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Meningococcal Vaccine: Who and When to Vaccinate

For Healthcare Providers

There are three types of meningococcal vaccines available in the United States:

  • Meningococcal conjugate vaccines (Mentactra®, MenHibrix® and Menveo®)
  • Meningococcal polysaccharide vaccine (Menomune®)
  • Serogroup B meningococcal vaccines (Bexsero® and Trumenba®)

 

Preteens and Teens: Who Needs to Be Vaccinated?

Meningococcal disease can be devastating and often — and unexpectedly — strikes otherwise healthy individuals. Anyone can get meningococcal disease, but teens and young adults 16 through 23 years of age are at increased risk for meningococcal disease. Meningococcal bacteria can cause severe disease, including meningitis and sepsis, resulting in permanent disabilities and even death.

Meningococcal Conjugate Vaccine

All 11–12 year olds should be vaccinated with a quadrivalent (protects against serogroups A, C, W, and Y) meningococcal conjugate vaccine (Menactra® or Menveo®).  A booster dose is recommended at age 16 years. For adolescents who receive the first dose at age 13 through 15 years, a booster dose should be administered, preferably at age 16 through 18 years, before the period of increased risk. Adolescents who receive their first dose of quadrivalent meningococcal conjugate vaccine at or after age 16 years do not need a booster dose.

Booster recommendation for quadrivalent meningococcal conjugate vaccine

When quadrivalent meningococcal conjugate vaccine was first recommended for adolescents in 2005, the expectation was that protection would last for 10 years; however, currently available data suggest it wanes in most adolescents within 5 years. Based on that information, a single dose at the recommended age of 11 or 12 years may not offer protection through the adolescent years at which risk for meningococcal infection is highest (16 through 23 years of age).

For patients who are about to start college and got their first dose of quadrivalent meningococcal conjugate vaccine more than 5 years ago

For the best protection, it is recommended that these patients receive a booster dose of quadrivalent meningococcal conjugate vaccine. This vaccination is required to attend many colleges. The Advisory Committee on Immunization Practices (ACIP) suggests that students receive the vaccine less than 5 years before starting college.

Booster dose of quadrivalent meningococcal conjugate vaccine for patients younger than 16 years who you might not see again

It's recommended that you use your clinical judgment in a situation where you may not have another opportunity to provide the booster dose to this patient. The minimum interval between doses is 8 weeks.

Polysaccharide versus conjugate vaccine

Only the quadrivalent meningococcal conjugate vaccine is recommended for adolescents. However, a first dose of meningococcal vaccine administered as polysaccharide vaccine can be counted as valid in the adolescent schedule. The booster dose of meningococcal vaccine should always be a quadrivalent meningococcal conjugate vaccine (among persons younger than 56 years). If polysaccharide vaccine is inadvertently administered as the booster dose, CDC recommends revaccination with a quadrivalent meningococcal conjugate vaccine.

Quadrivalent meningococcal conjugate vaccine use in adolescents with HIV

Adolescents aged 11 through 18 years with HIV should be routinely vaccinated with a 2-dose primary series administered 2 months apart. Those adolescents should also receive the routine booster dose at age 16 years if the primary series is received before the 16th birthday.

Minimum booster dose interval for quadrivalent meningococcal conjugate vaccine

Adolescents aged 16 through 18 years can get the booster dose at any time. The minimum interval between doses is 8 weeks. A booster is not indicated if the initial dose was given after age 16 in healthy persons.

Safety of quadrivalent meningococcal conjugate vaccine booster dose

Available data suggest that the booster dose is very safe, but vaccine safety will continue to be monitored.

Serogroup B Meningococcal Vaccine

Serogroup B meningococcal vaccines are only routinely recommended for people 10 and older identified as being at increased risk, either because of a serogroup B meningococcal disease outbreak or certain medical conditions. Those conditions include complement component deficiencies (e.g., C5-C9, properdin, factor H, factor D, or are taking Soliris®) and functional or anatomic asplenia. Clinicians can use serogroup B meningococcal vaccines for people 10 through 25 years of age consistent with the labeled indication.

ACIP is also currently considering use of serogroup B meningococcal vaccines in adolescents and young adults. A decision on recommendations is expected soon.

For additional details, consult the Meningococcal ACWY Vaccine Information Statement, the Serogroup B Meningococcal Vaccine Information Statement, and the Adolescent Immunization Schedule.

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Adults: Who Needs to Be Vaccinated?

See also: Adult Immunization Schedule

Meningococcal Conjugate Vaccine

Adults should get a quadrivalent meningococcal conjugate vaccine if:

  • They have complement component deficiency (e.g., C5-C9, properdin, factor H, factor D, or are taking Soliris®)
  • They have functional or anatomic asplenia
  • They are a microbiologist who is routinely exposed to Neisseria meningitidis (the causal pathogen)
  • They are traveling or residing in countries in which the disease is common
  • They are part of a population identified to be at increased risk because of a serogroup A, C, W or Y meningococcal disease outbreak
  • They are a first-year college student living in a residence hall
  • They are a military recruit

Adults at increased risk because of complement component deficiencies and persons with functional or anatomic asplenia should receive a two-dose primary series 2 months apart and then get a booster dose every 5 years.

Polysaccharide versus conjugate vaccine

Meningococcal polysaccharide vaccine is the only licensed meningococcal vaccine for adults aged ≥56 years and is immunogenic in older adults. For meningococcal vaccine-naïve persons aged ≥56 years who anticipate requiring a single dose of meningococcal vaccine (e.g., travelers and persons at risk as a result of a community outbreak), meningococcal polysaccharide vaccine is preferred.  For persons now aged ≥56 years who were vaccinated previously with meningococcal conjugate vaccine and are recommended for revaccination or for whom multiple doses are anticipated (e.g., persons with asplenia and microbiologists), meningococcal conjugate vaccine is preferred. Adults aged ≥56 years at increased risk because of complement component deficiencies and persons with functional or anatomic asplenia who have not previously received meningococcal conjugate vaccine should receive a two-dose primary series 2 months apart and then get a booster dose every 5 years.

Polysaccharide Vaccine

Adults 56 years and older should get the meningoccoccal polysaccharide vaccine if they are anticipated to only need one dose and:

  • They are traveling or residing in countries in which the disease is common
  • They are part of a population identified to be at increased risk because of an outbreak of a serogroup A, C, W or Y meningococcal disease outbreak

Serogroup B Meningococcal Vaccine

Adults should get a serogroup B meningococcal vaccine if:

  • They have complement component deficiency (e.g., C5-C9, properdin, factor H,  factor D, or are taking Soliris®)
  • They have functional or anatomic asplenia
  • They are a microbiologist who is routinely exposed to Neisseria meningitidis (the causal pathogen)
  • They are part of a population identified to be at increased risk because of a serogroup B meningococcal disease outbreak

For additional details, consult the Meningococcal ACWY Vaccine Information Statement, the Serogroup B Meningococcal Vaccine Information Statement, and the Adult Immunization Schedule.

Healthcare Personnel Vaccination Recommendations [1 page]

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Infants and Children: Who Needs to Be Vaccinated?

Meningococcal Conjugate Vaccine

Meningococcal conjugate vaccine (Menactra®, Menveo®, MenHibrix®) is recommended for certain children at increased risk from ages 2 months through 10 years.

This vaccine is routinely recommended for children at increased risk for meningococcal disease, including those:

  • With complement component deficiencies (e.g., C5-C9, properdin, factor H, factor D, or are taking Soliris®)
  • With functional or anatomic asplenia
  • Who travel to specific countries
  • Who are part of a population identified to be at increased risk because of a serogroup A, C, W or Y meningococcal disease outbreak

Persons over 2 years of age at increased risk because of complement component deficiencies and persons with functional or anatomic asplenia should receive a two dose primary series 2 months apart. For children at prolonged increased risk for meningococcal disease, ACIP recommends booster doses of conjugate meningococcal vaccine after completion of the primary series.  If the most recent dose was received before age 7 years, a booster dose should be administered 3 years later.  Additional boosters should be administered every 5 years thereafter.

Special considerations for use of Menactra® for children with functional or anatomic asplenia

Children with functional or anatomic asplenia are NOT recommended to receive Menactra® until 2 years of age in order to avoid interference with the immunologic response to the infant series of pneumococcal conjugate vaccine (PCV). ACIP recommends that infants 2 through 23 months of age with functional or anatomic asplenia either receive Menveo® or MenHibrix® or wait until 2 years of age to receive Menactra®.

Children who receive MenHibrix® are not protected for travel

Infants and children who received the bivalent (protects against serogroups C and Y) meningococcal conjugate vaccine and Haemophilus influenza type b conjugate vaccine called MenHibrix® and are traveling or residing in countries where the disease is common should receive a quadrivalent (protects against serogroups A, C, W and Y) meningococcal conjugate vaccine (Menveo® or Menactra®) before travel.

For additional details, consult the ACIP recommendations, Meningococcal ACWY Vaccine Information Statement and the Childhood Immunization Schedule.

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