What are the guidelines for administering the Men B (Meningococcal B) vaccine?

Meningococcal B Vaccine Guidelines

The Advisory Committee on Immunization Practices (ACIP) recommends MenB vaccination for persons aged ≥10 years at increased risk for serogroup B meningococcal disease and as a consideration for all adolescents and young adults aged 16-23 years through shared clinical decision-making. 1

Target Populations and Vaccination Schedules

High-Risk Groups (Category A Recommendation)

Persons aged ≥10 years with the following conditions should receive MenB vaccination:

1. Persistent complement component deficiencies:

   • Ages 10+ years:
     • MenB-FHbp (Trumenba): 3 doses at 0,1-2, and 6 months
     • MenB-4C (Bexsero): 2 doses ≥1 month apart
   • Booster doses: Single dose at 1 year after primary series and every 2-3 years thereafter 1

2. Anatomic or functional asplenia (including sickle cell disease):

   • Ages 10+ years:
     • MenB-FHbp: 3 doses at 0,1-2, and 6 months
     • MenB-4C: 2 doses ≥1 month apart
   • Booster doses: Single dose at 1 year after primary series and every 2-3 years thereafter 1

3. Persons using complement inhibitors (e.g., eculizumab, ravulizumab):

   • Same schedule as for persistent complement deficiencies
   • Administer at least 2 weeks before starting complement inhibitor therapy (unless delay poses greater risk) 1

4. During serogroup B outbreaks:

   • Ages 10+ years:
     • MenB-FHbp: 3 doses at 0,1-2, and 6 months
     • MenB-4C: 2 doses ≥1 month apart
   • Booster dose: If previously vaccinated, single dose if ≥1 year after primary series 1

5. Microbiologists routinely exposed to N. meningitidis isolates

Healthy Adolescents and Young Adults (Category B Recommendation)

For adolescents and young adults aged 16-23 years (preferred age 16-18 years) who are not at increased risk:

• MenB-FHbp: 2 doses at 0 and 6 months
• If second dose is given earlier than 6 months, administer a third dose at least 4 months after the second dose 1
• MenB-4C: 2 doses at least 1 month apart

Important Considerations

1. Vaccine Interchangeability: MenB-FHbp and MenB-4C are NOT interchangeable. The same product must be used for all doses in a series 1

2. Minimum Interval: The minimum interval between any two doses of MenB vaccine is 4 weeks 1

3. Co-administration: MenB vaccines may be administered concomitantly with other vaccines indicated for this age group, but at different anatomic sites when feasible 1

4. Timing with DTaP: When using MenACWY-D in children, it should be given either before or at the same time as DTaP to avoid immune interference 1

5. Fever Management: For infants receiving 4CMenB (Bexsero), prophylactic paracetamol/acetaminophen may reduce post-vaccination fever without clinically relevant effects on immune responses 2

Implementation Challenges

1. Low Awareness: Studies show limited awareness of MenB disease and vaccination options among parents and young adults, with only 49.7-61.0% of unvaccinated individuals aware of the vaccine 3

2. Provider Role: Healthcare providers play a crucial role in initiating conversations about MenB vaccination, as many vaccinated individuals report relying on their primary care provider's recommendation 3

3. Shared Decision-Making: Despite ACIP recommendations for shared clinical decision-making for healthy adolescents, awareness of this approach remains low (35.1-45.3%) 3

4. Global Variation: There is significant heterogeneity in MenB vaccination policies worldwide, with only 24 out of 58 countries where the vaccines are authorized having established national policies 4

Effectiveness and Persistence

• At least 2 doses of 4CMenB (Bexsero) has been shown to reduce MenB invasive disease by 50-100% in various age groups 5
• Bactericidal antibodies wane after infant vaccination with 4CMenB, but an anamnestic response occurs with a booster dose at 40-44 months of age 6

Key Pitfalls to Avoid

1. Incomplete vaccination series: Ensure patients complete the full recommended series for optimal protection
2. Mixing vaccine products: MenB-FHbp and MenB-4C are not interchangeable
3. Inadequate timing with other vaccines: Particularly important when administering MenACWY-D with DTaP
4. Missing high-risk individuals: Proactively identify patients with complement deficiencies, asplenia, or those using complement inhibitors
5. Overlooking booster doses: High-risk individuals need periodic boosters to maintain protection

By following these guidelines, clinicians can effectively implement MenB vaccination strategies to reduce the risk of invasive meningococcal disease, particularly in high-risk populations and adolescents.