MenQuadfi (Meningococcal Conjugate Vaccine) Administration Guidelines
MenQuadfi (MenACWY-TT) is recommended as a single 0.5 mL intramuscular injection for routine vaccination of adolescents at ages 11-12 years with a booster at age 16 years, and for high-risk individuals aged ≥2 years for prevention of invasive meningococcal disease caused by serogroups A, C, W, and Y.
Indications and Dosing
Routine Vaccination
- Adolescents aged 11-12 years: Single primary dose
- Booster dose: At age 16 years (if first dose administered before 16th birthday)
- Adolescents who receive first dose at or after age 16: No booster needed 1
High-Risk Populations (aged ≥2 years)
MenQuadfi is indicated for individuals with:
- Persistent complement component deficiencies (C3, C5-C9, properdin, factor D, factor H)
- Complement inhibitor use (eculizumab, ravulizumab)
- Functional or anatomic asplenia
- HIV infection (2-dose primary series, 8-12 weeks apart)
- Travel to hyperendemic/epidemic areas (e.g., meningitis belt of sub-Saharan Africa)
- Microbiologists routinely exposed to N. meningitidis
- First-year college students living in residence halls 1, 2
Dosing Schedule for High-Risk Individuals
- Ages ≥2 years: 2-dose primary series administered 8 weeks apart
- Booster doses:
- Ages 2-6 years: First booster 3 years after primary series, then every 5 years
- Ages ≥7 years: First booster 5 years after primary series, then every 5 years 1
Administration
- Route: Intramuscular injection (0.5 mL), preferably in the deltoid region
- Co-administration: Can be given with other age-appropriate vaccines at different anatomic sites 2
- No reconstitution needed: MenQuadfi is supplied as a ready-to-use solution, unlike some other meningococcal vaccines 3
Efficacy and Safety
- MenQuadfi has demonstrated non-inferiority to other licensed meningococcal conjugate vaccines
- The vaccine elicits robust immune responses against all four serogroups (A, C, W, Y)
- Safety profile is comparable to other meningococcal conjugate vaccines 4, 5
- The tetanus toxoid carrier protein in MenQuadfi may provide improved immunogenicity compared to other carrier proteins 4
Special Considerations
College Students
- First-year college students living in residence halls should receive at least one dose of MenACWY within 5 years before college entry
- If only one dose was administered before the 16th birthday, a booster dose should be given before enrollment 1
Travelers
- Individuals traveling to regions with high endemic rates of meningococcal disease (e.g., "meningitis belt" of sub-Saharan Africa) should receive MenQuadfi at least 10 days before travel
- For optimal protection against all major disease-causing serogroups, travelers should be protected against serogroups A, C, W, and Y 1
Outbreak Control
- MenQuadfi can be used for control of outbreaks caused by vaccine-preventable serogroups (A, C, W, and Y)
- An outbreak is defined as ≥3 confirmed or probable primary cases of the same serogroup within ≤3 months, resulting in ≥10 cases per 100,000 population 1
Important Clinical Notes
- MenQuadfi does not protect against serogroup B meningococcal disease; separate MenB vaccination may be needed for comprehensive protection
- Contraindication: Severe allergic reaction to any component of MenQuadfi or after a previous dose
- For individuals who previously received a different MenACWY vaccine, MenQuadfi can be used for subsequent doses 1, 2
- Current modeling suggests maintaining both the 11-12 year dose and 16-year booster is more effective in preventing disease than single-dose strategies 6
By following these guidelines for MenQuadfi administration, healthcare providers can help reduce the morbidity and mortality associated with invasive meningococcal disease while optimizing patient protection against serogroups A, C, W, and Y.