It Is Useful To Give Meningococcal Vaccine To University Students
Question: Our oldest son is going to attend university later this year. He is planning to live in residence. I have been on the Internet and found that in United States, the government recommends university students to receive meningococcal vaccine. Should we get him this vaccine before he goes?
Answer:
Well, the Internet is making an impact on the lives of many Canadians in ways that we never imagined even ten years ago. You are coming with a question after you read some information on the Internet. It is an interesting and important question. I will try to give you an answer that hopefully will help you to make the right decision.
Meningococcal vaccine protects a person against the bacteria Neisseria meningitidis (also called meningococcus). There are 13 recognized groups of meningococcus. The most common ones that cause infection are A, B, C, Y, and W-135. Interesting enough, humans are the only ones susceptible to meningococcus.
About 10-30% of healthy teenagers and adults carry meningococcus in their throat. It is spread from person to person through droplets from the respiratory tract. That is why these bacteria spread more easily in crowded situations and when people share drinking or eating utensils. However, it is not clear why some carry the bacteria and stay healthy, while others would get seriously ill when infected.
Sporadic cases of meningococcal infection occur all around Canada. Young children, especially those under one year of age, are most often struck by these bacteria, probably because of their weaker and immature immune system. However, all age groups are susceptible to meningococcus.
From time to time, epidemics of meningococcal infection will occur, usually in late winter and early spring, in different communities across North America. They usually attract lots of media attention. During these outbreaks, the victims are frequently high school and university students. It is also during these epidemics when you hear about vaccination campaigns to prevent the spread of these bacteria.
Meningococcal infection starts in the throat, and very quickly invades the body through the blood stream. If infection stays in the blood, it is called septicaemia. These patients become extremely sick very rapidly, and can die within hours. Very often, bleeding will occur on the skin as small dots or large patches.
The most common complication of meningococcal infection is meningitis. That is why the germ is called meningococcus. Other complications like pneumonia and septic arthritis (joint infection) can also occur.
Overall, about 10% of patients who develop meningococcal disease will die, although many more will suffer various complications, including brain damage and hearing loss.
In addition to over-crowding, exposure to cigarette smoke has also been recognized as one of the risk factors. Those who have immunodeficiency, especially those without a functioning spleen, are most susceptible to fatal meningococcal disease.
Over the last twenty years, many of the outbreaks in Canada are due to group C meningococcus, although infections due to other groups do occur from time to time.
Around the world, meningococcal infections are much more common in poor and under-developed countries. Malnutrition and over-crowding are most important factors. In Africa, there is a ‘meningitis belt’ in the sub-Saharan region with epidemics occurring every 5-10 years. Cycles of epidemics every 10 years have also been reported in some parts of China.
In the last few years, outbreaks of meningococcal infection have occurred in pilgrims to Mecca, Saudi Arabia. As a result, the government have required pilgrims attending the annual Hajj pilgrimage in Mecca to receive meningococcal vaccine at least two weeks before their trip.
Although meningococcal infections can be treated with antibiotics, fatality and complications remain very high. Therefore, great deal of research has been devoted to the development of effective vaccines.
It was discovered that each group of meningococcus carry a unique substance, called polysaccharide, outside the bacterial cell. This polysaccharide can induce immunity and protect future infection. Vaccines have been developed against groups A, C, Y, and W-135, using these different polysaccharides. Unfortunately group B polysaccharide does not produce useful immunity; therefore no vaccine is available for group B meningococcus.
There is still another catch to the vaccine development. The polysaccharide vaccines to A, C, Y, and W-135 are fairly effective for older children and adults. However, young children who are most susceptible to meningococcal infection do not respond to the vaccine very well, and they remain unprotected.
Last year, a new meningococcal vaccine was marketed which was more effective for young infants and children. It is called Menjugate. This vaccine links the group C polysaccharide with a protein molecule, so that the immune system of young children can recognize the polysaccharide, and mount an effective antibody response.
Unfortunately, Menjugate is only effective against group C meningococcus. Research is still ongoing for the other groups. No doubt additional combined vaccine that is effective for several groups of meningococcus will be available in the next few years. Since group C is responsible for most of the outbreaks in Canada, using Menjugate can still prevent many of these outbreaks, and provide individuals with long-term protection against the bacteria.
Parents who have young children should consider getting this vaccine for their children. At the present time, this vaccine is too expensive for any province to provide it routinely to all young children. The recommended immunization schedule for infants is three doses at 2, 4, and 6 months of age, the same as all other routine vaccination. Unvaccinated children between 4 to 11 months should receive two doses of this vaccine at least one month apart. Children over one year of age can be adequately protected with a single dose of Menjugate.
Recent research in United States has shown that college and university students living in residence are more likely to carry meningococcus in their throat. Outbreaks of meningococcal infection have occurred in this group of students. Therefore, the American Academy of Paediatrics has recommended that students entering post-secondary education should be offered meningococcal vaccine.
Similar outbreaks in universities have not occurred in Canada. However, there is still the increased risk if your son is going to live in university residence. The most likely germ is group C, although other groups can also cause serious infection. The best thing to do is to give him Menjugate, which will protect him against group C meningococcus. If you want to be extra cautious, the polysaccharide A, C, Y, and W-135 vaccine can be given after another 2 weeks. This will give him additional protection against other groups of meningococcus.
We are all waiting for the new vaccine that will be effective in preventing multiple groups of meningococcus. This will likely happen in the next few years. Another big hurdle is the cost of the new vaccine. We certainly hope that governments can work out a mechanism so that all children can receive this vaccine as part of their routine immunization.
[Note to Readers: Like many other vaccines, there have been major advances to meningococcal vaccine. There is one for the B strain of meningococcus, a much more difficult one to manufacture compared with other strains. Please refer to your local public health department, or family doctor, to find out what is being done in different provinces about routine vaccination against meningococcus infection.]