Meningococcal A/C/Y and W-135 polysaccharide vaccine

The meningococcal A/C/Y and W-135 polysaccharide vaccine is a prescription medication belonging to the vaccine class.

The meningococcal A/C/Y and W-135 polysaccharide vaccine is approved for the prevention of meningococcal infection caused by Neisseria meningitidis serogroups A, C, Y, and W-135 in adults, adolescents, children, and infants ≥2 months of age.

It is not a part of national routine immunization programmes.

The meningococcal A/C/Y and W-135 polysaccharide vaccine is given intramuscularly or subcutaneously. It does not function according to standard pharmaceutical pharmacokinetics. Instead of passing through the normal absorption, distribution, metabolism, or elimination processes, it stimulates the immune system to produce antibodies to protect against several strains of the Neisseria meningitidis bacteria, specifically serogroups A, C, Y, and W-135.

The common side effects of meningococcal A/C/Y and W-135 polysaccharide vaccine include pain, swelling, redness at the injection site, nausea, headache, sleepiness, irritability, malaise, and myalgia.

The meningococcal A/C/Y and W-135 polysaccharide vaccine is available as a powder for injections.

The meningococcal A/C/Y and W-135 polysaccharide vaccine is available for travellers to at-risk areas in the United States, Canada, United Kingdom, Australia, India, Brazil, UAE and New Zealand.

The meningococcal A/C/Y and W-135 polysaccharide vaccine belonging to the vaccine class is a sterile injectable solution.

Neisseria meningitidis, a Gram-negative diplococcus, is the cause of severe and even fatal invasive diseases. By the chemical composition of the capsular polysaccharide (CPS), it is divided into several serogroups. The majority of meningococcal infections are linked to serogroups A, B, C, W, Y, and these serogroups' CPS are attached to the carrier protein CRM197 and found in the Meningococcal (groups A, C, Y, and W-135) Oligosaccharide Diphtheria CRM197 Conjugate Vaccine. With simple polysaccharide vaccines, this conjugation improves antibody responses. Once administered, the vaccine stimulates the development of bactericidal antibodies, which target the capsular polysaccharides of serogroups A, C, Y, and W-135. This immune response is essential because it protects against the invasive meningococcal disease caused by these particular serogroups in individuals who have received the vaccination. This vaccination is essential to public health measures to stop the spread of meningococcal infections and protect people—especially those most vulnerable to these severe and possibly life-threatening diseases.

The Meningococcal Vaccine (Group A, C, Y, and W-135) is available as a powder for injection.

Powder for injection: To be administered parenterally, as applicable.

The meningococcal A/C/Y and W-135 polysaccharide vaccine can be used as follows:

• To protect against Neisseria meningitidis serogroup A, C, W-135 and Y bacteria that can cause severe and life-threatening infections such as meningitis and sepsis (blood poisoning) but does not prevent N. meningitidis serogroup B infections.
• It is administered to teenagers, college students, and tourists, especially when they visit areas where meningococcal disease transmission is more prevalent, protecting against potential exposure.
• This vaccine helps prevent severe conditions like meningitis and septicemia, potentially saving lives.

The Meningococcal Vaccine (Group A, C, Y, and W-135) can help support the following health benefits:

• Meningococcal prevention: The meningococcal vaccination (Group A, C, Y, and W-135) helps protect against meningococcal disease in children (from 2 years of age), adolescents, and adults that are caused by Neisseria meningitidis serogroups A, C, Y, and W-135. The most beneficial way to prevent meningococcal disease is to continue being current with prescribed vaccinations. It may also be avoided by maintaining healthy routines like getting enough sleep and avoiding close contact with sick individuals.
• High-risk populations: Meningococcal illness is more common in adolescents and college students due to variables including shared housing and intimate social connections. Giving the vaccination to this population group significantly decreases their chance of developing these potentially fatal diseases. Additionally, those with certain medical disorders that weaken their immune systems are more vulnerable, considering vaccination essential for their protection.
• Safety for travellers: This vaccination benefits tourists visiting areas with more common meningococcal illnesses. There are several different degrees of meningococcal disease risk around the world. Meningococcal vaccinations can help travellers feel more at ease and lessen the health hazards of travel by lowering their risk of acquiring the disease while travelling.
• Life-Threatening Diseases: These serogroups can cause invasive meningococcal illness, resulting in severe and sometimes fatal disorders such as meningitis (inflammation of the tissues or membranes surrounding the brain and spinal cord) and septicemia (bloodstream infection). These diseases have a high fatality rate and the potential for developing quickly. The most important benefit of vaccination is its capacity to fight off these illnesses, potentially protecting lives and lowering the possibility of adverse effects.
• Herd immunity: Public health benefits significantly from this widespread vaccination. The possibility of severe meningococcal disease is reduced within the community. It protects the person vaccinated and those individuals with weaker immune systems, children, the elderly, and vulnerable populations, reducing the burden on healthcare systems and improving overall community wellbeing.

The meningococcal A/C/Y and W-135 polysaccharide vaccine is approved for its use in the following clinical indications:

• Indicated for those children aged two years and older who want to actively avoid invasive meningococcal illness, which is caused by a bacteria called Neisseria meningitidis serogroups A, C, Y, and W-135
• Asplenia
• HIV

Parenterally: The Meningococcal Vaccine (Group A, C, Y, and W-135) is given parenterally. The vaccine is injected directly into the upper arm muscle (deltoid) for children (from 2 years of age), adolescents and adults. It should only be administered intramuscularly or subcutaneously and never IV or intradermally.

When given concurrently with injectable vaccines, the shots have to be delivered using different syringes at different places. Following immunization, monitoring for at least 15 minutes for signs of acute allergic reactions is essential.

The dosage and duration of treatment should be as per the treating physician's clinical judgment.

Powder for injection: 0.5mL/vial

Dosage Adjustment for Adult Patients

Meningococcal Vaccination

The Advisory Committee on Immunization Practices (ACIP) recommendations the preferred vaccine for adults ≥56 yr who have not received the MenACWY conjugate vaccine (Menactra, Menveo) previously and who require a single dose only (e.g., travellers)

0.5 mL subcutaneously as a single dose.

The Meningococcal Vaccine (Group A, C, Y, and W-135) is available as a powder for injection.

Meningococcal Vaccine (Group A, C, Y, and W-135) should be used to prevent Diphtheria and Tetanus toxoid (DT)virus infections in high-risk individuals, along with no appropriate nutritional restrictions.

Meningococcal Vaccine (Group A, C, Y, and W-135) usually has little effect on dietary or food substances when administered. Consuming regular foods and drinks before and after receiving the vaccine is safe.

Staying well hydrated by drinking water or other fluids is commonly advised. Maintaining a rich-balanced diet that includes a variety of fruits, vegetables and lean proteins to help boost the body's immunological response to the vaccine and overall health during vaccination.

The dietary restriction should be individualized as per patient requirements.

Meningococcal Vaccine (Group A, C, Y, and W-135) may be contraindicated in the following conditions-

• Hypersensitivity (previous dose of the vaccine or any of its components)
• Guillain-Barré syndrome
• Severe immunosuppressive diseases like HIV/AIDS or those receiving immunosuppressive medications
• Allergic to latex rubber (present in vial stopper)
• Allergic reactions to polysaccharides or proteins in the vaccine

The treating physician must closely monitor the patient and keep pharmacovigilance as follows.

• Children with weak immune systems, such as those with HIV/AIDS infection or cancer or who are taking certain drugs, may not respond as well to the meningococcal Vaccine (Group A, C, Y, and W-135) and may consult a healthcare professional who might suggest modifying the vaccine schedule or giving additional doses to these people to improve protection.
• If the individual has a moderately critical acute sickness (with or without fever of over 101.3°F or 38.5°C), administration of the vaccine should be postponed.
• When administering intramuscular injections to individuals with thrombocytopenia or other bleeding disorders, caution should be used.
• If an individual is receiving other vaccines simultaneously, healthcare providers should cautiously administer the vaccine, considering all the potential interactions and the intervals between vaccinations.
• Following immunisation, individuals may experience fainting (syncope). Thus, they should be observed for 15 minutes.
• Seizures after immunisation may be more frequent in people with a history of seizures.

Caution is advised when consuming alcohol with the Meningococcal Vaccine (Group A, C, Y, and W-135).

Caution is advised when using Meningococcal Vaccine (Group A, C, Y, and W-135) in the breastfeeding population.

Generally considered safe to use during pregnancy.

There is no sufficient scientific evidence regarding the use and safety of the Meningococcal Vaccine (Group A, C, Y, and W-135) in concurrent use with any particular food.

The adverse reactions related to the Meningococcal Vaccine (Group A, C, Y, and W-135) can be categorized as

• Common: Pain, swelling, redness at the injection site and low-grade fever.
• Less common: Fatigue, headache, muscle/joint pain,
• Rare: Severe Allergic Reactions (Anaphylaxis), seizures, high-grade fever and Syncope.

The clinically relevant drug interactions of the Meningococcal Vaccine (Group A, C, Y, and W-135) are briefly summarized here:

• Immunosuppressants- The immunological response to Meningococcal Vaccine (Group A, C, Y, and W-135) may be suppressed by immunosuppressive treatments such as radiation, antimetabolites, alkylating agents, cytotoxic medicines, and corticosteroids (used in dosages larger than therapeutic doses).
• Other Vaccines- Multiple vaccinations, including the Meningococcal Vaccine (Group A, C, Y, and W-135), given at the same time may increase the risk of adverse reactions. To reduce such a risk, medical professionals frequently adhere to vaccination regimens considering the time and space of vaccines.

The common side of the Meningococcal Vaccine (Group A, C, Y, and W-135) includes the following-

• Pain, redness, swelling or hard lump where the shot was given
• Fatigue
• Headache
• Feeling tired or weak
• Joint pain or swelling
• GI disturbances like nausea, vomiting or diarrhoea.
• Mild fever
• Loss of appetite
• Fussiness or irritability(in infants)

The Meningococcal Vaccine (Group A, C, Y, and W-135) should be prudent in the following population groups.

• Pregnancy: Meningococcal vaccines (Group A, C, Y, and W-135) are usually considered safe during pregnancy.

Pregnancy Category: C; If benefits exceed risks, USE WITH CAUTION. Risk is demonstrated by animal research, yet human studies are either unavailable or have not been conducted.

• Paediatrics: The Meningococcal Vaccine (Group A, C, Y, and W-135) is considered to be safe for use in children and protects against meningococcal illnesses that can be fatal. Lowering the overall occurrence of these life-threatening illnesses benefits not just vaccinated children but also the general population.

Dosage Adjustment for Paediatric Patients

Immunisation

The polysaccharide vaccine is not recommended by ACIP paediatric immunisation guidelines while being FDA-approved for children under two years of age.

<2 years: No evidence of safety or effectiveness

A single dose of 0.5 mL SC

• Geriatrics: Meningococcal Vaccine (Group A, C, Y, and W-135) is not administered for geriatric populations. Elderly patients are typically not routinely given the meningococcal vaccine (Group A, C, Y, and W-135) because it is primarily advised for specific groups, including adolescents, college students, travellers to high-risk areas, and individuals with certain medical conditions that increase susceptibility to meningococcal disease.

• Lactating mothers: In the breastfeeding population, caution is advised when using the Meningococcal Vaccine (Group A, C, Y, and W-135). According to the limited human evidence, the vaccine does not seem to pose any significant risk to the developing foetus.

Dosage Adjustment in Kidney Impairment

There are no specific dosage adjustments provided.

Dosage Adjustment in Hepatic Impairment

There are no specific dosage adjustments provided.

Overdosage of the Meningococcal Vaccine (Group A, C, Y, and W-135) rarely occurs because these vaccines are administered as single doses based on recommended schedules by healthcare professionals according to specific or precise dosing guidelines.

There is no specific antidote or treatment for excessive intake of Meningococcal Vaccine (Group A, C, Y, and W-135). Medical attention should be sought immediately when an overdose is suspected, followed by close monitoring for any adverse effects or allergic reactions. Supportive therapy may include, if necessary, addressing any symptoms that persist or worsen. Physical treatment might be added if required.

Pharmacodynamics of Meningococcal Vaccine (Group A, C, Y, and W-135):

The Meningococcal Vaccine (Group A, C, Y, and W-135) has a potential physiological mechanism that plays a role in its pharmacodynamics, involving its interaction with the immune system. Purified capsular polysaccharides from the serogroups A, C, Y, and W-135 of Neisseria meningitidis are found in this vaccine and attached to a protein carrier. Following immunisation, the immune system identifies these polysaccharides as foreign antigens.

To protect against specific serogroups' capsular polysaccharides, the vaccine's primary effect is to promote the production of particular antibodies to fight against the specific meningococcal serogroups; these antibodies are necessary. They support the bacteriophage neutralisation and phagocytosis processes, which enable immune cells to absorb and eliminate invaders.

Pharmacokinetics of Meningococcal Vaccine (Group A, C, Y, and W-135):

The Meningococcal Vaccine (Group A, C, Y, and W-135) is given subcutaneously. It does not function according to standard pharmaceutical pharmacokinetics. Instead of passing through the normal absorption, distribution, metabolism, or elimination processes, it stimulates the immune system to produce antibodies to protect against several strains of the Neisseria meningitidis bacteria, specifically serogroups A, C, Y, and W-135.

• Deeks, Emma D. “Meningococcal quadrivalent (serogroups A, C, w135, and y) a conjugate vaccine (Menveo): in adolescents and adults.” BioDrugs: Clinical immunotherapeutics, biopharmaceuticals and gene therapy vol. 24,5 (2010): 287-97. doi:10.2165/11204790-000000000-00000.
• Cooper, Brian et al. “Menveo®): a novel quadrivalent meningococcal CRM197 conjugate vaccine against serogroups A, C, W-135 and Y.” Expert review of vaccines vol. 10,1 (2011): 21-33. doi:10.1586/erv.10.147
• Myers, Tanya R, and Michael M McNeil. “Current safety issues with quadrivalent meningococcal conjugate vaccines.” Human Vaccines & Immunotherapeutics vol. 14,5 (2018): 1175-1178. doi:10.1080/21645515.2017.1366393

• Explain to the caregivers the vaccine's dosage and schedule, including the number of doses and intervals between them. Assure them that the immunisation series must be completed for optimal protection.
• Inform the vaccination recipient, their parents, or their guardians whether they had any side effects from a prior dosage of the meningococcal A/C/Y and W-135 polysaccharide vaccine and the benefits of vaccination, such as preventing life-threatening diseases.
• Assure caregivers that meningococcal A/C/Y and W-135 polysaccharide vaccine immunizations are generally safe, with only minor, short side effects. Encouraging them to immediately report any unexpected or severe responses to the healthcare physician and, whenever applicable, to use reporting systems like the Vaccine Adverse Event Reporting System (VAERS)
• Inform caregivers of the recommended immunization schedule, which usually consists of two or three doses, depending on the vaccine brand used. Also, mention the ages at which the doses should be administered and give the Vaccine Information Statements, which must be disclosed before immunization by the National Childhood Vaccine Injury Act of 1986 about the Centres for Disease Control and Prevention (CDC) website (www.cdc.gov/vaccines), these resources are freely accessible.

https://main.mohfw.gov.in/sites/default/files/Universal.pdf

https://www.indianpediatrics.net/oct2014/785 figure1.pdf

http://www.cdc.gov/vaccines/schedules/hcp/index.html

https://www.cdc.gov/vaccines/hcp/vis/vis-statements/mening.html