Proposal to widen access to meningococcal ACWY vaccine for people in close-living situations

Medicines

Consultation Closed

We are proposing to widen access to funded meningococcal ACWY vaccine (Menactra) for people aged 13 to 25 years in close-living situations, from 1 December 2019.

Section I

Either:

1.      Any of the following:

  1. Up to three doses and a booster every five years for patients pre- and post splenectomy and for patients with functional or anatomic asplenia, HIV, complement deficiency (acquired or inherited), or pre or post solid organ transplant; or
  2. One dose for close contacts of meningococcal cases; or
  3. A maximum of two doses for bone marrow transplant patients; or
  4. A maximum of two doses for patients following immunosuppression*; or

2.      Both: 

  1. Person is aged between 13 and 25 years, inclusive; and
  2. Either:
    1. One dose for individuals who are in their first year of living in boarding school hostels, tertiary education halls of residence, military barracks or prisons; or
    2. One dose for individuals who are currently living in boarding school hostels, tertiary education halls of residence, military barracks, or prisons, from 1 December 2019 to 30 November 2020.

Note: children under seven years of age require two doses 8 weeks apart, a booster dose three years after the primary series and then five yearly.

*Immunosuppression due to steroid or other immunosuppressive therapy must be for a period of greater than 28 days.


Section H

Restricted

Initiation

Either:

1.      Any of the following:

  1. Up to three doses and a booster every five years for patients pre- and post splenectomy and for patients with functional or anatomic asplenia, HIV, complement deficiency (acquired or inherited), or pre or post solid organ transplant; or
  2. One dose for close contacts of meningococcal cases; or
  3. A maximum of two doses for bone marrow transplant patients; or
  4. A maximum of two doses for patients following immunosuppression*; or

2.      Both:

  1. Person is aged between 13 and 25 years, inclusive; and
  2. Either
    1. One dose for individuals who are in their first year of living in boarding school hostels, tertiary education halls of residence, military barracks, or prisons; or
    2. One dose for individuals who are currently living in boarding school hostels, tertiary education halls of residence, military barracks, or prisons, from 1 December 2019 to 30 November 2020.

Notes: children under seven years of age require two doses 8 weeks apart, a booster dose three years after the primary series and then five yearly.

*Immunosuppression due to steroid or other immunosuppressive therapy must be for a period of greater than 28 days.

What we’re proposing

We are proposing to widen access to funded meningococcal ACWY vaccine (Menactra) for people aged 13 to 25 years in close-living situations, from 1 December 2019.

Vaccination would be funded for people entering boarding school hostels, tertiary education halls of residence, military barracks and prisons. There would also be a one-year catch-up programme to vaccinate people aged from 13 to 25 years who are already living in these close-living situations.

Our clinical advisors have reviewed and recommended several options for widening access to meningococcal vaccines. This proposal is to progress funding for people in close-living situations; other options for widening of funded access to the meningococcal ACWY vaccine remain under consideration.

Feedback to this consultation will help us decide if this proposal should be approved. 

Consultation closes at 5 pm on Monday, 16 September 2019 and feedback can be emailed to vaccines@pharmac.govt.nz.

Who we think will be interested

  • People who live in institutional close-living situations
  • Doctors in general practice, other primary care prescribers, nurses and vaccinators
  • Secondary schools with boarding facilities, universities and other tertiary educational institutions, student health services
  • DHBs
  • Department of Corrections prisons
  • New Zealand Defence Force and military health services
  • Suppliers and wholesalers
  • Organisations with an interest in immunisation

What would the effect be?

From 1 December 2019, people aged from 13 to 25 years who are in their first year of living in institutional close-living situations, namely boarding school hostels, tertiary education halls of residence, military barracks and prisons, would be eligible to receive one funded dose of meningococcal ACWY vaccine from general practice.

There would also be a catch-up programme from 1 December 2019 to 30 November 2020, where people aged from 13 to 25 years who are already resident in close-living situations would be eligible to receive one funded dose of meningococcal ACWY vaccine.

We estimate that approximately 35,000 people would be eligible for vaccination during the first-year catch-up period, and approximately 8,000 people in each following year.

Vaccination of adolescents and young adults in close-living situations would reduce the carriage of meningococcal bacteria and reduce the risk of these people developing meningococcal disease.

Meningococcal infection rates are typically higher in Māori and Pacific peoples compared to the total population. This proposal would improve access to meningococcal vaccination for Māori and Pacific peoples in the groups proposed for funding.

For funders and service providers

From 1 December 2019, PHARMAC expects there would be an increase in eligible young people accessing funded vaccination in primary care. The Ministry of Health is responsible for supporting the implementation of changes to the National Immunisation Schedule and would lead communications with service providers about the vaccination programme.

Funded vaccine supply would be available through ProPharma as with other funded vaccines. As with most other funded vaccines (apart from influenza vaccine), pharmacist vaccinators would not be able to administer this funded vaccine at this time. Significant changes would be required to the current funding process to allow pharmacists to administer funded vaccines. We continue to work on changes to the Pharmaceutical Schedule that would allow pharmacists to administer funded vaccines in the future.

About meningococcal disease and meningococcal ACWY vaccine

Meningococcal disease is caused by the Neisseria meningitidis bacterium. Meningococcal bacteria are commonly carried in the nose and throat, and do not usually cause disease. Carriage rates are highest in teenagers and young adults. The bacterium can be spread from carriers or people with meningitis to other people by coughing, sneezing or contact with saliva. Occasionally an individual who is carrying the bacterium may develop severe disease such as meningitis (inflammation of the membranes around the brain), septicaemia (blood infection) or pneumonia (lung infection).

People who survive meningococcal disease may have long term consequences, including skin scarring, amputation of limbs and extremities, hearing loss, seizures or brain injury. Even when meningococcal disease is diagnosed and treated early, 10% to 20% of affected people may die.

The Menactra brand of meningococcal vaccine is approved for immunisation for the prevention of invasive meningococcal disease caused by meningococcal groups A, C, W and Y. Each 0.5 ml dose of Menactra contains 4.0 mcg each of meningococcal polysaccharide Group A, C, W and Y individually conjugated to a carrier protein. Adolescents and young adults from 13 to 25 years of age require a single dose of Menactra. Vaccination with Menactra would provide protection against meningococcal groups A, C, W and Y for five to eight years.

Further information regarding Menactra dosing and administration can be found in the Medsafe datasheet(external link).

Why we’re proposing this

In recent years there has been an increasing trend of meningococcal disease cases being notified in New Zealand, with 59 cases notified and 7 deaths in 2018 that were caused by meningococcal groups A, C, W or Y (the groups covered by vaccination with Menactra).

This proposal is for individuals 13 to 25 years of age in institutional close-living situations.  Adolescents and young adults who live in close proximity to each other in multi-residential institutions are particularly at risk of meningococcal disease due to the ease of transmission from person to person. The rate of meningococcal carriage and possible development of meningococcal disease due to groups A, C, W and Y in some individuals would be reduced by the vaccination of this group. Other people in this age group who do not live in close-living situations are at lower risk of developing meningococcal disease.

Our clinical advisors, the Pharmacology and Therapeutics Advisory Committee (PTAC) and the Immunisation Subcommittee of PTAC, reviewed a funding application for meningococcal vaccine and recommended funding with a high priority for meningococcal ACWY vaccine for a range of different patient groups, including:

  • individuals 13 to 25 years of age in close-living situations;
  • children 1 to 4 years of age with catch-up;
  • individuals 5 to 21 years of age with catch-up; and
  • individuals 13 to 21 years of age with catch-up.

PHARMAC has evaluated all of these recommendations using our Factors for Consideration and we are currently in a position to progress a funding proposal for the close-living situations group, which is the subject of this proposal. The additional groups recommended by our clinical experts remain under active consideration by PHARMAC for future funding.

More information about the assessment of funding for the close-living situations group, including links to the relevant clinical advice, can be found on the Application Tracker(external link).

Details about our proposal

We are proposing to widen access to meningococcal ACWY vaccine in Section I and Part II of Section H of the Pharmaceutical Schedule from 1 December 2019 for people aged from 13 to 25 years who are new entrants into institutional close-living situations, namely boarding school hostels, tertiary education halls of residence, military barracks and prisons.

There would also be a one-year catch-up programme from 1 December 2019 to 30 November 2020 for people aged from 13 to 25 years who are already living in these close-living situations. The proposed eligibility criterion for the catch-up programme would be deleted from the Schedule from 1 December 2020.

A confidential net price would continue to apply to Menactra.

The eligibility criteria for meningococcal ACWY vaccine (Menactra) would be amended in Section I and Part II of Section H of the Pharmaceutical Schedule as follows (additions in bold):