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→Interactions of MenACWY conjugate vaccines and other vaccines
*highest < 2 y/o and adolescent
*annual outbreak during dry season in meningitis belt
**dry winds make people's nose drier resulting in easyeasier capture and membrane breakthrough
*wide range difference of nasopharynx carriage between countries
**reason totally unknown
**NZ & 3%
**Nigeria muslim boarding house school 30-40%*日本で戦後急速に発生が減ったのは，抗菌薬の導入普及と発熱早期での過剰投与，および住宅環境の改善による小児の集蔟が減少したためかもしれない
==transmission==
*fever
*distinctive petechiae anywhere in whole body
**apparent pain accompanies with petechia in contrast to dengue
**in earlier stage rashes are inflammation, not petechiae
*no fading by pressure with glass tumbler - "tumbler test"
*resulting in purple bruising of skin
*1990s - conjugated vaccines for A and C after success of Hib conjugate vaccine
*2000s - monovalent A vaccine for Africa
**"MenAfriVac"[[file:Development history of meningococcal vaccine.jpg|500px]] ===current vaccines===*A polysaccharide**MenAfriVac*C conjugate*A,C,Y,W135 conjugate**Menactra (Sanofi Pasteur)**Menveo (GSK)**Nimenrix (Pfizer)*B protein (not polysaccharide)**Bexsero (GSK)**Trumenba (Pfizer)**VA-MENGOC-BC (Finlay Institute of Cuba) ===issues of men B vaccine===*polysaccharide of B is relatively low immunogenic**the reason is considered because of interaction between B polysaccharide and fetal brain tissue, resulting in possible immunotolerance***interaction is observed as antibodies against B-PS have also affinity to fetal brain tissue**it means B-PS vaccine has potential of neurological damage for young infants*currently available men B vaccines are protein-based vaccine, not PS vaccine**proteins expressed on the surface of ''N. meningitidis'' group B are purified through bacterial culture ===Interactions of MenACWY conjugate vaccines and other vaccines==={|class="wikitable"|-!!MenACWY-DT*conjugated with diphtheria toxoid*メナクトラ Menactra!MenACWY-TT*conjugated with tetanus toxoid*メンクアッドフィ MenQuadfi|-!PCV7*conjugated with DT|*In a clinical trial of Menactra<sup>1)</sup>*Concomitant administration of Menactra+PCV7 at 12 months of age showed '''unmet non-inferiority criteria of pneumococcal IgG in 3 serotypes''' out of 7 in PCV7||-!PCV13*conjugated with DT||*MenQuadfi+PCV13 can be administered concomitantly<sup>2)</sup>, though SBA of serogroup A was lower of unknown clinical relevance|-!Td|*In an RCT<sup>1)</sup>*Serum bactericidal assay (SBA) titers of serogroups C, W and Y in 11-17 years of age were '''higher in concomitant administration of Menactra+Td''' than single Menactra||-!DTaP*containing DT & TT|*In an RCT<sup>1)</sup>*SBA titers of all 4 serogroups in 4-6 years of age were '''lower in [DTaP (DAPTACEL) → 30days → Menactra]''' than in [Menactra → 30days → DTaP (DAPTACEL)]||-!Tdap*containing DT & TT||*MenQuadfi+Tdap can be administered concomitantly<sup>2)</sup>, though antibody titer against pertussis antigen PT was non-inferior whereas titers against pertussis FHA, RPN and FIM were lower of unknown clinical relevance|} {{quote|content=*1) [https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=4d8781ff-9366-462c-8161-6e958f44fcb4 14.3 Concomitant Vaccine Administration, Drug LabelInformation, MENACTRA. DailyMed, National Library of Medicine] (last accessed 15th Feb 2023)*2) [https://www.ema.europa.eu/documents/product-information/menquadfi-epar-product-information_en.pdf 4.5 Interaction with other medicinal products and other forms of interaction, MenQuadfi:EPAR-Product information, European Medicines Agency] (last accessed 15th Feb 2023) }}
