Nimenrix is funded for children under 12 months of age meeting the eligibility criteria outlined in the Pharmaceutical Schedule.  (MenQuadfi is funded for those eligible from 12 months of age). Nimenrix is also available for private purchase from HCL.

Conjugated meningococcal vaccine is recommended, but not funded, for individuals:

• Who are infants and young children aged under 5 years, adolescents and young adults who do not meet the eligibility criteria to receive funded Nimenrix or MenQuadfi
• Who are travelling to high-risk countries or before the Hajj

Administration

Infants aged 6 weeks to under 6 months:
‍Administer two doses eight weeks apart followed by a booster dose aged 12 months or a minimum of six months after the second dose, whichever is later.

Infants aged 6 months to under 12 months:
‍Administer one dose followed by a booster dose aged 12 months or a minimum of eight weeks after first dose, whichever is later.**

** In some situations, e.g. an infant aged 6 months to under 12 months has a medical condition that increases their risk of meningococcal disease in addition to their age-related risk: Administration of two doses eight weeks apart followed by a booster dose aged 12 months or a minimum of six months after second dose, whichever is later, may be appropriate. (The second primary dose in this instance will not be funded).

Children aged 12 months or older, adolescents and adults:
Administer one dose. A booster dose may be indicated in some individuals.

• Protection against meningococcal group A disease wanes quickly over the first year after immunisation with Nimenrix. Where protection against meningococcal A disease is most important a booster dose of Nimenrix could be considered one year after the previous dose
• Protection against meningococcal groups C, Y, and W, wanes more slowly than protection against meningococcal group A disease after immunisation with Nimenrix. A booster dose of Nimenrix could be considered for children vaccinated as toddlers, five years after the previous dose if they continue to be at increased risk of meningococcal disease

Nimenrix can be administered at the same visit as other vaccines including all vaccines on the National Immunisation Schedule. Separate syringes and different injection sites should be used.

The vaccine is for intramuscular injection only.

In children aged 6 weeks to 23 months of age, the vaccine should be administered in the vastus lateralis and for those over 2 years of age in the deltoid. Under no circumstances should Nimenrix be administered intravascularly, intradermally or subcutaneously.

Storage and preparation

Store the lyophilised vaccine as per cold chain between 2°C to 8°C. Protect from light. The sterile 0.9% saline diluent may be refrigerated or stored at room temperature but must not be frozen.

Nimenrix must be reconstituted by adding the entire contents of the pre-filled syringe of solvent to the vial containing the powder. After the addition of the solvent to the powder, the mixture should be well shaken until the powder is completely dissolved. The reconstituted vaccine is a clear colourless solution. After reconstitution, the vaccine should be used promptly. Although delay is not recommended, stability has been demonstrated for 8 hours at 30°C after reconstitution. If not used within the 8 hours, do not administer the vaccine.

Special groups

Nimenrix is funded (maximum three doses dependent on age at first dose) for the following special groups under the age of 12 months:

• 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
• Close contacts of meningococcal cases of any group
• A child who has previously had meningococcal disease of any group
• Bone marrow transplant patients
• A child pre- and post-immunosuppression*

Note: infants from 6 weeks to less than 6 months of age require a 2+1 schedule, infants from 6 months to less than 12 months of age require a 1+1 schedule. Refer to the Immunisation Handbook for recommended booster schedules with meningococcal ACWY vaccine. (Noting that from 12 months of age MenQuadfi is given, click here for more information on MenQuadfi.
*Immunosuppression due to steroid or other immunosuppressive therapy must be for a period of greater than 28 days.

More than 20 years of studies and safety monitoring have shown that the conjugate meningococcal vaccines have excellent safely profiles.

Nimenrix should not be given to:

• Anyone with severe allergy (anaphylaxis) to a previous dose of a meningococcal vaccine or a component of the vaccine
• Administration of Nimenrix should be postponed in individuals suffering from a fever over 38°C. The presence of a minor infection is not a reason to delay immunisation

Specialist advice should be sought for the following groups:

• Those with bleeding disorders, such as haemophilia. The vaccine should be administered in accordance with the haematologist’s instructions.

Protection against meningococcal disease is dependent on an individual having adequate existing circulating protection provided by antibodies because the bacteria cause disease more quickly than the immune system can generate new protection. Immunisation generates circulating antibodies. Over time the antibody levels decrease. The number and quality of antibodies and how long they last depend on what type of vaccine is used, the meningococcal group(s) covered by the vaccine, and the age of the person receiving the vaccine.

As there are generally low numbers of meningococcal disease cases in countries such as Australia, England, Germany, New Zealand and the United States, it is not possible to determine exactly how many cases of disease are prevented by vaccination and how long protection after vaccination lasts. Instead, the immune system response and antibody levels are used as an alternative measure of how well and how long meningococcal vaccines can protect from disease.

Nimenrix generates long term memory cells and a booster immunisation will rapidly generate more circulating protection years later.

In children, adolescents and adults:

• Protection against disease caused by meningococcal group A decreases quickly over the first year after immunisation
• Protection against disease caused by meningococcal groups C, Y, and W is expected to last at least five years after immunisation

The following table shows the percentage of individuals with protective levels of circulating antibodies against meningococcal groups A, C, Y and W one month after receipt of two infant doses of Nimenrix (at 2 months and 4 months of age), two infant doses plus a booster dose of Nimenrix at 12 months of age, and a single dose of Nimenrix when aged 12 months or older.

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• Dbaibo, G., El-Ayoubi, N., Ghanem, S. et al. Drugs Aging (2013) 30: 309. https://doi.org/10.1007/s40266-013-0065-0
• European Medicines Agency. EPAR product information: Nimenrix [Internet]. London: European Medicines Agency; 2012; [updated 2020 July 31; cited 2020 September 28]. Available from: https://www.ema.europa.eu/en/documents/product-information/nimenrix-epar-product-information_en.pdf
• Institute of Environmental Science and Research Ltd. Meningococcal disease quarterly report Jan - Dec 2019. Porirua: Institute of Environmental Science and Research Ltd (ESR); 2020.
• Lopez L, Sherwood J. The epidemiology of meningococcal disease in New Zealand 2013. Wellington: Institute of Environmental Science and Research Ltd (ESR); 2014. Report No.: FW14023.
• Medsafe. Datasheet: Nimenrix [Internet]. Wellington: New Zealand Medicines and Medical Devices Safety Authority; 2014 [updated 2021 May 10; cited 2021 August 13]. Available from: https://medsafe.govt.nz/profs/Datasheet/n/nimenrixinj.pdf
• Health New Zealand | Te Whatu Ora, Immunisation handbook [Internet]. Available from: https://www.tewhatuora.govt.nz/for-health-professionals/clinical-guidance/immunisation-handbook