What are the recommendations for meningococcal (Neisseria meningitidis) vaccination?

Meningococcal Vaccination Recommendations

Routine meningococcal vaccination is recommended for all adolescents at age 11-12 years with a booster dose at age 16 years, and for persons at increased risk for meningococcal disease regardless of age. 1

Routine Recommendations by Age Group

Infants and Children (2 months - 10 years)

• Not routinely recommended unless at increased risk for meningococcal disease
• For high-risk children:
  • Infants 2-18 months at increased risk: 4-dose primary series of Hib-MenCY-TT 1
  • Children 9-23 months with complement deficiencies: 2-dose series of MenACWY-D 1
  • Children ≥2 years with persistent risk factors: 2 doses of MenACWY (MenACWY-D or MenACWY-CRM) 8-12 weeks apart 1

Adolescents (11-23 years)

• Primary vaccination: 1 dose of MenACWY at age 11-12 years
• Booster dose: 1 dose at age 16 years if first dose was administered before 16th birthday
• Catch-up vaccination: MenACWY may be administered to persons aged 19-21 years who haven't received a dose after their 16th birthday
• MenB vaccination: MenB series may be given at age 16-23 years (preferred age 16-18 years) based on shared clinical decision-making 1
  • MenB-FHbp: 2 doses at 0 and 6 months
  • MenB-4C: 2 doses ≥1 month apart

Adults (≥24 years)

• Not routinely recommended unless at increased risk for meningococcal disease

Recommendations for High-Risk Groups

Persons with Persistent Complement Component Deficiencies or on Complement Inhibitors

• MenACWY: 2-dose primary series 8 weeks apart, with booster doses every 5 years 1, 2
• MenB: Complete primary series with booster doses 1 year after completion and every 2-3 years thereafter 2
• For those on complement inhibitors (e.g., ravulizumab):
  • Both MenACWY and MenB vaccines must be administered
  • Ideally vaccinate at least 2 weeks before starting therapy 2

Persons with Anatomic or Functional Asplenia

• MenACWY: 2-dose primary series 8-12 weeks apart, with booster doses
• For children 2 months-6 years: Booster 3 years after primary series and every 5 years thereafter
• For persons ≥7 years: Booster every 5 years 1

Persons with HIV Infection

• MenACWY: 2-dose primary series 8-12 weeks apart, with booster doses every 5 years

College Freshmen Living in Residence Halls

• Should receive at least 1 dose of MenACWY within 5 years before college entry
• If only 1 dose was administered before the 16th birthday, a booster dose should be given before enrollment 1

Travelers to or Residents in Countries with Hyperendemic/Epidemic Meningococcal Disease

• MenACWY for persons aged ≥9 months traveling to areas with high endemic rates 1

Laboratory Personnel with Occupational Exposure

• MenACWY with booster dose 5 years after prior dose if at continued risk 1

Important Considerations

Vaccine Interchangeability

• MenACWY vaccines (MenACWY-D, MenACWY-CRM, MenACWY-TT) are interchangeable for primary vaccination and booster doses 1
• MenB vaccines are not interchangeable - must use same product for all doses in a series 2

Booster Dose Timing

• For adolescents who receive their first dose at age 13-15 years, a booster should be given at age 16-18 years 1
• Minimum interval between MenACWY doses is 8 weeks 1

Off-Label Uses

• Two-dose primary series of MenACWY for persons ≥2 years with high-risk conditions
• Repeated booster doses for persons at prolonged increased risk
• MenACWY-D or MenACWY-CRM in persons ≥56 years at increased risk
• MenB vaccination in persons ≥26 years at increased risk
• MenB booster doses in persons ≥10 years at increased risk 1

Effectiveness and Impact

Recent evidence shows that the current two-dose MenACWY schedule (ages 11-12 and 16) has significantly reduced meningococcal disease incidence. After implementation of the booster dose recommendation, serogroup C, W, and Y meningococcal disease decreased by 35.6% annually among adolescents aged 16-22 years 3. An estimated 222 cases were averted through vaccination 3. High proportions (89.9-98.2%) of individuals maintain protective antibody titers 4 years after receiving a MenACWY booster dose 4.

Pitfalls to Avoid

1. Missing the booster dose: Failure to administer the booster dose at age 16 can leave adolescents vulnerable during their highest risk period.

2. Incomplete vaccination of high-risk individuals: Persons with complement deficiencies or on complement inhibitors need both MenACWY and MenB vaccines.

3. Inadequate timing before complement inhibitor therapy: Ideally, vaccination should be completed at least 2 weeks before starting complement inhibitor therapy 2.

4. Overlooking revaccination needs: Individuals at persistent risk require regular booster doses to maintain protection.

5. Confusing MenACWY and MenB vaccines: These protect against different serogroups and are not interchangeable - both are needed for complete protection in high-risk individuals.