Updated March, 2011
Meningococcal Diseases are associated with the bacterium, Neisseria meningitidis, also referred to as meningococcus, and include the invasive diseases, meningitis and blood poisoning, both of which can also be caused by other pathogens. Currently, there are five major serogroups of meningococcus. According to the 2006 Canadian Immunization Guide, serogroups B and C were predominant at that time; serogroup Y, which mainly occured in older adults,was less prevalent; and serogroups W135 and A were even rarer in Canada. However, even B and C cases were so rare that they were almost non-existent. Statistics from the years 2000-2003 show the average yearly total of meningococcal C cases in infants and children up to 4 yrs old was 4 to 9 for the whole country.
The US Centers for Disease Control (CDC) tells us that, “High fever, headache, and stiff neck are common symptoms of meningitis in anyone over the age of 2 years. These symptoms can develop over several hours, or they may take 1 to 2 days. Other symptoms may include nausea, vomiting, discomfort looking into bright lights, confusion, and sleepiness. In newborns and small infants, the classic symptoms of fever, headache, and neck stiffness may be absent or difficult to detect, and the infant may only appear slow or inactive, or be irritable, have vomiting, or be feeding poorly. As the disease progresses, patients of any age may have seizures.”
Regarding transmission, the CDC explains, “The bacteria are spread through the exchange of respiratory and throat secretions (i.e., coughing, kissing). Fortunately, none of the bacteria that cause meningitis are as contagious as things like the common cold or the flu, and they are not spread by casual contact or by simply breathing the air where a person with meningitis has been.” In 2002, Health Canada’s website described meningococcal disease as “not very contagious”.
In a paper published in the Medical Journal of Australia, epidemiologist Dr Mahomed Patel noted that introduction of vaccines against two other bacterial infections, those of pneumococci and Haemophilus influenzae type b, were followed by increases in bacterial strains not included in the vaccines. He commented, “It’s not unlikely that this may occur with the meningococcal vaccines”. In fact, it appears his prediction was correct. A winter, 2010 cross-Canada study has shown that, since 2006, the meningococcal C vaccine introduced in 2003 has been largely ineffective for prevention of invasive meningoccal disease (IMD) in children. In children, but not adults, the incidence of serogroup B has become greater than that of C; from 2006 to 2009, the incidence of B was 69% whereas that of C was 5%. Accounting for all five serogroups and all regions, the study found serogroup B associated with 74% of IMD in Newfoundland, 71% in Quebec and 41% in the other provinces.
So, we have the vaccines, Menjugate® and Menactra® to cover all the less numerous serogroups but no vaccine for the most predominant one. Discussing the Quebec preponderance of B, the National Advisory Committee on Immunization (NACI) has stated: “The increase in serogroup B IMD two years after the introduction of a mass meningococcal vaccination program using conjugate C meningococcal vaccine for individuals 2 months to 20 years of age raises the possibility of serogroup replacement.” Similar to the universal and frequent use of antibiotics, the universal and frequent use of vaccines may cause as much infectious disease as it prevents.
But, even if this were not so, the NACI has also stated that although, “vaccination with conjugate meningococcal vaccine primes the immune system for memory and induces good anamnestic [antibody memory] responses after challenges with meningococcal C polysaccharide or conjugate vaccines…because of the short incubation period of IMD (range 2 to 10 days, commonly 3 to 4 days) it is now generally accepted that the anamnestic response cannot be relied upon to prevent disease and that circulating antibodies [from previous infection or repeated recent vaccination] are necessary for protection.” Citing UK studies which showed numerous vaccine failures, the NACI acknowledged, “These data suggest that [vaccine-derived] immunity wanes over time, and that immunization after one year of age provided longer term protection against IMD than immunization in infancy.” But, taking their pro-vaccine stance to the extreme and as if to justify injecting infants with risky meningococcal vaccines, they added, “Auckland et al. were…able to demonstrate that vaccine failures with IMD mounted a memory response to disease…”. And why was this any more beneficient than a memory response mounted as a result of IMD in the unvaccinated? It was because, during their convalescence, the failed vaccine group had higher antibody levels than convalescing unvaccinated controls. Evidence that this higher level was maintained beyond convalescence wasn’t provided.
The 2006 monograph for Menjugate® vaccine tells us that, like the pneumococcal vaccine, Prevnar®, it is a conjugate vaccine; it contains a portion of the meningococcal C bacterium joined to a protein carrier which is a non-toxic mutant of diphtheria toxin. Menjugate® also contains mannitol, sodium phosphate monobasic monohydrate, sodium phosphate dibasic heptahydrate, aluminum hydroxide, and sodium chloride.
The monograph states, “No pharmacodynamic or pharmacokinetic studies have been conducted with Menjugate®, in accordance with its status as a vaccine.” Presumably this means that, because vaccines are assumed to be effective if they elicit a significant production of antibodies, that effect should be sufficient evidence to convince us that further study of their action in the body is unnecessary.
The monograph instructs those who administer the vaccine that “Precautions such as the use of antipyretic measures should be relayed to the parent or guardian”. But, while lowering body temperature with the use of drugs may make the vaccine recipient feel better and parents less anxious, it could also possibly reduce immune response. In the case of a meningococcal infection, fever suppression is especially risky since reduced immune response may mask tell-tale symptoms of rapidly progressing meningococcal disease.
Because, during trials, other vaccines were injected along with Menjugate®, a convenient loophole was available regarding adverse event reporting. The monograph states: “In infants and toddlers symptoms including crying, irritability, drowsiness, impaired sleeping, anorexia, diarrhea and vomiting were common after vaccination but there was no evidence that these were related to Menjugate® rather than concomitant vaccines, particularly DPT.” Note that there was also no evidence that they were related to concomitant vaccines rather than Menjugate®. This points to the fallacy of co-administering other vaccines with trial vaccines and using vaccines as controls.
The monograph further states: “Although symptoms of meningism such as neck pain/stiffness or photophobia have been reported, there is no evidence that the vaccine causes meningococcal C meningitis. Clinical alertness to the possibility of coincidental meningitis should therefore be maintained.” Does this mean that Novartis made every attempt to find evidence that these symptoms were caused by their vaccine and found none, or does it mean they made every attempt to avoid looking for evidence?
Sanofi Pasteur’s Menactra®, another ‘subunit vaccine’, contains parts of meningococcal serogroups A, C, Y and W-135. Its approval for use anytime between 2 yrs and 55 yrs allows for repeated booster shots (as usual with new vaccines, “the duration of protection is unknown”).
The Menactra® monograph warns, “persons previously diagnosed with GBS [a type of paralysis] should not receive Menactra®.” since, “Based on evaluation of post-marketing adverse events, a slight increase in the number of GBS reports was observed following administration of Menactra®.” The monograph also warns, “There are no data on the use of this vaccine in pregnant women.” and, “the effect on breast-fed infants of the administration of Menactra® to their mothers has not been studied.”
Safety trials of Menactra® used Menomune®, a similar meningococcal vaccine, as the placebo. This means that the data generated are mostly useful to compare the types and rates of adverse events from the two vaccines, not to discover the extent of risk from Menactra®. Only if a true (non-reactive) placebo such as saline solution had been used could this have been accurately accomplished. The comparison between the two vaccines shows that in children 2 to 10 yrs old, Menactra® produced local reactions more often. In adolescents and adults it produced more local reactions, especially pain, and more systemic reactions, with headache, fatigue and malaise topping the list.
References
- Menactra® Product Monograph, (Sanofi Pasteur)
Meningococcal (Groups A, C, Y and W-135) Polysaccharide
Diphtheria Toxoid Conjugate Vaccine (Revised June 2012) - MENJUGATE® Product Monograph, (Novartis)
Meningococcal Group C–CRM197 Conjugate Vaccine (Date of approval February 15, 2011) - Mosby Medical Encyclopedia; Signet; 1996.
- National Advisory Committee on Immunization; ‘Vaccine-Preventable Diseases: Meningococcal’.
- Centers for Disease Control and Prevention; ‘Meningococcal Disease: Frequently Asked Questions’.
- ‘Meningococcal Vaccine’; Health Canada; Dec 16, 2002. (no longer available)
- ‘Call for further study on meningococcal vaccine’; Feb 14, 2007.
- ‘The epidemiology of serogroup B meningococcal invasive infections in Canada, IMPACT 2002-2009;Canadian Journal of Infectious Diseases & Medical Microbiology; Vol 21, No 24; Winter 2010 / 9th Canadian Immunization Conference Abstract 010.
- ‘Update on the Invasive Meningococcal Disease and Meningococcal Vaccine Conjugate Recommendations; CCDR; Vol 35; ACS-3; April, 2009.
