) College of Pharmacy in 2006 and completed a 2-year drug information residency. She served as a pharmacy professor at NSU’s College of Pharmacy for 6 years, managed the drug information center, and conducted medication therapy management reviews. Dr. Gershman has published research on prescription drug abuse, regulatory issues, and drug information in various scholarly journals. Additionally, she received the Sheriff’s Special Recognition Award for her collaboration with the Broward, Florida Sheriff’s Office to prevent prescription drug abuse through a drug disposal program. She has also presented at pharmacist and physician continuing education programs on topics that include medication errors, prescription drug abuse, and legal and regulatory issues. Dr. Gershman can be followed on Twitter @jgershman2