Initial vaccination of children Children two to ten years of age<unk> ho are at high risk for meningococcal disease, especially those<unk> ith certain chronic medical conditions and those<unk> ho travel to or reside in countries<unk> ith hyper-endemic or epidemic meningococcal disease. Although safety and efficacy of the vaccine have not been established in children younger than two years of age and under outbreak control, the unconjugated vaccine can be considered. Safety and efficacy of<unk>  have not been established in children younger than 11 years of age; however, clinical studies in children 2–10 years of age have been recommended. Adolescents 11 years of age or older It is recommend that primary immunization against meningococcal disease<unk> ith<unk>  for all young adolescents at 11–12 years of age and all unvaccinated older adolescents at 15 years of age. Although<unk>  is the preferred meningococcal vaccine in adolescents 11 years of age or older,<unk>  is an acceptable alternative if the conjugated vaccine is unavailable. Adults College students<unk> ho plan to live in dormitories receive primary immunization<unk> ith<unk> . Although the risk for meningococcal disease for is similar to 18–24 years of age that for the general population of similar age. The college students consider vaccination against meningococcal disease to reduce their risk for the disease and stated that college health-care providers should take a proactive role in providing information about meningococcal disease to students and their parents. Although<unk>  is the preferred meningococcal vaccine in adults 55 years of age or younger,<unk>  is an acceptable alternative for adults in this age group if the conjugated vaccine is unavailable. Since safety and efficacy of<unk>  in adults older than 55 years of age have not been established to date,<unk>  should be used for primary immunization in this group. Medical staff and laboratory personnel Health care<unk> orkers and laboratory personnel<unk> ho are routinely exposed to isolates of N. meningitidis are recommended to receive routine immunization against meningococcal disease. Laboratory personnel and medical staff are at increased risk of exposure to N. meningitidis or to people<unk> ith meningococcal disease. Hospital Infection Control Practices Advisory Committee (HICPAC) recommendations regarding immunization of health-care<unk> orkers state that routine vaccination of health-care personnel is recommended. Any individual 11–55 years of age<unk> ho<unk> ishes to reduce their risk of meningococcal disease may receive<unk>  as can those older than 55 years of age. Under certain circumstances if unvaccinated health-care personnel cannot get vaccinated and<unk> ho have intensive contact<unk> ith oropharyngeal secretions of infected patients and<unk> ho do not use proper precautions should receive anti-infective prophylaxis against meningococcal infection (i.e., 2-day regimen of oral rifampin or a single dose of intramuscular ceftriaxone or a single dose of oral ciprofloxacin). Military recruits Because the risk of meningococcal disease is increased among military recruits, all military recruits routinely receive primary immunization against the disease. Travelers Only Saudi Arabia requires that travelers to their country for the annual Hajj and Umrah pilgrimage have a certificate of vaccination against meningococcal disease issued not more than 3 years and not less than 10 days before arrival in Saudi Arabia. Travelers to or residents of areas<unk> here N. meningitidis is highly endemic or epidemic are at risk of exposure should receive primary immunization against meningococcal disease. Peaks of meningococcal disease (usually caused by serogroup A or C) occur regularly during the dry season (i.e., December through June) in that portion of sub-Saharan Africa known as the " meningitis belt,"<unk> hich extends from Mali to Ethiopia. In addition, major epidemics occur every 8–12 years. Travelers to these high-risk areas may be at risk of meningococcal disease and many of these countries do not have established means for surveillance and timely reporting of epidemics The vaccine (containing serogroups A, C, Y, and<unk> -135) is currently required by Saudi Arabia for pilgrims visiting Mecca for the Hajj or for the Umrah. HIV-infected individuals HIV-infected individuals are likely to be at increased risk for meningococcal disease; HIV-infected individuals<unk> ho<unk> ish to reduce their risk of meningococcal disease may receive primary immunization against meningococcal disease. Although efficacy of<unk>  has not been evaluated in HIV-infected individuals to date, HIV-infected individuals 11–55 years of age may receive primary immunization<unk> ith the conjugated vaccine. Vaccination against meningococcus does not decrease CD4+ T cell counts or increase viral load in HIV-infected individuals and there has been no evidence that the vaccines adversely affect survival. Close contacts of invasive meningococcal disease Protective levels of anticapsular antibodies are not achieved until 7–14 days following administration of a meningococcal vaccine, vaccination cannot prevent early onset disease in these contacts and usually is not recommended following sporadic cases of invasive meningococcal disease. Disease outbreak control<unk> 4 can be used for large-scale vaccination programs<unk> hen an outbreak of meningococcal disease occurs in Africa and other regions of the<unk> orld.<unk> henever sporadic or cluster cases or outbreaks of meningococcal disease occur in the US, chemoprophylaxis is the principal means of preventing secondary cases in household and other close contacts of individuals<unk> ith invasive disease.<unk> 4 rarely may be used as an adjunct to chemoprophylaxis, but only in situations<unk> here there is an ongoing risk of exposure (e.g.,<unk> hen cluster cases or outbreaks occur) and<unk> hen a serogroup contained in the vaccine is involved. It is important that clinicians promptly report all cases of suspected or confirmed meningococcal disease to local public health authorities and that the serogroup of the meningococcal strain involved be identified. The effectiveness of mass vaccination programs depends on early and accurate recognition of outbreaks.<unk> hen a suspected outbreak of meningococcal disease occurs, public health authorities<unk> ill then determine<unk> hether mass vaccinations <unk> ith or<unk> ithout mass chemoprophylaxis) is indicated and delineate the target population to be vaccinated based on risk assessment. Other Inherited properdin deficiency also is related<unk> ith an increased risk of contracting meningococcal disease. People<unk> ith a functional or anatomic lack of spleen function may not efficiently clear encapsulated Neisseria meningitidis from the bloodstream and are at increased risk of infection. Persons<unk> ith other conditions associated<unk> ith immunosuppression also may be at increased risk of developing meningitis disease. People<unk> ith component deficiencies in the final common complement pathway (C3, C5–C9) are more susceptible to N. meningitidis infection than complement-satisfactory people, and it<unk> as estimated that the risk of infection is 7,000 times higher in such individuals. In addition, complement component-deficient population frequently experience frequent meningococcal disease, since their immune response to natural infection may be less complete than that of complement none-deficient people.
NmVac4-A/C/Y/W-135
RUB A535
NDV-HXP-S
Kozak consensus sequence
H3S10P
H3K9me2
H3K9me3
H3K36me