PRACTICE GUIDELINE INFORMATION SHEET GUIDELINE TITLE KAISER PERMANENTE

GUIDES OF GOOD PRACTICE ORGANISING COMMONERS ASSOCIATIONS
INTRODUCTION THIS PRACTICE GUIDE OUTLINES VARIOUS CONSULTATIVE
PRACTICE NOTE SOURCING SUPPLEMENTARY EMERGENCY RESPONSE RESOURCES

& COUNCIL OF CIVIL SERVICE UNIONS GOOD PRACTICE FOR
(4021225) 8 N1260(E)(J14)H NATIONAL CERTIFICATE OFFICE PRACTICE N5 (4021225)
(still) More Naming Practice Write the Names of the

Practice Guideline Information Sheet

Practice Guideline Information Sheet

Guideline Title

Kaiser Permanente Colorado Region

Meningococcal Vaccine Guideline

Date Submitted Approved By: (Dept & Person)

July, 2003

The Prevention Committee; Eric France, MD, MSPH

Contact person to contact regarding this guideline’s content

Nancy Larson, RN, MS
Department		The Prevention Department
Phone	303-344-7382		Email	[email protected]

Author(s)

Eric France, MD & Nancy Larson, RN, MS

Clinical Category Choose one (more if needed) from the list below.

Allergy	Geriatrics	Pharmacy
Anesthesiology	Hematology/Oncology	Physiatry/Rehab
Cardiology	Infectious Disease	Podiatry
Cardiovascular Surgery	Mental Health	Pulmonology
Dermatology	Nephrology	Radiation Oncology
ENT/Head and Neck Surgery	Neurology	Radiology
Emergency Care	Neurosurgery	Rheumatology
Endocrinology	Obstetrics/Gynecology	Surgery
Eye Care	Orthopedics	Urology
Gastroenterology	Pathology/Laboratory Services	Primary Care

Keywords To aid in searching for the guideline

meningococcal, vaccine, meningitis

Abstract or other summary description of this guideline

Students entering college, especially those who will be living in dormitories, and their parents should be informed during routine prematriculation medical visits about the increased risk of meningococcal disease and potential benefits of immunization as well as limitations of the vaccine, primarily the lack of protection against serotype B meningococcal disease. Students who wish to be immunized should be vaccinated.

Intended Audience

All Providers	Physicians
All Providers and Staff	Nurses
Members	Physician Assistants
Other:

Practice Guideline Plan Sheet

What is the intended clinical outcome of implementing this guideline?

That all students entering college and planning to live in a dormitory situation have been appraised of their slightly increased risk of developing meningococcal disease and the availability and limitations of a vaccine to prevent some strains of meningococcal disease.

What is the implementation plan?

The guideline was initially implemented in April 2001.

The guideline is accessible on the PKC Connection and the Nursing Website.

Many colleges highly suggest or require the vaccine for admission of newly enrolled students.

What is the plan for evaluating the outcome of implementing this guideline?

Periodic chart audits.

The Immunization Task Force and The Pharmacy Department centralized distribution of the vaccine to medical clinic pharmacies, which allows close monitoring of usage.

Approximately 3,200 doses are given per year.

Practice Guideline Attachment Sheet

Attachment One: Reference Document

Kaiser Permanente Colorado Region

Meningococcal Vaccine Guideline

Adoption Date: 4/01 Page #1

Responsible Parties: Eric France MD MSPH, Chair, Immunization Task Force

Nancy Larson RN, Co-Chair Immunization Task Force

Review Date: 7/03 Next review Date:7/05

These guidelines are informational only and are not intended or designed to substitute the reasonable exercise of independent clinical judgment by providers in any particular set of circumstances for each patient encounter. The guidelines are flexible and are intended to be used as a resource for integration with a sound exercise of clinical judgment. They can be used to create an approach to care that is unique to the needs of each individual patient.

Rationale for Guideline: Studies conducted in college age students have shown that there is an elevated risk for sporadic meningococcal disease in this population. Freshmen living in dormitories have an increased incidence of meningococcal disease of 4.6 per 100,000 compared to a rate of 1 per 100,000 for similar aged young adults. A safe and effective quadrivalent polysaccharide vaccine exists that is ≥ 85% effective against the covered serotypes.

Target Population: College age students and people considered high-risk.

Recommendation: Specific recommendations for use of the meningococcal vaccine are as follows:

Students entering college, especially those who will be living in dormitories, and their parents should be informed during routine prematriculation medical visits about the increased risk of meningococcal disease and potential benefits of immunization as well as limitations of the vaccine, primarily the lack of protection against serotype B meningococcal disease.

Students who wish to be immunized should be vaccinated.

Immunization is not recommended for students who will not be living in dormitories because their risk of meningococcal disease is not increased relative to that of persons of similar age in the general population. However, immunization is not contra-indicated for these students and vaccine may be given if requested.

Routine reimmunization of college students who were immunized as freshmen is not indicated. However, for those who were immunized 3 to 5 years previously and are or will be in high-risk circumstances, such as travel to geographic areas with hyperendemic or epidemic meningococcal disease, reimmunization should be considered. Similarly, vaccine should be considered for matriculating freshmen who were immunized 3 or more years previously and will be living in dormitories.

People for whom the vaccine is recommended to be routinely given includes those populations considered high risk. High risk patients include people with underlying immune deficiencies, including HIV, terminal complement component deficiencies, anatomic or functional asplenia, and patients traveling to countries where the disease is considered common or endemic. Persons working in research, industrial or clinical laboratories that are routinely exposed to Neisseria meningitidis that may be aerosolized should consider vaccination.

Since the vaccine is a polysaccharide vaccine, it is not recommended for use in children < 2 years of age. The vaccine is relatively ineffective and has a relatively short duration of protection in this age group.

The vaccine is recommended to control serogroup C meningococcal outbreaks. An outbreak is defined as 3 or more confirmed or probable cases of serogroup C disease in a period of  3 months, with a resulting primary attack rate of at least 10 cases per 100,000 persons.

Performance measurement: The number of meningococcal vaccines administered by the Kaiser Permanente Colorado Region this year will be compared to the number of meningococcal vaccines administered the previous year.

References

CDC. Prevention and Control of Meningococcal Disease and Meningococcal Disease and College Students: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2000;49(No. RR-7): 1-20.

American Academy of Pediatrics. Meningococcal disease prevention and control strategies for practice-based physicians. Pediatrics. 2000;106:1500-1504.

PRACTICE GUIDELINE INFORMATION SHEET GUIDELINE TITLE KAISER PERMANENTE