Who should receive the meningococcal B vaccine?

Meningococcal B Vaccination Recommendations

Meningococcal B (MenB) vaccine is routinely recommended for persons aged 10 years and older who are at increased risk for meningococcal disease, and may be administered to adolescents and young adults aged 16-23 years (preferably 16-18 years) based on shared clinical decision-making. 1, 2

Persons Who Should Receive MenB Vaccination

Category A Recommendation (Routine Vaccination)

Persons aged 10 years and older with the following risk factors:

1. Persistent complement component deficiencies

   • Inherited or chronic deficiencies in C3, C5-C9, properdin, factor D, or factor H
   • Persons receiving complement inhibitor therapy (e.g., eculizumab) 1, 2

2. Anatomic or functional asplenia

   • Including sickle cell disease 1, 3

3. Laboratory personnel routinely exposed to isolates of Neisseria meningitidis 1, 2

4. Persons identified during outbreaks of serogroup B meningococcal disease 1, 2

5. Unvaccinated household contacts of a person with meningococcal B disease 3

Category B Recommendation (Shared Clinical Decision-Making)

• Adolescents and young adults aged 16-23 years (preferred age 16-18 years) 1, 2
• First-year college students aged ≤21 years living in residence halls 1, 2

Vaccination Schedule

MenB-FHbp (Trumenba)

• Healthy adolescents (16-23 years): 2-dose series at 0 and 6 months 1, 2
• High-risk individuals: 3-dose series at 0,1-2, and 6 months 1, 2

MenB-4C (Bexsero)

• All groups: 2-dose series at least 1 month apart 1, 2

Important Clinical Considerations

1. Vaccine interchangeability: The two MenB vaccines are NOT interchangeable. The same product must be used for all doses in a series 2

2. Booster doses:

   • For persons who remain at increased risk for meningococcal disease, booster doses are recommended 1
   • Not routinely recommended for healthy adolescents unless they become at increased risk 1

3. Co-administration:

   • MenB vaccines can be administered simultaneously with other vaccines (including MenACWY) at different anatomic sites 2
   • When MenACWY-TT/MenB-FHbp (pentavalent vaccine) is used, subsequent doses of MenB should be from the same manufacturer 4

4. Efficacy considerations:

   • Immunogenicity may be reduced in patients with complement deficiencies, particularly those receiving eculizumab 5
   • Protection is not immediate and requires completion of the series 3

Cost-Effectiveness and Epidemiological Context

The permissive (Category B) recommendation for healthy adolescents is based on:

• Very low incidence of serogroup B meningococcal disease in persons without risk factors 1
• High number needed to vaccinate (NNV) to prevent cases:
  • 102,000-203,000 to prevent one case
  • 638,000-1,512,000 to prevent one death 1
• Cost per quality-adjusted life-year (QALY) ranging from $3.7-8.7 million 1

Adverse Events

Common adverse events include:

• Severe pain at injection site: 20-29% (MenB-4C), 5-8% (MenB-FHbp)
• Fever ≥38°C: 1-5% (MenB-4C), 2-8% (MenB-FHbp)
• Severe headache, fatigue, and muscle pain are more common with MenB-4C 1

Clinical Pitfalls to Avoid

1. Not completing the full series - Ensure patients complete all recommended doses for optimal protection
2. Mixing different MenB vaccines - The vaccines are not interchangeable
3. Delaying vaccination for high-risk individuals - For unvaccinated household contacts of a MenB case, vaccination should be administered as soon as possible 3
4. Overlooking the need for booster doses in persons with ongoing risk factors
5. Failing to recognize all high-risk conditions that warrant vaccination

By following these evidence-based recommendations, clinicians can appropriately target MenB vaccination to those who will benefit most while engaging in shared decision-making with adolescents and young adults without specific risk factors.