Abstract Ref Number = APCP54
Traveler Vaccination for Meningococcal Infection in Children from Non-endemic Country
Professor of Pediatrics and Pediatric Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
President Elect of the International Society of Tropical Pediatrics ISTP
International travel has been recently steadily increasing, including children traveling from non-endemic countries to regions endemic with invasive meningococcal disease (IMD) and areas with meningococcal outbreaks. Although IMD is relatively rare in travelers, it remains a serious threat because of its potentially poor outcome and the ability of infection to spread rapidly among a population. Travel to any of the 22 African countries stretching from Ethiopia in the east to Senegal in the west comprising the ‘‘meningitis belt’ and the annual Hajj pilgrimage in Saudi Arabia currently pose 2 of the greatest risks for contracting IMD. The worldwide spread of Neisseria meningitidis infection serogroup A in 1987 and serogroup W135 after 2000/2001 Hajj pilgrimage seasons provides a strong evidence of the role of international travel in the globalization of infections.
Preparing children from non-endemic countries to travel safely to potentially infected regions necessities strict public health precautions. Pediatricians should complete vaccination schedules for children whose primary series is incomplete. Furthermore, vaccination is the best method for preventing IMD. With available vaccines targeting single serogroups or a combination of multiple serogroups; together, these vaccines can provide protection against 5 of the 6 major disease-causing meningococcal serogroups (A, B, C, W, and Y). Specifically, various formulations of conjugated quadrivalent ACWY vaccines are commonly used to target serogroups A, C, W, and, Y and recombinant protein vaccines target serogroup B.
The Advisory Committee on Immunization Practice of the American Academy of Pediatrics recommends that travelers who visit or reside in the “meningitis belt” during the dry season (December–June) and travelers to other countries where outbreaks of meningococcal disease are recognized must receive vaccination with a quadrivalent (serogroup A, C, W, or Y) meningococcal vaccine before travel. The preferred vaccine for people aged 2 months through 55 years and meningococcal vaccine-nonnaïve people aged ≥56 years is the conjugate MenACWY. The polysaccharide MPSV4 is preferred for meningococcal vaccine-naïve people aged ≥56 years. For infants aged <9 months, MenACWY-CRM (Menveo) is the only licensed vaccine that protects against serogroups A and W and therefore should be used for travelers in this age group. In children initiating vaccination at 2 months of age, MenACWY-CRM should be administered as a 4-dose series at 2, 4, 6, and 12 months of age. In children initiating vaccination at 7–23 months of age, MenACWY-CRM should be administered as a 2-dose series, with the second dose administered at ≥12 months of age and ≥3 months after the first dose, although it can be administered as early as 8 weeks after the first dose before travel. For travelers initiating vaccination at ≥9 months, either MenACWY-CRM or MenACWY-D (Menactra) may be used. For travelers 9–23 months of age who receive MenACWY-D, 2 doses should be administered, with the second dose administered at ≥3 months after the first dose, although it can be administered as early as 8 weeks after the first dose before travel. Infants and children who received Hib-MenCY-TT (MenHibrix) are not protected against serogroups A and W and should receive a quadrivalent vaccine before travel. . Children at highest risk for IMD are those with inherited complement deficiency, asplenia, human immune deficiency virus infection, and chronic underlying illness and need additional dosing instructions (https://wwwnc.cdc.gov/travel/destinations/list). Many other non-endemic countries have similar or only slightly different, recommendations for travelers.