TABLE 2
Rates* of serogroup C, Y, and W-135 meningococcal disease†
| Age group (y) | ||
|---|---|---|
| Year | 11-19 | ≥20 |
| 2004-2005 | 0.23 | 0.16 |
| 2006-2007 | 0.27 | 0.22 |
| 2008-2009 | 0.14 | 0.21 |
| *Annual rate per 100,000. †Serogroup A disease is too rare for inclusion here. Source: Cohn A. Advisory Committee on Immunization Practices Meeting; October 27, 2010.2 | ||
TABLE 3
Average annual number of cases of C, Y, and W-135 meningococcal disease
| Age group (y) | 2000-2004 | 2005-2009 | Change |
|---|---|---|---|
| 11-14 | 46 | 12 | -74% |
| 15-18 | 106 | 77 | -27% |
| 19-22 | 62 | 52 | -16% |
| Total (11-22) | 214 | 141 | -34% |
| Source: Cohn A. Advisory Committee on Immunization Practices Meeting; October 27, 2010.2 | |||
ACIP weighed the options for a booster dose
Three options were presented at the October 2010 ACIP meeting:
- Option 1: No change to the current recommendation for vaccination of 11- to 12-year-olds. Wait and see what happens to disease incidence over several more years.
- Option 2: Move the age of vaccination to 15 years with no booster. This would allow protection to persist through the years of highest risk (16-21 years).
- Option 3: Keep the recommendation for vaccination at ages 11 to 12 years, and add a booster dose at age 16.
The first option was the least cost effective: $281,000/quality-adjusted life year (QALY). The second option was the most cost effective at $121,000/QALY. The last option came out in the middle: $157,000/QALY, but it would save the most lives—9 more per year compared with Option 2.1 There is, however, a caveat with regard to the cost-effectiveness estimates. The numbers were obtained using incidence data from the year 2000; incidence has declined since then, and cost-effectiveness estimates would be much less favorable using today’s rates.
These issues were discussed at length, and the decision to add a booster dose at age 16 was made on a close vote. This decision illustrates how difficult vaccine policy-making has become in recent years, when choices must be made about recommending safe, effective, and expensive vaccines to prevent illnesses that are both rare and serious.
The new MCV4 recommendations will be added to the child immunization schedule for 2011.
The take-home message for family physicians is to strive to increase the proportion of 11- to 12-year-olds who are fully vaccinated and in 2011 to begin to advise those who are between the ages of 16 and 20 years of the recommendation for a booster dose of MCV4.