Meningococcal Vaccine Schedule
For routine adolescent vaccination, administer MenACWY at ages 11-12 years and again at age 16 years; for MenB vaccination, offer a 2-dose series at ages 16-23 years based on shared clinical decision-making, with doses separated by 6 months, or use a 3-dose series (0,1-2, and 6 months) for high-risk individuals aged ≥10 years. 1, 2
Routine Adolescent Schedule (MenACWY)
The standard MenACWY schedule consists of:
- First dose at age 11-12 years (routine)
- Booster dose at age 16 years (routine)
This two-dose approach is critical—the first dose contributes ≥90% of the disease reduction benefit 3. Available MenACWY vaccines include MenACWY-D (Menactra), MenACWY-CRM (Menveo), and MenACWY-TT (MenQuadfi) 2.
Important Timing Considerations:
- MenACWY-D and DTaP: Give MenACWY-D before or simultaneously with DTaP to avoid immune interference in children 2
- Special populations with asplenia or HIV: Do not give MenACWY-D before age 2 years; wait at least 4 weeks after completing all PCV doses to prevent pneumococcal vaccine interference 2
MenB Vaccination Schedule
For Healthy Adolescents (Ages 16-23 Years):
The 2025 updated guidance offers flexibility 1:
- Bexsero (MenB-4C): 2 doses separated by 6 months (new extended interval option)
- Trumenba (MenB-FHbp): 2 doses at 0 and 6 months
This is administered based on shared clinical decision-making, not routine recommendation—meaning providers should discuss individual risk factors and preferences with patients and families 1, 2.
For High-Risk Individuals (Age ≥10 Years):
Use a 3-dose series 1:
- Trumenba (MenB-FHbp): 0,1-2, and 6 months
- Bexsero (MenB-4C): Follow manufacturer guidance for high-risk populations
High-risk categories include:
- Complement component deficiencies (including complement inhibitor use)
- Functional or anatomic asplenia
- Microbiologists routinely exposed to Neisseria meningitidis
- Outbreak situations
- Travel to hyperendemic areas
Booster Doses
MenACWY Boosters:
- Age <7 years: Single booster if ≥3 years since last dose
- Age ≥7 years: Single booster if ≥5 years since last dose
- High-risk individuals may need boosters every 3-5 years 2
MenB Boosters:
- If previously vaccinated and at continued increased risk: Single booster dose if ≥1 year after primary series completion (≥6 months may be considered in outbreak settings) 2
Pentavalent MenABCWY Vaccine (Penbraya)
A newer option combines protection against all five serogroups:
- Licensed for ages 10-25 years
- Two-dose schedule: 0 and 6 months 4, 5
- Can be used when both MenACWY and MenB are indicated at the same visit
- Demonstrates non-inferior immunogenicity compared to separate MenACWY and MenB vaccines 5
Special Populations
Infants and Young Children (Ages 2-23 Months):
MenACWY-CRM dosing 2:
- First dose at 2 months: 4 doses at 2,4,6, and 12 months
- First dose at 3-6 months: Follow catch-up schedule
- First dose at 7-23 months: 2 doses (second dose ≥12 weeks after first and after 1st birthday)
MenACWY-D: 2 doses ≥12 weeks apart for ages ≥9 months 2
Children Ages 2-9 Years:
- Primary vaccination: Single dose of any MenACWY vaccine
- MenB vaccines are not recommended for this age group unless high-risk 2
Critical Pitfalls to Avoid
Do not eliminate the first MenACWY dose at age 11-12 years—this provides the majority of disease protection and removing it would significantly increase IMD incidence 6, 3
Timing with other vaccines: Pay attention to MenACWY-D interactions with DTaP and PCV in young children to avoid immune interference 2
Shared clinical decision-making for MenB: This is NOT a routine recommendation—requires individualized discussion about risk factors, college attendance, and outbreak potential 1, 2
High-risk populations need 3 doses of MenB, not 2—this is frequently missed 1
Booster intervals matter: Don't give boosters too early; follow the age-specific intervals (3 years for <7 years old, 5 years for ≥7 years old) 2