Immune Responses in U.S. Military Personnel Who Received Meningococcal Conjugate Vaccine (MenACWY) Concomitantly with Other Vaccines Were Higher than in Personnel Who Received MenACWY Alone

Abstract

A tetravalent meningococcal conjugate vaccine for serogroups A, C, W, and Y (MenACWY) is one of several recommended routine vaccinations for all new U.S. military recruits during enlisted basic training or officer accession training. Military recruits at all basic training centers routinely receive five or more concomitant vaccinations, including combination vaccines, within the first week of arrival at training facilities. While the safety and immunogenicity of coadministered vaccines in infants and children have been widely studied (1-9), the same approach has not been systematically followed for immunizations in adults and, in particular, for meningococcal polysaccharide conjugate vaccines in military personnel.The effects on immunogenicity of concomitant vaccine administration are variable and may be vaccine specific. For example, inactivated polio vaccine (IPV) given alone or coadministered with other vaccines in military personnel showed that seroconversions to polio were more likely when multiple vaccines were administered (10). In contrast, it has been reported that immune response to the concomitant administration of the tetanus-diphtheria-acellular pertussis (Tdap) vaccine and the trivalent influenza vaccine was reported to be noninferior to sequential administration despite lower concentrations of antibody to tetanus, diphtheria, and pertussis toxin components (11, 12). West et al. reported that antibodies to rubella virus and pertussis filamentous hemagglutinin were below predicted levels in healthy adults who received concurrent administration of the bivalent Haemophilus influenzae type b (Hib)-hepatitis B vaccine (HBV) with priming doses of the diphtheria, tetanus, acellular pertussis (DTaP) vaccine and a booster dose of DTaP, oral polio vaccine, IPV, or measles, mumps, and rubella (MMR) vaccine (13). Bar-On et al. carried out a meta-analysis of 18 studies comparing the immune responses to and safety of concomitant and sequential administration of . They reported significantly lower immunological responses to Hib and HBV vaccines and more-localized reactions when these vaccines were coadministered.

Immunogenicity of meningococcal polysaccharide ACWY vaccine in primary immunized or revaccinated adults

“…Briefly, 96-well plates were coated with 100 μl/well of A, C, W 135 , Y Men-Ps, kindly donated by Novartis Vaccines (now GSK), Siena, Italy, at a concentration of 10 μg/ml in phosphate-buffered saline (PBS) pH 8·2 and incubated at +4°C overnight. The seroconversion, defined as a twofold increase in IgG concentrations from T0 to T2, was considered a measure to identify subject responders to vaccination or booster doses [11]. After three more washes, 100 μl/well of the samples and control serum [kindly donated by Novartis Vaccines (now GSK), Siena, Italy] diluted in TPBS 1 : 200 were incubated for 2 h at 37°C.…”

“…The concentration of Men-Ps-specific IgG in test sera was obtained by plotting the control serum dilutions (from 1 : 50 to 1 : 6400) and the corresponding IgG concentration values (μg/ml). As the titre of serum bactericidal antibodies is considered the gold standard for meningococcal seroprotection and IgG ELISA values are considered a surrogate of protection [14], we defined the IgG concentration ≥ 2 μg/ml as a 'putative' seroprotective level [11,[15][16][17][18][19]. The seroconversion, defined as a twofold increase in IgG concentrations from T0 to T2, was considered a measure to identify subject responders to vaccination or booster doses [11].…”

“…Moreover, conjugate protein-Ps vaccines, by transforming T cell-independent into T cell-dependent antigens, are believed to stimulate B cell memory effectively, thus increasing the specific immune response. Furthermore, the response may even be influenced by concomitant administration of other vaccines [11]. Furthermore, the response may even be influenced by concomitant administration of other vaccines [11].…”

“…In particular, it has been proposed that even in periodically revaccinated adults, the use of conjugate instead of plain Ps vaccines may be preferable to prevent the risk of depletion of the peripheral memory B cell pool [10]. Furthermore, the response may even be influenced by concomitant administration of other vaccines [11].…”

Concomitant administration of meningococcal vaccines with other vaccines in adolescents and adults: a review of available evidence

“…One study was excluded because the concomitant vaccines differed from subject to subject rather than being consistent across all subjects; 51 2 arms of another study were excluded for the same reason. 52 In total, 21 studies were included in this review.…”