National Immunization Technical Advisory Group: Meningococcal B immunization Program - Report Example

A report to submit to a National Immunization Technical Advisory Group on the introduction and evaluation of a national Meningococcal B immunization program Name Professor Institution Course Date Introduction Meningococcal disease is a description of the spectrum of various infections resulting from Neisseria meningiditis, and this includes bacteremia, meningitdis, as well as bacteremic pneumonia. Two types of meningococcal polysaccharide-protein conjugate vaccines that offer protection against the serogroups of meningococcal A, C, Y, and W .meningococcal polysaccharide protein conjugate vaccine that protects against serogroups of meningococcal Y and C along with the type B of Haemophilus. This report summarizes and compiles all recommendations on the introduction and evaluation of a national Meningococcal B immunization program to be submitted to the National Immunization Technical Advisory Group. This report also offers recommendations regarding routine vaccination for the people who are at increased risk for meningococcal disease. This includes the people who have deficiencies of persistent complement as well as those who have functional or anatomic asplenia and microbiologists who have a routine exposure to isolates of N. meningitides. The other group of people is that involving recruits in the military and those who reside or travel in areas where meningococcal disease is epidermic or hyperendemic. There is also the provision of guidelines for the management and evaluation of suspected meningococcal disease outbreaks. Background Meningococcal disease is a bacterial infection that results from N. meningitidis. Meningococcal disease has a usual clinical presentation as one of three syndromes: bacteremic pneumonia (9.2%), meningitis (50.2%) or bacteremia (37.5%). The mucosal surfaces of the nasopharynx are colonized by N. meningitides and its transmission is made by direct contact with secretions of large-droplet respiratory tract coming from asymptomatic carriers or patients. The rates of nasopharyngeal carriage are highest in young adults and adolescent who are serving as transmission reservoirs for N. meningitidis. Invasive disease does not frequently result from nasopharyngeal colonization (Offit, 2010, p. 153). Epidemiology of Meningococcal Disease During the period between the years 2005 and 2011, an estimation of 800 to 1,200 cases of meningococcal infection took place annually in the United States. This is a representation of incidences of 0.3 cases in a population 100,000 population. There has been an annual decline of Meningococcal Disease Incidences since it peak which took place during the late 1990s (Figure 1). Even before the recommendation of the use of meningococcal conjugate vaccine in a routine manner on adolescence in 2005, there was an overall decrease of 64 per cent in the annual incidences from 1.1 cases of a population of 100,000 in 1996 to about 0.4 cases of a population of 100,000 in 2005. There have been declines taking place among several age groups as well as all vaccine-containing sero-groups in 2005. In addition, the disease incidences that were attributed to serogroup B did not for part of the vaccine (Breslow, 2012, p. 234). Figure 1: Rate of Meningococcal Disease in the United States between 1970 and 2010 Even though the disease incidence occured at historic lows, the entire fatality-case ratio remains at 15%–10%, and 19%–11% of the patients who survived having long-term sequelae such as digit or limb loss, loss of hearing and neurologic disability. Serogroups Y, C, and B are the main causes of meningococcal Infection in the United States, each one of those accounts for about a third of all the cases. However, the proportion of incidences resulting from each serogroup varies depending on the age group. About 60 per cent of meningococcal infection among children whose age is between 0 through 59 months is as a result of serogroup B N. meningitidis, which is not preventable through vaccines that are currently licensed. Serogroups Y, W, or C, which are included in in the available vaccines in the United States, are responsible for causing 73 per cent of all cases of meningococcal infection among persons aged between 11 years and more. About 98 per cent of meningococcal infections in the United States are regarded as sporadic. However, meningococcal disease outbreak continues to take place. During 2010, there were outbreak reports of two different serogroup C meningococcal (Breslow, 2012, p. 319). In the two reported incidences, there was the recommendation of meningococcal conjugate vaccination that was made and which targeted the officials of state health and other local community members as a measure of control. These outbreaks disappeared shortly following the implementation of the vaccination campaigns, but it is still not known whether the occurrence of additional cases was prevented by the vaccination. In 2010, there were also reported cases of two serogroup B outbreaks. Cases related to all reported outbreaks were a representation of about 108 (1.5 per cent) of the 7,343 of all the reported cases between the years 2005 and 2011. Instances of meningococcal infection were at the peak among people in three age groups. These include children and infants aged 5 years and below, young adults and adolescents who are between the ages of 16 and 21 years, and adults aged 65 years or below. The highest incidence of meningococcal infection in the first five years of life takes place among infants aged between 0 and 5 months; 47 per cent of serogroup Y and C disease among children aged between 0 and 59 months takes place before age 6 months. About 60 per cent of meningococcal infection in the first year of life results from serogroup B. The third incidence of peak happens among adults aged 65 years or below; the features of bacteremia pneumonia characterize about 60 per cent of these cases result from serogroup Y, and 43 per cent. The highest ration of case-fatality ratio (23.8 per cent) occurs among adults (Breslow, 2012, p. 305). Invasive meningococcal disease caused by serogroup B meningococci As indicated in Figure 2, serogroup B meningococcus (MenB) is one the most predominant serogroups that has been associated with the cause of invasive meningococcal disease (IMD) in the United States for the past couple of years. In particular, since, the commencement meningococcal C conjugate vaccine program in 2011–2012, invasive meningococcal disease (IMD) was representing about 84 per centof all IMD in patients who were diagnosed with serogroup B meningococcus (MenB). Figure 2: rates of notification for confirmed invasive meningococcal disease, by serogroup and year (excluding non-groupable isolates), USA, 1999–2012 Risk Factors for Meningococcal Disease Risk factors associated with meningococcal disease can be classified into three categories, which include organism, environmental and host factors. Noncapsular strains of N. meningitidis are less virulent in comparison to capsular strains. Here are demonstrations that have been made that suggest that people coming from low socioeconomic backgrounds were faced with higher risk for meningococcal disease attack in comparison with other persons (Shaw, 2009, p. 165). However, low socioeconomic background and race are also regarded as indicators for other risk factors such as household crowding and smoking. As meningococcal disease incidence has had a decrease, differences resulting from race have also gone down, and no difference with regard to meningococcal disease instances exists now among people from various races. One study of meningococcal disease involving clinical microbiologists who are involved in routine work with N. meningitidis isolates indicated a rate of attack of 13 cases in 100,000 microbiologists and raised the ratios of case-fatality. In the 16 cases that were identified, 15 took place among clinical microbiologists who did not use respiratory protection when they went through exposure. Generally, health-care personnel are not classified as a group that is faced with high risks unless they expose themselves to respiratory secretions of a patient infected with meningococcal disease. Since the instances of both HIV and meningococcal disease infections are low in the United States, studies have not been able to establish HIV as an independent risk factor for the infection of meningococcal (Chosewood, et al, 2009, p. 301). Immunization and health systems When making decisions as to whether to bring about a vaccine into the program for national immunization, those involved in decision-making must consider the potential impact of introducing the program on the entire health system, including its potential in providing other important health services. If there are already weaknesses that are considered serious in the program of immunization, addition of new vaccine may bring about additional burdens and hence affect the performance of the program in a negative way. For instance, if there are failures in the current program with regard to reaching a large proportion of the targeted population, a new vaccine will be in a position to provide only limited advantages to those who are mostly in need of it (Cave and Mitchell, 2011, p. 287). In such instances, bringing about delays in introduction of the vaccine until when major program weaknesses are addressed may be a good option. Those involved in decision-making must also make decisions as to whether the health systems and immunization have the ability to handle, store and administer the vaccine in an adequate manner, considering its specific features, such as the amount of doses as well as the interval between doses. The seriousness of the vaccine schedule, its freeze tolerance as well as freeze tolerance, and the space requirements of storage is another consideration for decision-making. Looking beyond the program of immunization, if the existing workforce is not sufficient, poorly motivated or inadequately trained to handle the existing health package for health services, and then the introduction of a new vaccine to the program may bring about in more stress to that workforce. Poor distribution of the new vaccine and those that are already in the program as well as less attention and time paid to other important health services and programs and services. However, the introduction of a new vaccine may also offer opportunities to for improvement of health systems and the immunization program. For instance, the health workers training regarding the new vaccine offers opportunities to the health workers to refresh their knowledge and skills in immunization and other associated health services (Pollard and Maiden, 2010, p. 207). The introduction of vaccine can also bring about the strengthening of national immunization and technical advisory committees in making appropriate decisions. This is also important in enhanced planning and upgrading of the logistic system and cold chain. Immunization against meningococcal disease Immunization against meningococcal bacteria is considered the most appropriate protection against meningococcal disease. It is worth noting that even if someone has had meningococcal disease, has not acquired immunity and should still go through immunization. Protection against meningococcal serogroup B results from the serogroup B strain of bacteria, which is offered under the schedule of National Immunization Program. For children who are aged 12 months and below, the immunization against meningococcal serogroup B is provided together with a booster vaccine dose against the Haemophilus influenza type B (Hib). For children aged from 13 months up to and including those aged nine years, catch-up immunizations are provided for the ones who have not undergone a full vaccination (Shaw, 2009, p. 43). Immunization targeted against meningococcal serogroup B bacteria was brought into being following increasing incidences of meningococcal disease from this bacteria strain. Because of the introduction there are decreases in such cases that have been witnessed a catch-up immunization was offered to all children and young people who are aged between one year and 19 years, which is a group of high risk of contracting the disease. Infants as well as young children, particularly those aged below 24 months and adolescents aged between 15 and19 years are considered to be at high risks. Adults who are having medical conditions that put them at a great risk of meningococcal disease, such as improper functioning of spleen, lack of it or those with disorders of complement component are also at risk (Cave and Mitchell, 2011, p. 143). These adults include laboratory personnel who are involved in frequent handling of Neisseria meningitidis. In addition to the vaccine against the bacteria causing meningococcal B, there is a combination vaccine against serogroups C, Y, A and W135 bacteria that is considerd helpful for those travelling to countries where meningococcal disease epidemics are taking place, and for persons with poor functioning spleen or without or those having a complement component disorder. Fever management after immunization The common side effects that are normally experienced after immunization are usually temporal and mild. This is because they take place during the initial days following immunization. In such a case, there are usually no specific treatments required. Several alternatives of treatment that are able to lower the side effects of immunization and they include (Pollard and Maiden, 2010, p. 176): Taking extra fluids and avoiding overdressing in case of fever Even though it is not advisable to use paracetamol after immunization, in the presence of fever paracetamol can be offered with the advice of a pharmacists Instances of fever are common in children aged between 2 and 12 months when meningococcal B immunization is provided on the same day that other vaccines can be given. This is common in infants in comparison to when meningococcal B immunization and other routine vaccines are provided on different days. It is important to note that the use paracetamol with every dose of meningococcal B vaccine given to children who are below two years of age, reduces the possibilities of severity of fever that may come about after immunization with meningococcal B vaccine. The initial paracetamol dose of (15 mg/kg per dose) is advisable within the 30-minute duration before immunisation or as soon as it is practicable afterwards, whether fever is present or not. This can be followed by addition of two more paracetamol doses administered six hours apart (Salgaller, 2010, p. 242). Conclusion Meningococcal as an infection and a disease infection is comes about as a result of the action of meningococcal bacteria. This bacteria is also described as Neisseria meningitidis. These bacteria are capable of causing infections that are life-threatening such as to the brain (meningitis) and to the blood (septicaemia). Immunization (Vaccines) is capable of protecting against certain strains of meningococcal infection. The National Immunisation Program should offer immunisation against meningococcal B bacteria. Allergic reactions or Serious side effects to Meningococcal B immunization are rare (Chosewood, et al, 2009, p. 265). Recommendations Based on their high risks associated with Meningococcal B disease, MenB immunization is recommended for: Young children and infants, particularly those aged below 24 months Adolescents who are aged between 15 and 19 years Children as well as adults having medical conditions that subject them to high risks of invasive meningococcal disease (IMD), such as anatomical or functional asplenia or disorders of complement component Laboratory personnel who are involved in frequent handling of Neisseria meningitidis Recommend schedule of Meningococcal B immunization program Age of commencement for vaccination Primary immunization Primary dose intervals Age requirement for dose booster 2 months 3 doses provided at 2, 4 and 6 months Intervals of 2 months and at least one month One year Between 3 and 5 months 3 doses 1 to 2 months One year Between 6 and 11 months 2 doses 2 months One year or 2 months after the previous dose, whichever comes late Between 12 months and 10 years 2 doses 2 months No booster needed 11 years and above 2 doses 1 to 2 months No booster needed Table 1: Recommend schedule of Meningococcal B immunization program References Arvin, A. M., & National Center for Biotechnology Information (États-Unis). (2009). Human herpesviruses: Biology, therapy, and immunoprophylaxis. Cambridge: Cambridge University Press. Breslow, L. (2012). Encylopedia of public health: Vol. 1. New York, NY [u.a.: Macmillan Reference. Cave, S., & Mitchell, D. R. (2011). What your doctor may not tell you about children's vaccinations. Cecil, R. L., Goldman, L., & Ausiello, D. A. (2010). Cecil textbook of medicine. Philadelphia, Penns: Saunders. Chosewood, L. C., Wilson, D. E., Centers for Disease Control (U.S.), National Institutes of Health (U.S.), & Health and Human Services Department. (2010). Biosafety in microbiological and biomedical laboratories. Washington: U.S. G.P.O. Dykes, F., & Hall-Moran, V. (2009). Infant and Young Child Feeding. Chichester: John Wiley & Sons. Offit, P. A. (2010). Deadly Choices: How the Anti-Vaccine Movement Threatens Us All. New York: Basic Books. Pollard, Andrew J., & Maiden, Martin C.j. (2010). Meningococcal Disease. Humana Pr Inc. Salgaller, M. L. (2010). Biotechnology entrepreneurship: From science to solutions. Washington, DC: Logos Press. Shaw, S. (2009). International Council of Nurses: nursing leadership. Oxford, Blackwell Pub. Read More