ATAGI recommendations for Meningococcal C

Please find below recommendations from the Australian Technical Advisory Group on Immunisation (ATAGI) arising from Wyeth's distribution of a letter to doctors concerning their Meningitec vaccine and a booster dose.

If anyone requires further information regarding this matter please do not hesitate to contact the Immunisation Program on telephone 1300 882 008.

ATAGI Recommendations

ATAGI considered the issue of whether it should be recommended that children who had been vaccinated on the private market be recalled for booster vaccination at 12 months of age. ATAGI considered data from the UK that assessed protection provided by a compressed infant schedule (2,3,4 months of age), against the Australian schedule of 2,4,6 months of age. The data from the UK show little to no protection over time with the compressed schedule, but reasonable protection using the Australian schedule, 5 years post vaccination. ATAGI also noted that no evidence of vaccine failure in these children had been identified, and for these reasons (based on current evidence) felt comfortable recommending that, in Australia, a booster dose for children vaccinated in infancy using privately purchased vaccine at 2,4,6 months of age, was not necessary at this time.

Additional advice from ATAGI is that children who have travelled to Australia from the UK, who received the compressed 2,3,4 month schedule should receive the recommended booster dose at 12 months of age. Some of these children will be eligible for free vaccine under the NIP, while others will be required to purchase the vaccine privately.

ATAGI agreed to amend the Australian Immunisation Handbook to reflect both the updated Meningitec product information, and the updated NeisVac-C product information. (Recently, TGA also approved a change to the NeisVac-C product information such that infants receive a primary course at 2 and 4 months of age, with a booster at 12 months of age.) TGA has advised that no changes have been made to the Menjugate product information.

At present the draft words that will be included in the 9th Edition meningococcal disease Handbook chapter pertinent to this issue are:

"The product information for meningococcal C conjugate vaccines state that under the age of 12 months, either two (NeisvacC) or three doses of vaccine (Meningitec and Menjugate) are required. The NHMRC recommends that, for infants aged between 4 to 11 months at the commencement of vaccination, 2 doses of MenCCV are sufficient. For children vaccinated under 12 months of age, the product information (for Meningitiec and Neisvac C) states that a booster dose of MenCCV is required at 12 months of age based on UK data of reduced vaccine efficacy for children immunised at 2-3-4 months of age. Reduced efficacy was not seen in children vaccinated after 4 months of age in the UK. Based on current Australian data, the risk of meningococcal C disease in children vaccinated at 2-4-6 months of age prior to January 2006 is very low and a catch up dose is not necessary at this time."