My son is on methotrexate for juvenile chronic arthritis. Is it safe for him to have the meningitis immunization? I have been told that the methotrexate brings the immune system down.

Caroline

Meningitis is a potentially life-threatening infection of the membranes covering the brain and spinal cord. There has been a lot of discussion recently on the use of a vaccine to prevent it, specifically meningitis caused by the bacterium Neisseria meningitidis (meningococcus). Briefly, meningitis causes fever, headache and (usually) a stiff neck. When the organism responsible for the infection is a virus, meningitis usually resolves without treatment and has no lasting effects. But when caused by bacteria -- usually meningococcus, pneumococcus or Haemophilus influenzae -- it is fatal without treatment. In the United States, the vaccine for H. influenzae (or HIB) is given routinely to all children and has been responsible for a remarkable reduction in the number of cases of meningitis caused by this organism. There is also a fairly effective vaccine for preventing pneumococcal infection, but it is not routinely given to all children at this time.

The vaccine for preventing meningococcal infection is also not given routinely. It is effective only against certain strains (varieties) of meningococcus, and it is not very effective in children under the age of two. Typically, it is given to military recruits and other people at special risk for infection with the organism. Most major outbreaks of meningococcal disease in the United States have occurred in areas of close living conditions, such as military barracks. Because recent studies have shown that college freshmen living in dormitories also are at increased risk, the vaccine now should be offered to those entering college.

The meningococcal vaccine is quite safe, with pain at the site of injection the most common adverse effect. It is not a live vaccine; it only contains parts of the wall of the bacterium. Therefore, it should not pose a risk to your son or anyone else who may have a weakened immune system. The vaccine is not given to children under the age of two, and is also usually avoided in pregnancy, unless there is a compelling reason to give it.