Recommended Number of Doses for Meningococcal Vaccine
The recommended number of doses for meningococcal vaccine varies by age, risk factors, and vaccine type, with most healthy adolescents requiring a primary dose at age 11-12 years followed by a booster dose at age 16 years. 1, 2
Dosing Recommendations by Age and Risk Group
Infants and Young Children (2-23 months)
- Only recommended for high-risk infants
- MenACWY-CRM (Menveo):
- Starting at 2 months: 4 doses at 2,4,6, and 12 months
- Starting at 3-6 months: Follow catch-up schedule with doses at 8-week intervals until 7 months, then additional dose at ≥7 months, followed by final dose ≥12 weeks later and after 1st birthday
- Starting at 7-23 months: 2 doses with second dose ≥12 weeks after first dose and after 1st birthday 1
- MenACWY-D (Menactra): Only for ages ≥9 months, 2 doses ≥12 weeks apart 1
Children 2-10 Years
- Not routinely recommended unless at increased risk
- For children with high-risk conditions:
- MenB vaccines not recommended for this age group 1
Adolescents and Young Adults (11-23 years)
- Routine recommendation for all adolescents:
- College freshmen living in residence halls: At least 1 dose within 5 years before college entry 1
- MenB vaccines (ages 16-23, preferably 16-18): Based on shared clinical decision-making
- MenB-FHbp (Trumenba): 2 doses at 0 and 6 months
- MenB-4C (Bexsero): 2 doses ≥1 month apart 1
Adults ≥24 years
- Not routinely recommended unless at increased risk 1
Special Risk Groups (All Ages)
Persistent Complement Deficiencies or Complement Inhibitor Use
- MenACWY: 2 doses ≥8 weeks apart
- MenB (if ≥10 years):
- MenB-FHbp: 3 doses at 0,1-2, and 6 months
- MenB-4C: 2 doses ≥1 month apart
- Boosters:
Anatomic/Functional Asplenia (including Sickle Cell Disease)
- Similar to complement deficiency schedule
- Important: MenACWY-D should not be administered until at least 4 weeks after completion of all PCV doses 1
During Outbreaks
- MenACWY: 1 dose
- MenB (if ≥10 years):
- MenB-FHbp: 3 doses at 0,1-2, and 6 months
- MenB-4C: 2 doses ≥1 month apart 1
Important Clinical Considerations
Vaccine Effectiveness and Duration of Protection
- Single dose of MenACWY has 69% effectiveness overall, but wanes over time:
- 79% at <1 year post-vaccination
- 69% at 1 to <3 years
- 61% at 3 to <8 years 3
- This waning effectiveness is why a booster dose is recommended at age 16 for those who received their first dose before age 16 1, 3
Vaccine Interchangeability
- MenACWY vaccines (MenACWY-D, MenACWY-CRM, MenACWY-TT) are interchangeable for the primary series and booster doses 1
- MenB vaccines (MenB-FHbp and MenB-4C) are NOT interchangeable - use same product for all doses in series 1
Timing Considerations
- MenACWY-D should be given either before or at the same time as DTaP to avoid interference with immune response 1
- For patients using complement inhibitors, meningococcal vaccines should be administered at least 2 weeks before the first dose of the inhibitor, unless delay risks outweigh benefits 1
Common Pitfalls to Avoid
- Inadequate protection for college students: Ensure college freshmen living in residence halls have received a dose within 5 years before college entry
- Missed booster doses: Adolescents who received their first dose before age 16 need a booster at age 16
- Incorrect spacing for high-risk groups: High-risk individuals require specific dose spacing and regular boosters
- Vaccine interference: MenACWY-D should not be given to children with asplenia or HIV before age 2 years due to interference with PCV response
- Assuming interchangeability: While MenACWY vaccines are interchangeable, MenB vaccines must be completed with the same product
The evidence strongly supports that appropriate dosing schedules significantly reduce morbidity and mortality from meningococcal disease, particularly during the highest risk periods in adolescence and for those with specific risk factors 1, 2.