What is the recommended meningitis vaccine protocol for a patient who needs vaccination against both meningitis A and B and may be eligible for immunotherapy as an outpatient?

Meningococcal Vaccination Protocol for Patients Eligible for Immunotherapy

For patients who may be eligible for outpatient immunotherapy, vaccination against both meningococcal serogroups A, C, W, Y and serogroup B is recommended to prevent potentially life-threatening meningococcal disease. 1

Recommended Vaccination Schedule

For Adults (≥10 years of age):

MenACWY Vaccination (Serogroups A, C, W, Y):

• Primary vaccination: Administer 1 dose of MenACWY vaccine (MenACWY-D, MenACWY-CRM, or MenACWY-TT) 1
• Timing: Should be administered at least 2 weeks before starting immunotherapy 1
• Products available:
  • MenACWY-D (Menactra)
  • MenACWY-CRM (Menveo)
  • MenACWY-TT (MenQuadfi)

MenB Vaccination (Serogroup B):

• Primary vaccination: Administer either:
  • MenB-FHbp (Trumenba): 3-dose series at 0,1-2, and 6 months, OR
  • MenB-4C (Bexsero): 2 doses at least 1 month apart 1
• Important: MenB-FHbp and MenB-4C are not interchangeable; the same product must be used for all doses in a series 1

Special Considerations

Timing Relative to Immunotherapy

• Meningococcal vaccines should be administered at least 2 weeks before starting immunotherapy to ensure optimal immune response 1
• Both MenACWY and MenB vaccines can be administered during the same visit but at different injection sites 1

Booster Doses

• If the patient remains at increased risk due to ongoing immunotherapy:
  • MenACWY booster: Single dose 5 years after primary vaccination and every 5 years thereafter 1
  • MenB booster: Single dose 1 year after completion of primary vaccination and every 2-3 years thereafter 1

Age-Specific Considerations

• For patients aged 56 years or older: Administration of MenACWY-D, MenACWY-CRM, or MenB vaccines is considered off-label but is recommended for those at increased risk 1
• For patients aged 26 years or older: Administration of MenB vaccine is considered off-label but is recommended for those at increased risk 1

Rationale for Vaccination

Patients receiving immunotherapy may be at increased risk for meningococcal disease due to potential immunomodulation effects. This is particularly important for:

• Patients receiving complement inhibitors (such as eculizumab or ravulizumab) 1
• Patients with functional or anatomic asplenia 1
• Patients with persistent complement deficiencies 1
• Patients with HIV infection 1

Common Pitfalls to Avoid

1. Not administering both vaccine types: Failing to provide both MenACWY and MenB vaccines leaves patients vulnerable to serogroup B, which is a common cause of meningococcal disease outbreaks in the US 2

2. Incorrect timing: Administering vaccines too close to immunotherapy initiation may result in suboptimal immune response 1

3. Mixing MenB vaccine products: Using different MenB products within the same series will result in inadequate protection 1

4. Overlooking booster doses: Protection from meningococcal vaccines wanes over time, with studies showing significant waning 3-8 years post-vaccination 3

5. Neglecting documentation: Ensure proper documentation of vaccination to avoid unnecessary revaccination or missed doses

By following this protocol, you can help ensure comprehensive protection against meningococcal disease for patients who may be eligible for immunotherapy as outpatients.