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Malaysian Society of Infectious Diseases & Chemotherapy

Guidelines for Adult Immunisation

Content

Message from Editor

Editorial Panel

Adult Immunisation Schedule

Contraindications and Special Considerations

Temporary Deferral of Immunisation

Route and Site of Administration

Post Vaccination

Anaphylaxis

Vaccine Storage and Disposal of Vaccines

Vaccine Combinations

Multiple Vaccinations

Adverse Event Following Immunisation (AEFI)

Immunosenescence

Cholera

COVID-19

Dengue

Diphtheria

Tetanus

Pertussis

Haemophilus influenzae type b

Hepatitis A

Hepatitis B

Human Papillomavirus (HPV)

Influenza

Japanese Encephalitis (JE)

Measles

Mumps

Rubella

Meningococcal Disease

Mpox

Pneumococcal Disease

Poliomyelitis

Rabies

Respiratory Syncytial Virus (RSV)

Typhoid Fever

Chickenpox (Varicella)

Yellow Fever

Shingles (Zoster)

Passive Immunisation

Avian Influenza

Chikungunya

Clostridioides difficile

Ebola

Human Immunodeficiency Virus (HIV)

Malaria

Zika

Adults Who Missed Childhood Immunisation

Older Adults and Patients With Chronic Ilnesses

Healthcare workers

Human Immunodeficiency Virus (HIV)

Immunocompromised Patients

Miscellaneous Groups

Travelers

Vets & Animal Handlers

Abbreviations

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Available Vaccines

Meningococcal Disease

In this chapter:

Introduction

Meningococcal disease is most commonly manifested as meningitis or sepsis but can also present as septic arthritis or carditis. It is caused by Neisseria meningitidis, which is classified into 12 serogroups of which serogroups A, B, C, W135, X, or Y capsular polysaccharides have been associated with invasive disease.

Neisseria species, which usually reside asymptomatically in the human nasopharynx, are easily transmitted to close contacts by respiratory droplets. Nasopharyngeal carriage of potentially pathogenic N. meningitidis has been reported in 4%–35% of healthy adults. In particular, high carriage rates have been found in relatively confined populations such as college students and army recruits. Studies in the UK and US have revealed that students, in their first year of college and who are living in dormitories are at a higher risk of meningococcal disease, compared to other college students and age-matched general population. Outbreaks following the Hajj pilgrimage to Mecca illustrate how high levels of transmission of N. meningitidis can occur under crowded conditions.

The case-fatality is typically 10–15% and can be higher in meningococcemia, even with treatment.

In the African meningitis belt, which is considered to have the highest annual incidence in the world, serogroups A, C and W135 are the main causes of epidemic meningococcal meningitis. Serogroup B is generally associated with sporadic disease but may cause some upsurges or outbreaks. Serogroup W135 has caused international outbreaks in 2000 and 2001 among Hajj pilgrims and household contacts of returning pilgrims.

Vaccines

  • Currently, tetravalent vaccines protecting against A, C, Y and W135 are available. These vaccines are derived from the capsular polysaccharide and can be either conjugated to diphtheria/tetanus toxoid or CRM197 (a non-toxic protein of Corynebacterium diphtheriae). These vaccines offer no protection against serogroup B organisms.
  • A vaccine against serogroup B meningococcal disease is used in some countries but it is not currently available in Malaysia. It is a multicomponent vaccine made from three meningitidis proteins and capsular group B outer membrane vesicles. Fortunately, Men B vaccination is not included in current immunisation strategies in Kingdom of Saudi Arabia (KSA), or for individuals entering the country for the Hajj and Umrah pilgrimages
  • A pentavalent meningococcal ACWYX conjugate vaccine (Men5CV), the first to include NmX, was prequalified by WHO in July 2023, with an indication for use in individuals aged ≥1 year. Countries (especially in the African meningitis belt) with >10 districts crossing the epidemic threshold, or >300 outbreak cases since 2011,27 are considered high risk and should be prioritized for Men5CV introduction.

Table 18.1 Vaccines Registered in Malaysia

Table 18.2 High-Risk Groups in Malaysia

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  • * functional or anatomical asplenia or complement component disorders (C5-C9, properdin, factor D or factor H), persons receiving treatment with eculizumab (a monoclonal antibody directed against complement component C5), or those post haematopoietic stem cell transplantation.

NOTE:

  • The different conjugate vaccine products can be used interchangeably for the booster doses.
  • If Menactra® is used, it should be administered at least four weeks after completion of all pneumococcal conjugate vaccine doses.

Implication for Health Care Workers (HCWs)

Recommended for laboratory staff who frequently handle N. meningitidis isolates.

Evidence of Safety & Effectiveness

Contraindications and Undesirable Effects
For the conjugate vaccines, adverse reactions are generally mild with pain and redness at the injection site, fever, headache, anorexia and nausea. While there were initial concerns regarding Guillain-Barré syndrome (GBS) with Menactra®, recent safety studies found no increased risk in the general population or in those with a history of GBS. Meningococcal vaccines are not routinely recommended for pregnant or breastfeeding women but can be given if clinically indicated.

To date, the most frequently reported adverse events for meningococcal vaccines received by the National Pharmaceutical Regulatory Agency (NPRA) include local site reactions such as injection site swelling and pain, fever, muscle pain and rash.

Evidence of Effectiveness
The meningococcal conjugate vaccines elicit a T cell-dependent memory response that results in an improved primary response to vaccination and a strong anamnestic response at re-exposure when compared with polysaccharide vaccines.  Effectiveness of the quadrivalent vaccine within 3-4 years after vaccination is 80-85%. However, the effectiveness seems to wane with time. Five years post vaccination, the proportion with protective antibody levels drops to 56–72% among adolescents.

References

  1. Andersen B. M. (1978). Mortality in meningococcal infections. Scandinavian Journal of Infectious Diseases, 10(4), 277–282. https://doi.org/10.3109/inf.1978.10.issue-4.04
  2. Bruce, M. G., Rosenstein, N. E., Capparella, J. M., Shutt, K. A., Perkins, B. A., & Collins, M. (2001). Risk factors for meningococcal disease in college students. JAMA, 286(6), 688–693. https://doi.org/10.1001/jama.286.6.688
  3. Centers for Disease Control and Prevention (CDC) (2013). Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports, 62(RR-2), 1–28. https://www.cdc.gov/mmwr/pdf/rr/rr6202.pdf
  4. Keyserling, H., Papa, T., Koranyi, K., et al. (2005). Safety, immunogenicity, and immune memory of a novel meningococcal (groups A, C, Y, and W-135) polysaccharide diphtheria toxoid conjugate vaccine (MCV-4) in healthy adolescents. Archives of Pediatrics & Adolescent Medicine, 159(10), 907–913. https://doi.org/10.1001/archpedi.159.10.907
  5. Macneil, J. R., Cohn, A. C., Zell, E. R., Schmink, S., Miller, E., Clark, T., Messonnier, N. E., & Active Bacterial Core surveillance (ABCs) Team and MeningNet Surveillance Partners (2011). Early estimate of the effectiveness of quadrivalent meningococcal conjugate vaccine. The Pediatric Infectious Disease Journal, 30(6), 451–455. https://doi.org/10.1097/INF.0b013e31820a8b3c
  6. The Malaysian National Centre of Adverse Drug Reactions Database. [Accessed: 10 October 2019]
  7. Nelson, S. J., Charlett, A., Orr, H. J., et al. (2001). Risk factors for meningococcal disease in university halls of residence. Epidemiology and Infection, 126(2), 211–217. https://doi.org/10.1017/s0950268801005301
  8. National Advisory Committee on Immunization, Canada. (January, 2013). Update on the Use of Quadrivalent Meningococcal Vaccines: Canadian Communicable Disease Report (CCDR). An Advisory Committee Statement (ACS), 39(ACS-1), 1–40. https://doi.org/10.14745/ccdr.v39i00a01
  9. Wilder-Smith, A., Barkham, T. M., Ravindran, S., Earnest, A., & Paton, N. I. (2003). Persistence of W135 Neisseria meningitidis carriage in returning Hajj pilgrims: risk for early and late transmission to household contacts. Emerging Infectious Diseases, 9(1), 123–126. https://doi.org/10.3201/eid0901.020131
  10. World Health Organization. (November 18, 2011). Meningococcal vaccines: WHO position paper, Weekly epidemiological record, 47:521-539. https://iris.who.int/server/api/core/bitstreams/fa4b8b3c-3b14-4f1d-85ce-a7ae0f31f2e3/content
  11. World Health Organization. (January 12, 2024). Meningococcal vaccines: WHO position paper on the use of multivalent meningococcal conjugate vaccines in countries of the African meningitis belt. Weekly epidemiological record, 99(1/2):1-10.
  12. Badur, S., Mona, A., Dabbagh, Al, et al. (2021). The Epidemiology of Invasive Meningococcal Disease in the Kingdom of Saudi Arabia: A Narrative Review with Updated Analysis. Infect Dis Ther,10:2035-2049. https://doi.org/10.1007/s40121-021-00467-x
  13. Health requirements and recommendations for travelers to Saudi Arabia for Hajj and Umrah [Internet]. Riyadh: Ministry of Health (Saudi Arabia); 2025 May 24.https://www.moh.gov.sa
  14. Centers for Disease Control and Prevention (CDC). Use of meningococcal vaccines in persons with increased risk for invasive meningococcal disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2020;69(RR-9):1–41.
  15. Centers for Disease Control and Prevention. Meningococcal disease: Clinical overview and vaccine recommendations. In: Pink Book — Epidemiology and Prevention of Vaccine-Preventable Diseases. 14th ed. Atlanta: CDC; 2024.
  16. National Pharmaceutical Regulatory Agency (NPRA). Sistem Pendaftaran Produk & Perlesenan. https://quest3plus.bpfk.gov.my/pmo2/index.php