Patient Encounter 2

An 18-year-old male is having a routine physical before leaving for college. He will be a freshman and is looking forward to dormitory life. The health care provider recommends some vaccinations be given at this visit.

Which vaccines should be administered?

What is the risk of not receiving the vaccines?

A meningococcal polysaccharide vaccine containing serogroups A, C, Y, and W-135 has been available in the United States for a number of years. Meningococcal polysaccharide vaccine is similar to other polysaccharide vaccines, in that it is poorly immunogenic in infants and children less than 2 years of age, and does not produce lasting immunity. Meningococcal polysaccharide vaccine produces a T-cell-independent response and fails to induce a memory response. Repeated vaccination results in hyporesponsiveness to serogroups A and C; the clinical implication of this finding is unknown.

In January 2005, a new meningococcal polysaccharide diphtheria toxoid conjugate vaccine was approved by the FDA. This vaccine also contains meningococcal serogroups A, C, Y, and W-135. Polysaccharide-protein conjugate vaccines are known to produce improved immunogenicity and memory responses. Meningococcal conjugate vaccine has shown similar immunologic response for all four serogroups when compared to meningococcal polysaccharide vaccine. However, this vaccine does not offer protection against diphtheria.

Meningococcal conjugate vaccine is recommended for routine vaccination in individuals 11 to 18 years of age. Ideally, this should be done at the routine preadolescent health care visit. Routine meningococcal vaccination is also recommended for persons aged 19 to 55 years at increased risk for meningococcal disease, such as college freshman living in dormitories, microbiologists who are routinely exposed to isolates of N meningitidis, military recruits, persons who travel to or reside in countries in which N meningitidis is hyperendemic or epidemic, persons who have terminal complement component deficiencies, and persons who have anatomic or functional asplenia.13 Additionally, meningococcal conjugate vaccine should be administered to children 2 to 10 years of age who are high-risk of meningococcal disease.14 Routine revaccination is not recommended at this time.12 A history of Guillain-Barre syndrome is a relative contraindication to receiving meningococcal conjugate vaccine, and the risk versus benefit should be carefully considered. Individuals may be given the meningococcal polysaccharide vaccine in lieu of the conjugate vaccine.

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