Meningococcal Vaccine

There are 6 meningococcal vaccines available for use in the United States.

For serogroups ACWY (quadrivalent):

• Meningococcal conjugate vaccines (4 strain) (MenACWY-CRM or MenACWY-TT)

For serogroup B (monovalent):

• Meningococcal group B vaccine (3 strain) (MenB-4C) Meningococcal group B vaccine (3 strain) (MenB-4C)

• Meningococcal group B vaccine (4 strain) (MenB-FHbp)Meningococcal group B vaccine (4 strain) (MenB-FHbp)

For serogroups ABCWY (pentavalent):

• Meningococcal groups A, B, C, W, and Y vaccine (5 strain) (MenACWY-TT/MenB-FHbp)

• Meningococcal groups A, B, C, W, and Y vaccine (5 strain) (MenACWY-CRM/MenB-FHbp)

The quadrivalent conjugate meningococcal vaccine is a routine childhood vaccination administered to adolescents, preferably at age 11 or 12 years, with a booster dose at age 16 years (1). It is also recommended for younger children who are at high risk of infection (2).

MenACWY conjugate vaccines are recommended for adults who are at increased risk of meningococcal infection (3), such as the following:

• Anatomic or functional asplenia (including sickle cell disease)

• HIV infection

• Persistent complement component deficiencies

• 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. MenACWY is also preferred for at-risk people > 55 years who have not received MenACWY previously and who require only 1 dose (eg, travelers).

Revaccination with MenACWY every 5 years is recommended for adults who were previously vaccinated with MenACWY and who remain at increased risk of infection (see list of indications above).

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 N. meningitidis, and those at risk because of a meningococcal disease outbreak attributed to serogroup B). MenB vaccines are not routinely recommended by the CDC for all adolescents. However, they may be administered based on individual clinical decision making to anyone aged 16 to 23 years; the preferred age for vaccination is 16 to 18 years. Booster doses are generally not recommended.

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

Indications for MenACWY-CRM/MenB-FHbp are similar to those for MenACWY-TT/MenB-FHbp.

The main contraindication for meningococcal vaccines is:

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

The main precautions with meningococcal vaccines are the following:

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

• Preterm birth (MenACWY only)

• Pregnancy (MenB only)

• Hypersensitivity to latex (MenB-4C only)

Meningococcal conjugate vaccines may be administered to pregnant patients who are at increased risk of serogroups A, C, W, or Y meningococcal disease.

MenB vaccines are recommended to be deferred during pregnancy unless patients 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 administered during the same visit but should be separated by ≥ 4 weeks.

Patients ≥ 10 years of age may be given MenB vaccine simultaneously with MenACWY vaccine, if indicated, but at a different anatomic site, if feasible. Patients may receive a single dose of either of the pentavalent MenACWY/MenB vaccines as an alternative to separate administration of MenACWY and MenB when both vaccines would be administered on the same day.

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

For more information about adverse effects of these vaccines, refer to the prescribing information.

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): ACIP Recommendations: Meningococcal Vaccine

2. ACIP: Changes in the 2025 Adult Immunization Schedule

3. ACIP: Changes in the 2025 Child and Adolescent Immunization Schedule

4. Centers for Disease Control and Prevention (CDC): Meningococcal

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