в настоящее время в РФ нет официальных рекомендаций по вакцинации против менингококковой инфекции, крме как вакцинация по эпидемическим показаниям. Поэтому можно ознакомиться с рекомендациями США, особенно в преддверии появления в РФ конъюгированных 4-валентных менингококковых вакцин.
1. For the pediatric population, an age-appropriate meningococcal conjugate vaccine is preferred to the meningococcal polysaccharide vaccine, unless there is a contraindication for the meningococcal conjugate vaccine.
2. Adolescents should be routinely immunized at 11 to 12 years of age and given a booster dose at 16 years of age with a quadrivalent conjugated meningococcal vaccine.
3. Adolescents who received their first dose at age 13 to 15 years should receive a booster at age 16 to 18 years at least 8 weeks or up to 5 years after their first dose.
4. Adolescents who receive their first dose of meningococcal conjugate vaccine at or after 16 years of age do not need a booster dose.
5. Unvaccinated or previously vaccinated first-year college students through age 21 years living in residence halls who received their last dose before their 16th birthday (ie, incompletely vaccinated) should receive a single dose of quadrivalent meningococcal conjugate vaccine.
6. For individuals who are at increased risk for invasive meningococcal disease because of persistent complement (eg, C3, C5–C9, properdin, factor H, or factor D) deficiency or functional or anatomic asplenia, a 2-dose primary series (MenACWY-D or MenACWY-CRM) is administered to individuals 2 to 55 years of age, and a 4-dose primary series (MenACWY-CRM or Hib-MenCY-TT) is administered to children 2 to 18 months of age. MenACWY-D can be administered as a 2-dose series to infants 9 to 23 months of age with persistent complement component deficiency, and in infants up to 23 months of age after the fourth dose of the primary pneumococcal conjugate vaccine has been given in children who have functional or anatomic asplenia.
7. HIV infection is not an indication for routine MenACWY immunization before 11 years of age. However, HIV-infected children 11 years of age or older should be given a 2-dose primary series 8 to 12 weeks apart (MenACWY-D or MenACWY-CRM) with a single booster dose, consistent with recommendations for healthy adolescents.
8.For children older than age 2 years who have persistent risk for meningococcal disease because of complement component deficiency or asplenia, their primary series should include 2 doses of quadrivalent meningococcal conjugate vaccine 8 to 12 weeks apart (MenACWY-D or MenACWY-CRM).
9. For children 2 months to 6 years of age at persistent risk for meningococcal disease (Table 2), a booster dose should be given 3 years after the primary series and every 5 years thereafter. For children and adolescents 7 years or older at persistent risk for meningococcal disease (Table 2) whose initial meningococcal vaccination was administered at 7 years or older, boosters of quadrivalent meningococcal conjugate should be repeated every 5 years
Routine vaccination against meningococcal disease is not recommended for healthy children 2 months to 10 years of age unless they are at increased or persistent risk for meningococcal disease (Table 2). Hib-MenCY-TT (MenHibrix) may be administered to any infant for routine vaccination against Haemophilus influenzae type b (Hib). If Hib-MenCY-TT is used for protection against meningococcal disease, it should be used for all 4 doses of Hib vaccine, and other Hib-containing vaccines should not be used.
Limited data suggest that different conjugate vaccine products can be used interchangeably. If the same vaccine product used for the first dose is not available or if it is not known which vaccine product was used previously, administration of the vaccine should not be deferred if indicated, and any licensed age-appropriate conjugate vaccine can be administered.
The meningococcal vaccine is not routinely recommended for HIV-infected children until they reach 11 years of age, similar to other non–HIV-infected adolescents. HIV-infected children should receive 2 doses as their primary series.
A primary series consisting of 2 or more doses (depending on the age of the child) is indicated for children who have asplenia (reduced antibody response after a single primary dose) and complement component deficiency (higher antibody levels are needed for bacterial clearance mechanisms, such as opsonization, and more rapid antibody waning).1
For travelers to areas with high meningococcal endemicity (parts of sub-Saharan Africa [the so-called “meningitis belt”] or the Hajj in Saudi Arabia), an age-appropriate meningococcal vaccine that includes serogroups A and W is indicated. Periodically, there may be other areas in the world with meningococcal outbreaks (eg, serogroup W in Chile). Travelers need to monitor this possibility. Completion of the entire series is preferred before travel as follows: (1) for children <9 months of age: 2, 4, and 6 months of age (with booster at 12 to 18 months of age) with MenACWY-CRM; (2) for children ≥9 months to 23 months of age: 2 doses separated by at least 8 weeks (MenACWY-D) or 2 doses separated by at least 3 months (Menveo); and (3) for people >24 months of age: a single dose (MenACWY-D or MenACWY-CRM).
Pregnancy and breastfeeding do not preclude vaccination with MenACWY (Menactra or Menveo) or MPSV4 (Menomune) if indicated.
Neisseria meningitidis is responsible for a spectrum of infections, such as meningitis, bacteremia, and pneumonia, and may be associated with long-term sequelae and death. Five serogroups of N. meningitidis (A, B, C, W, and Y) are responsible for the vast majority of disease in children and adults. Specific meningococcal serogroups appear to cause a preponderance of disease in certain age groups and geographic areas. For example, in the United States, N. meningitidis serogroup B is predominant in children younger than age 5 years, whereas serogroups C and Y are responsible for the majority of cases in adolescents. N. meningitidis serogroup A is hyperendemic in sub-Saharan Africa (the so-called “meningitis” belt) but it is rarely diagnosed in the United States.
In the United States, 4 licensed meningococcal vaccines are available. One is a quadrivalent (A, C, W-135, Y) polysaccharide vaccine (MPSV4 [Menomune, Sanofi Pasteur, Inc, Swiftwater, PA]). There are 2 quadrivalent conjugate vaccines (A, C, W, Y) (MenACWY-D [Menactra, Sanofi Pasteur, Inc] and MenACWY-CRM [Menveo, Novartis Vaccines and Diagnostics, Inc, Cambridge, MA]), and 1 bivalent (C; Y) conjugate vaccine (HibMenCY-TT [MenHibrix, GlaxoSmithKline Biologicals, Research Triangle Park, NC]), which is also approved as a vaccine for Haemophilus influenzae type b