What is the recommended number of doses of meningococcal B (MenB) vaccine for an 18-year-old?

Meningococcal B Vaccine Dosing for 18-Year-Olds

For an 18-year-old, the recommended dosing schedule for meningococcal B (MenB) vaccine is either a 2-dose series of MenB-4C (Bexsero) at least 1 month apart or a 2-dose series of MenB-FHbp (Trumenba) at 0 and 6 months. 1, 2

Vaccine Options and Dosing Schedules

There are two MenB vaccines available, and the dosing schedule depends on which product is used:

1. MenB-4C (Bexsero):

   • 2-dose series with doses administered at least 1 month apart 2, 3

2. MenB-FHbp (Trumenba):

   • For healthy adolescents (standard schedule): 2 doses administered at 0 and 6 months
   • Important note: If the second dose is administered earlier than 6 months after the first dose, a third dose should be administered at least 4 months after the second dose 1, 2

Risk-Based Considerations

The dosing schedule may differ for individuals at increased risk for meningococcal disease:

• For high-risk individuals (those with persistent complement component deficiencies, anatomical or functional asplenia, microbiologists routinely exposed to N. meningitidis, or during outbreaks):
  • MenB-FHbp: 3-dose series (0,1-2, and 6 months)
  • MenB-4C: 2-dose series (≥1 month apart) 1, 2

Important Clinical Considerations

• The two MenB vaccines are not interchangeable - the same product must be used for all doses in a series 1
• MenB vaccines can be administered concomitantly with MenACWY vaccines, but at different anatomical sites 1
• The preferred age range for MenB vaccination in healthy adolescents is 16-23 years, with optimal timing at 16-18 years 2
• For first-year college students aged ≤21 years living in residence halls, MenB vaccination should be considered based on shared clinical decision-making 1, 2

Antibody Persistence

Studies show that protective antibody levels persist after vaccination:

• After two doses of MenB-4C, 77-94% of subjects maintained protective antibody titers 18-24 months post-vaccination 4
• For MenB-FHbp, protective antibody titers initially decline but remain stable through 48 months post-vaccination 5

Pitfalls to Avoid

1. Mixing vaccine products: Never interchange MenB-4C and MenB-FHbp within a vaccination series
2. Incorrect intervals: If using MenB-FHbp and the second dose is given earlier than 6 months after the first dose, a third dose is required
3. Confusing with MenACWY: MenB vaccines specifically target serogroup B and are different from MenACWY vaccines that target serogroups A, C, W, and Y
4. Missing booster doses: For high-risk individuals who remain at increased risk, follow the specific booster recommendations

By following these evidence-based recommendations, clinicians can ensure optimal protection against meningococcal serogroup B disease in 18-year-old patients.