Thursday 25 May 2017

Update on ACWY conjugate vaccine booster

Please note this information was up to date at the time of writing this piece and is updated information to my posting on the subject on 31st August 2016.  It has subsequently been updated again on 22nd June 2017. 

The vaccines we use in the UK and the reason for giving for travel purposes

In the UK we use two quadravalent meningococcal vaccines against the strains A, C, W135 and Y. These two CONJUGATE vaccines are Menveo (supplied by GSK) and Nimenrix (supplied by Pfizer - please note Nimenrix is no longer a black triangle drug). These vaccines are given to travellers going to endemic areas in the meningitis belt of Africa and for travellers undertaking pilgrimage - Hajj and Umrah for which a certificate of proof of vaccination is required, enabling the traveller to obtain a visa for entry to Saudi Arabia.

The Ministry of Health for the Kingdom of Saudi Arabia (KSA) publishes annually its requirements and recommendations for Hajj and Umrah. The new guidance was published in June for 2017 - see here and of significant importance it says 'the conjugate meningococcal vaccine certificate is valid for 5 years.  However, the certificate must state clearly that the Hajji actually received the conjugate meningococcal vaccine. If the vaccine type it not indicated in the certificate, then it will be assumed that it is not the conjugate vaccine and it the validity of the certificate will to be for 3 years.

Whereas in 2016 the KSA announced new information for the length of time to write on the certificate stating 8 years for a conjugate vaccine.  This information should NOW NOT be followed. The should not be administered less than ten days before arrival in the KSA.

For more details about Hajj and Umrah see this NaTHNaC Factsheet

In the UK because we now only use the conjugate vaccines, it is very important to write the name of the vaccine given on the certificate.

On my vaccine chart found at item no. 3 in the TOOLS section of my website, I have put 'when or if a booster should be given is not clear at the current time'  because there is nothing out there giving clear guidance as far as I can see!

  • KSA are saying 8 years for a conjugate vaccine on the certificate (as above). 
  • The Green Book chapter 22 on Meningococcal was updated September  2016 and says:
    • Children and young adults aged 10 years to less than 25 years (including students up to 25 years attending university for the first time) may also be eligible, or will shortly become eligible, for the teenage MenACWY conjugate vaccine. Those in this group who have never received a MenC-containing vaccine should be offered a single dose of the MenACWY conjugate vaccine. No further vaccination is then required.  (page 12)
    • In the section for children and adults with asplenia, splenic dysfunction or complement disorders it says booster doses of MenACWY conjugate vaccine in at-risk individuals are currently not recommended because the need for, and the timing of, boosters has not yet been determined. (page 13)
    • In the section for travellers, the previous information for boosting has just been removed. (page 14)

  • NaTHNaC has no information about boosting. 
  • TRAVAX says 'The need for and timing of a booster dose in those over 1 year of age has not yet been determine'. 
  • The Pharma companies GSK and Pfizer both have data for 5 years. 

Out of interest, looking up information for the CDC Yellow Book online in relation to conjugate vaccines (2016 version still online but also in the 2018 book just published) it says for those over 7 years at continued risk boost at 5 years and every 5 years thereafter for people who are at continued risk.

However here in the UK as nurses we must follow UK guidance.  If and when I learn of any new information then I will post here but at the current time I don't think things are very clear and perhaps you need to phone one of the travel helplines to make a final decision for your traveller after performing a travel risk assessment.  See item no 8 here for these details.