When is a meningitis vaccine booster needed?

Meningococcal Vaccine Booster Recommendations

Meningococcal vaccine boosters are needed based on age, risk factors, and time since initial vaccination, with adolescents requiring a booster at age 16 if vaccinated at 11-12 years, persons with high-risk conditions needing boosters every 5 years, and international travelers requiring boosters if their last dose was 3-5 years prior.

Routine Adolescent Booster Recommendations

• Adolescents who received their first dose of MenACWY at age 11-12 years should receive a booster dose at age 16 years 1
• Adolescents who received their first dose at age 13-15 years should receive a booster dose at age 16-18 years 1
• Adolescents who received their first dose at or after age 16 years do not need a booster dose unless they become at increased risk for meningococcal disease 1
• College freshmen living in residence halls should receive at least one dose of MenACWY within 5 years before college entry; if the only dose was received before the 16th birthday, a booster should be administered before enrollment 1

High-Risk Group Booster Recommendations

• Persons with persistent complement component deficiencies (e.g., C3, C5-C9, properdin, factor D, factor H) or functional/anatomic asplenia should receive boosters every 5 years after their primary series 1
• For children 2 months to 6 years of age with persistent risk factors, a booster dose should be given 3 years after the primary series and every 5 years thereafter 1
• For children and adolescents 7 years or older with persistent risk factors, a booster dose should be given every 5 years 1
• Military recruits require boosters every 5 years based on assignment requirements 1
• Persons with HIV infection should follow the same booster schedule as other high-risk individuals 1

International Travel Booster Recommendations

• International travelers should receive a booster dose of MenACWY if the last dose was administered 3-5 or more years previously (depending on age at most recent dose) 1
• Vaccination is required by the Kingdom of Saudi Arabia for all travelers to Mecca during the Hajj and Umrah pilgrimages 1

Important Clinical Considerations

• MenACWY-D and MenACWY-CRM are licensed for a single booster dose for persons aged 15-55 years if at least 4 years have elapsed since the last dose 1
• MenACWY-TT is licensed for a single booster dose for persons aged ≥15 years if at least 4 years have elapsed since the last dose of MenACWY 1
• Booster doses administered outside these age ranges or administration of more than one booster dose are considered off-label but may be necessary for those at continued high risk 1
• Serogroup B meningococcal (MenB) booster doses may be indicated for persons ≥10 years who remain at increased risk for serogroup B meningococcal disease 1

Common Pitfalls and Caveats

• Failure to recognize the need for a booster in adolescents who received their primary dose before age 16 can leave them vulnerable during peak risk years 1
• Not identifying patients with complement deficiencies or asplenia who need more frequent boosters increases their risk of invasive disease 1
• Overlooking the need for boosters in international travelers to endemic regions may result in inadequate protection 1
• Recent studies show that antibody persistence remains high for at least 4 years after a booster dose of MenACWY-D, supporting the current booster recommendations 2
• Long-term studies indicate that MenACWY provides immune persistence for at least 5 years after primary vaccination, with robust responses to booster doses 3