ACIP: Meningococcal Vaccine Recommendations for HIV-Infected Patients

The ACIP previously recommended routine vaccinations for persons aged ≥2 months with specific conditions
The ACIP previously recommended routine vaccinations for persons aged ≥2 months with specific conditions

The Advisory Committee on Immunization Practices (ACIP) recommends that persons aged ≥2 months, infected with the human immunodeficiency virus (HIV) should routinely receive meningococcal conjugate vaccine (serogroups A, C, W, and Y; including MenACWY-D [Menactra, Sanofi Pasteur] or MenACWY-CRM [Menveo, GlaxoSmithKline]).

The ACIP had previously recommended routine vaccinations for persons aged ≥2 months who had specific medical conditions that increase the risk for meningococcal disease. In recommending the vaccine for HIV infected persons aged ≥2 months, the ACIP reviewed the immunogenicity and safety data from two studies (Lujan-Zilbermann J, Warshaw MG, Williams PL, et al. and Siberry GK, Warshaw MG, Williams PL, et al.) of MenACWY-D in HIV-infected individuals. According to a literature search of PubMed using the terms “meningococcal conjugate vaccine,” “quadrivalent,” and “HIV,” and consultation with the manufacturers, the two studies represent all known evidence for the immunogenicity and safety of these vaccines in HIV-infected persons. 

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Results showed that from a lifetime perspective, it is estimated that compared with no vaccination, approximately 122 (95% CI =116–129) cases and 23 (CI=18–29) deaths could be prevented. Additionally a total of 385 (CI=230–458) quality-adjusted life years (QALY) could be saved, at a mean cost per QALY of $732,000 (CI = $337,000–$1,218,000). These figures are based on an assumed conjugate vaccination program that includes a primary vaccination series followed by lifelong booster doses until age 70 years, targeting all currently HIV-infected persons aged ≥2 months in the U.S.

ACIP acknowledges that the recommendation for the vaccine in children aged 2 months to 2 years and persons aged ≥25 years are based on expert opinion as the vaccine was not studied in HIV-infected persons in these age groups. On the basis of available data and expert opinion, either MenACWY-CRM or MenACWY-D may be used in HIV-infected persons.

Specifically, the ACIP recommends that HIV-infected infants (aged 2 to 23 months) receive MenACWY-CRM; they should not receive MenACWY-D before the age of 2 years, similar to the recommendation for children with functional or anatomic asplenia.

All HIV-infected persons aged ≥2 months should routinely receive meningococcal conjugate vaccine; children aged <2 years should be vaccinated using a multidose schedule. Persons aged ≥2 years with HIV who have not been previously vaccinated should receive a 2-dose primary series of meningococcal conjugate vaccine. Persons with HIV who have been previously vaccinated with meningococcal conjugate vaccine should receive a booster dose at the earliest opportunity (at least 8 weeks after the previous dose) and then continue to receive boosters at the appropriate intervals. If the most recent dose was received before age 7 years, a booster dose should be administered 3 years later. If the most recent dose was received at age ≥7 years, a booster should be administered 5 years later and every 5 years thereafter throughout life. 

MenACWY-CRM can be administered concomitantly with PCV13 as MenACWY-CRM does not demonstrate immune interference with 7-valent pneumococcal conjugate vaccine (PCV7) after the 12-month dose. 

The recommendations were approved on June 22nd at the ACIPs annual meeting.

For more information visit CDC.gov.

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