Meningococcal Vaccine

The quadrivalent conjugate meningococcal vaccine is a routine childhood vaccination given to adolescents, preferably at age 11 or 12 years, with a booster dose at age 16 years (see CDC: Child and Adolescent Immunization Schedule by Age). It is also recommended for younger children who are at high risk of infection. For more information, see also the ACIP's Infant Meningococcal Vaccination: ACIP Recommendations and Rationale.

MenACWY conjugate vaccines are recommended for adults who have conditions that increase risk of meningococcal infection (see CDC: Adult Immunization Schedule by Age), such as

• Anatomic or functional asplenia (including sickle cell disease)

• HIV infection

• Persistent complement component deficiencies

• Complement inhibitor use (eg, eculizumab, ravulizumab)Complement inhibitor use (eg, eculizumab, ravulizumab)

• Work in a microbiology laboratory involving routine exposure to isolates of Neisseria meningitidis

• Military recruitment

• Travel to or residence in endemic areas

• First year of residence in a college dormitory if students are ≤ 21 years and have not already received a dose on or after their 16th birthday

• Exposure to an outbreak attributable to a vaccine serogroup

If first-year college students aged ≤ 21 years received only 1 dose of vaccine before their 16th birthday, they should be given a booster dose before enrollment.

MenACWY is recommended for all adolescents (aged 11 to 18 years), including those with HIV infection.

MenACWY is preferred for people aged 11 to 55 years and for those > 55 years who were vaccinated previously with MenACWY and require revaccination or who may require multiple doses of vaccine.

Revaccination with MenACWY every 5 years is recommended for adults who were previously vaccinated with MenACWY or MPSV4 and who remain at increased risk of infection (eg, adults with anatomic or functional asplenia, HIV infection, or persistent complement component deficiencies; those who take eculizumab or ravulizumab; microbiologists routinely exposed to Revaccination with MenACWY every 5 years is recommended for adults who were previously vaccinated with MenACWY or MPSV4 and who remain at increased risk of infection (eg, adults with anatomic or functional asplenia, HIV infection, or persistent complement component deficiencies; those who take eculizumab or ravulizumab; microbiologists routinely exposed toN. meningitidis).

MenACWY is preferred for at-risk people > 55 years who have not received MenACWY previously and who require only a single dose (eg, travelers).

MenB-4C or MenB-FHbp is indicated for people ≥ 10 years with certain high-risk conditions (including people with functional asplenia or complement deficiencies, those who take eculizumab or ravulizumab, microbiologists routinely exposed to is indicated for people ≥ 10 years with certain high-risk conditions (including people with functional asplenia or complement deficiencies, those who take eculizumab or ravulizumab, microbiologists routinely exposed toN. meningitidis, and those at risk because of a meningococcal disease outbreak attributed to serogroup B). Meningococcal serogroup B vaccines are not routinely recommended by the Centers for Disease Control and Prevention for all adolescents. However, they may be given based on individual clinical decision to anyone aged 16 to 23 years; the preferred age for vaccination is 16 to 18 years. MenB-4C and MenB-FHbp are not interchangeable, so the same product should be used for all doses in series.

MenACWY-TT/MenB-FHbp is indicated for individuals aged 10 to 25 years. It is particularly recommended for healthy people between 16 and 23 years of age when both MenACWY and MenB-4C/MenB-FHbp vaccinations are appropriate and when clinical decision-making supports the MenB vaccination. Additionally, for some immunocompromised individuals aged 10 and older with an increased risk of meningococcal disease (such as those with chronic complement deficiencies, those on complement inhibitors, or individuals with functional or anatomical asplenia), both vaccines are also recommended.

The main contraindication for meningococcal vaccines is

• A severe allergic reaction (eg, anaphylaxis) after previous dose or to a vaccine component

The main precaution with meningococcal vaccines is

• Moderate or severe illness with or without a fever (vaccination is postponed until illness resolves if possible)

Meningococcal conjugate vaccines may be given to pregnant women who are at increased risk of serogroups A, C, W, or Y meningococcal disease. Meningococcal serogroup B vaccines are recommended to be deferred during pregnancy unless women are at increased risk of serogroup B disease and the benefits of vaccination are thought to outweigh potential risks.

For children with functional or anatomic asplenia, MenACWY and pneumococcal conjugate vaccine should not be given during the same visit but should be separated by ≥ 4 weeks.

The dose is 0.5 mL IM for MenACWY.

Two doses of MenACWY, given ≥ 8 weeks apart and followed by a booster every 5 years, are required for adults who have anatomic or functional asplenia, HIV infection, or persistent complement component deficiencies or who take eculizumab or ravulizumab. Adolescents (aged 11 to 18 years) with HIV infection are routinely vaccinated with a 2-dose primary series, given 8 weeks apart.Two doses of MenACWY, given ≥ 8 weeks apart and followed by a booster every 5 years, are required for adults who have anatomic or functional asplenia, HIV infection, or persistent complement component deficiencies or who take eculizumab or ravulizumab. Adolescents (aged 11 to 18 years) with HIV infection are routinely vaccinated with a 2-dose primary series, given 8 weeks apart.

A single dose of MenACWY meningococcal vaccine is given to microbiologists who are routinely exposed to isolates of N. meningitidis, military recruits, people at risk during an outbreak attributable to a vaccine serogroup, and those who travel to or live in endemic areas. If risk continues (eg, for microbiologists who continue working with N. meningitidis), a booster dose is given every 5 years.

Based on a shared clinical decision-making discussion, adolescents and young adults aged 16 to 23 years (preferred age 16 to 18 years) who are not at increased risk of meningococcal disease are given two doses of MenB-4C at least 1 month apart or a 2-dose series of MenB-FHbp given at 0 and 6 months (if dose 2 was given less than 6 months after dose 1, a third dose should be given at least 4 months after dose 2). The same MenB must be used for all doses.

People ≥ 10 years of age with certain high-risk conditions (including people with anatomical or functional asplenia, persistent complement component deficiency, complement inhibitor use [eg, eculizumab, ravulizumab], microbiologists routinely exposed to People ≥ 10 years of age with certain high-risk conditions (including people with anatomical or functional asplenia, persistent complement component deficiency, complement inhibitor use [eg, eculizumab, ravulizumab], microbiologists routinely exposed toN. meningitidis), and people identified to be at increased risk because of a meningococcal disease outbreak caused by serogroup B are given a 2-dose series of MenB-4C ≥ 1 month apart or a 3-dose series of MenB-FHbp at 0, 1 to 2, and 6 months (if dose 2 was given at least 6 months after dose 1, dose 3 is not needed; if dose 3 is administered earlier than 4 months after dose 2, a fourth dose should be administered at least 4 months after dose 3).

MenB vaccines may be given simultaneously with MenACWY, if indicated, but at a different anatomic site, if feasible. Patients may receive a single dose of the pentavalent MenABCWY vaccine as an alternative to separate administration of MenACWY and MenB when both vaccines would be given on the same day.

Adverse effects are usually mild. They include pain and redness at the injection site, fever, headache, and fatigue.

The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

1. Advisory Committee on Immunization Practices (ACIP): Meningococcal ACIP Vaccine Recommendations

2. ACIP: Infant Meningococcal Vaccination: ACIP Recommendations and Rationale

3. ACIP: Recommended Adult Immunization Schedule, United States, 2024 including Changes to the 2024 Adult Immunization Schedule

4. Centers for Disease Control and Prevention (CDC): Meningococcal Vaccination: Information for Healthcare Professionals

5. European Centre for Disease Prevention and Control (ECDC): Meningococcal Disease: Recommended vaccinations