What is the recommended use and administration of Menactra (Meningococcal conjugate vaccine)?

Menactra (MenACWY-D): Recommended Use and Administration

Menactra (MenACWY-D) is a quadrivalent meningococcal conjugate vaccine recommended for prevention of invasive meningococcal disease caused by serogroups A, C, W, and Y in specific age groups and high-risk populations, with administration schedules varying by age and risk factors.

General Recommendations and Age Indications

• Licensed for persons aged 9 months to 55 years 1
• Use in persons ≥56 years is considered off-label but may be appropriate for those at increased risk 1

Routine Vaccination for Adolescents

• Primary dose at 11-12 years of age
• Booster dose at 16-18 years of age 1
• Adolescents who receive their first dose at 13-15 years should receive a booster at 16-18 years 1
• Adolescents who receive their first dose at or after 16 years do not need a booster dose 1
• First-year college students through age 21 years living in residence halls who received their last dose before their 16th birthday should receive a single dose 1

Dosing Schedule by Age and Risk Group

Infants and Young Children (9-23 months) with High-Risk Conditions

• 2 doses administered 12 weeks apart 1
• High-risk conditions include:
  • Persistent complement component deficiencies
  • Community outbreak of vaccine-preventable serogroup
  • Travel to endemic regions

Children 2-10 years

• For healthy children: Not routinely recommended
• For high-risk children: 2 doses administered 8-12 weeks apart 1

Persons 11-55 years

• For healthy adolescents: Single primary dose
• For high-risk individuals: 2 doses administered 8-12 weeks apart 1

High-Risk Groups Requiring Vaccination

1. Persons with persistent complement component deficiencies (C3, C5-9, properdin, factor D, factor H) 1

   • 2-dose primary series (8-12 weeks apart)
   • Booster doses:
     • Age <7 years: First booster 3 years after primary series, then every 5 years
     • Age ≥7 years: Every 5 years after primary series

2. Persons with anatomic or functional asplenia 1

   • 2-dose primary series (8-12 weeks apart)
   • Same booster schedule as complement deficiencies
   • Important: For children with asplenia, MenACWY-D should not be given before age 2 years to avoid interference with pneumococcal conjugate vaccine (PCV) 1
   • If MenACWY-D is used in a person with asplenia, it should not be administered until at least 4 weeks after completion of all PCV doses 1

3. Persons using complement inhibitors (eculizumab, ravulizumab) 1

   • Same schedule as for complement deficiencies
   • Ideally administer at least 2 weeks before starting complement inhibitor therapy

4. Microbiologists routinely exposed to N. meningitidis 1

   • Single dose with boosters every 5 years if exposure continues

5. International travelers to endemic regions 1

   • Single dose for travel to "meningitis belt" of sub-Saharan Africa during dry season (December-June)
   • Booster if last dose was ≥5 years previously

6. Persons in a community outbreak 1

   • Single dose for those identified as being at increased risk

Booster Dose Recommendations

• Children who received primary series before age 7: First booster 3 years after primary series, then every 5 years 1
• Persons who received primary series at age ≥7: Booster every 5 years 1
• Adolescents: Booster at age 16-18 years if first dose given at age 11-15 years 1, 2

Important Administration Considerations

1. Timing with other vaccines:

   • MenACWY-D should be given either before or at the same time as DTaP to avoid interference with meningococcal vaccine response in children 1
   • May be given at any time in relation to Tdap or Td 1

2. Special considerations for asplenia or HIV:

   • For children with functional/anatomic asplenia or HIV infection, do not use MenACWY-D before age 2 years 1
   • If MenACWY-D is used in these populations, administer at least 4 weeks after completing all PCV doses 1

3. Route of administration:

   • Administer as an intramuscular injection 1

Contraindications and Precautions

• Severe allergic reaction to a previous dose or vaccine component
• Moderate or severe acute illness (temporary precaution)

By following these guidelines, healthcare providers can appropriately administer Menactra to protect individuals at highest risk for meningococcal disease, particularly focusing on those with complement deficiencies, asplenia, and adolescents during their peak risk period.