Enhanced Meningococcal Vaccine Program for Grade 7 Students : Questions and Answers for Health Care Providers

The Ministry of Health and Long-Term Care (the “ministry”) is providing broader protection against invasive meningococcal disease (IMD) by replacing the Men-C (monovalent) vaccine with the quadrivalent meningococcal (Men-C-ACWY) vaccine for the Grade 7 school-based immunization program.

Why is a quadrivalent conjugate meningococcal vaccine (Menactra®) being offered by the ministry and why is the program targeting grade 7 students?

In September 2004, Ontario introduced a publicly funded conjugate meningococcal C immunization program for one year olds. This program was expanded in January 2005 to include a catch up program for unimmunized grade 7 students through a school-based program, adolescents 15 to 19 years of age, and high risk individuals.

While meningococcal C vaccine, introduced in 2004, was having an impact on reducing the incidence of disease in children under 5, there were still cases in people over the age of 16. To address this potentially waning immunity, and to enhance the immune memory response, the National Advisory Committee on Immunization (NACI) now recommends that adolescents be immunized with a meningococcal vaccine.

Based on this advisement, Ontario is implementing routine immunization for adolescents. The current monovalent meningococcal C vaccine delivered by public health units in the grade 7 program will be replaced with a quadrivalent conjugate meningococcal vaccine. The change to a quadrivalent conjugate meningococcal vaccine (Menactra®) will meet NACI’s recommendation for a booster dose of meningococcal vaccine, and also provide broader protection against 3 additional types of IMD to include serogroups A, Y, W-135. The vaccine will provide protection to address the changing epidemiology of IMD in Ontario.

Who will administer the quadrivalent conjugate meningococcal (Men-C-ACWY) vaccine?

The vaccine will continue to be offered through the grade 7 Ontario school-based program. The program will remain voluntary and be offered through public health units. The vaccine will be administered by public health nurses in scheduled school clinics.

Is the vaccine free of charge?

The Men-C-ACWY vaccine is provincially funded for all grade 7 students and high risk individuals.

Will I be able to provide my patients with the vaccine?

In special circumstances a grade 7 student may require the vaccine to be administered in your office. The vaccine may be released by health units to family physicians or other health care providers for administration to eligible students and high risk persons.

Will a student remain eligible to receive the quadrivalent meningococcal vaccine after grade 7?

Yes. An unimmunized student will remain eligible to receive the quadrivalent meningococcal vaccine if they miss their opportunity while in grade 7. The vaccine can be obtained through their local health unit.

Can a student who was previously eligible or previously vaccinated with the school-based Men-C-C vaccine now receive the Men-C-ACWY vaccine if requested?

No. The Men-C-ACWY vaccine is only publicly funded for grade 7 students beginning in the 2009-2010 school year and forward. Unimmunized students who were previously eligible to receive the monovalent meningococcal vaccine (students who were in grade 7 from 2005 to 2008) remain eligible to receive the Men-C-C vaccine from their health care provider or local health unit.

Who is high risk and eligible to receive the publicly funded Men-C-ACWY vaccine?

Individuals between 2 and 55 years of age with high risk conditions who are eligible to receive publicly funded vaccine include the following :

• Persons with anatomic or functional asplenia;
• Persons with terminal complement component deficiencies such as properdin or factor D deficiency;
• Cochlear implant recipients (pre-post implant).

For close contacts of a vaccine preventable case of IMD, health units and health care providers should consult with the ministry.

See the Publicly Funded Immunization schedules for Ontario - January 2009, for further detail.

What is the vaccine ordering process?

Immunization providers can request the vaccine through your standard means of ordering (either through your local public health unit or Ontario Government Pharmaceutical and Medical Supply Service).

Will the recommendation and eligibility for meningococcal immunization change for infants?

The recommendation and eligibility for routine infant immunization remains the same for meningococcal vaccine; one dose of meningococcal C conjugate vaccine (Menjugate® or NeisVac-C® vaccine) given at 12 months of age.

Have there been studies on the co-administration of Men-C-ACWY vaccine?

Yes, there have been studies completed. There were no systemic reactions reported at a higher frequency when Menactra was co-administered with Tdap (Adacel®).

Please contact your local health unit for more information regarding the enhanced meningococcal vaccine program for grade 7 students.

References

1. Vaccine Product Monographs; Menactra®, Sanofi Pasteur Ltd., September 2008.
2. National Advisory Committee on Immunization advisory statement; Update on the Invasive Meningococcal Disease and Meningococcal Vaccine Conjugate, April 2009.

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