Important Information on Two New Vaccines to Prevent Meningitis and Other Serious Infections in Children:

Menjugate and Prevnar

Introduction

Two new vaccines have recently been approved for use in infants and older children for the prevention of meningitis, as well as serious blood infections and pneumonia.

Menjugate protects against Meningococcus, one of the bacteria which can cause meningitis and other serious infections.

Prevnar protects against Pneumococcus. This bacteria causes meningitis, blood infections and pneumonia, as well as less serious diseases including ear infections. The vaccine is designed to protect against many of the different strains of Pneumococcus which can cause serious disease.

Until now, the only vaccines which were available to protect against these two bacteria provided relatively short-term protection, and were not available for children under the age of two years.

How common and how serious are these infections?

The occurrence of Meningococcus infections is, on average, 2 cases per 100 000 people per year, or approximately 100 cases in Canada per year. Meningococcus C is a highly infectious bacteria and is potentially deadly. Approximately 1 in 10 people who get Meningococcus infections will die. 50% of those who get severe blood infections with Meningococcus will die. Many others will suffer serious long-term effects, such as deafness, paralysis, scarring, amputation or kidney damage. The most commonly affected people are children under the age of 5 and people aged 15 - 24.

Serious Pneumococcus infections include meningitis, severe blood infections, bone and joint infections, and severe pneumonia. The overall occurrence of these infections is approximately 15 cases per 100 000 people, but this is much higher in children under the age of 2 years, with rates of 60 to 112 cases per 100 000. Approximately 2% of children with a severe Pneumococcus infection will die, and others will have disabilities such as deafness or paralysis. The Pneumococcus bacteria is also a common cause of less severe infections, including ear infections, sinus infections, and mild pneumonia.

How well do the new vaccines work?

Menjugate

In studies of Menjugate, between 91% and 100% of vaccinated infants and children developed antibodies against the bacteria, and most experts feel that the immunity will be life-long. However, because the vaccine is relatively new, we only have short-term studies. In Great Britain, where the vaccine has been given to all infants and people under age 20 since 1999, Menjugate was shown to be extremely effective (97% in adolescents and 92% in infants) in preventing disease during a nine-month period. More studies are ongoing.

Prevnar

Studies have shown that greater than 90% of children vaccinated with Prevnar developed antibodies to the bacteria. Like Menjugate, this is thought to provide life-long immunity. Preliminary studies have shown the vaccine to be extremely effective (93% in one study) in preventing serious disease caused by Pneumococcus. It modestly decreases the number of ear infections by 7%. More studies are ongoing.

What are the side effects of the vaccines and how common are they?

Menjugate

Side effects of this vaccine are rare and non-serious. They include pain, redness, and swelling at the injection site which resolves within 48-72 hours; irritability, decreased appetite, headache, vomiting and diarrhea. Fever is rare and occurs in approximately 4-10% of children.

Prevnar

Like Menjugate, the side effects of Prevnar are rare and mild and resolve within several days. They include redness, swelling, and pain at the injection site, and rarely irritability.

Children who have an allergy to any component of the vaccines should not receive them.

How many shots are required?

Menjugate

Age at First Shot

Number of Shots Required

less than 4 months

three

4 months to 1 year

two

older than 1 year

one

Shots must be given at least 4 weeks apart.

Prevnar

Age at First Shot

Number of Shots Required

Booster shot @12-15 months

less than 7 months

three

yes

7 months to 2 years

two

yes

1-2 years

two

no

older than 2 years

one

no

Shots must be given at least 6-8 weeks apart.

Prevnar and Menjugate can be given at the same visit in separate injections, and can be given at the same visit as any of the routine vaccinations.

What is the cost?

These vaccines are not covered by the provincial health plan. The cost is approximately $90 per shot of Menjugate and $100 per shot of Prevnar. Some private health insurance plans may cover the cost of these vaccines, so check with yours.

(DIN # for Prevnar is 02244081; DIN # for Menjugate is 02243820)

What are the Current Recommendations?

Right now, Menjugate and Prevnar are not mandatory vaccines in Canada. Menjugate is currently given routinely in Great Britain, and Prevnar is given routinely in the United States.

The National Advisory Committee on Immunization (NACI), a Canadian body, recommends the routine use of Menjugate for infants and children up to the age of 4, and for adolescents and young adults. They state that Menjugate should be considered for children ages 5 and up who have not yet reached adolescence.

The NACI now recommends the routine use of Prevnar to all children under age 2, and to certain higher-risk children under the age of 5. Ask your doctor if your child fits into this group.

Since these are not currently mandatory vaccinations in Canada, the choice is ultimately up to you.

Other Sources of Information

Additional information about meningitis and the new vaccines is available at http://www.meningitis.ca/

For further information, ask your family doctor.

Danielle Manis, M.D.; February 2002