What is the recommended dosing schedule for meningococcal vaccine A (MenA) in children?

Meningococcal Vaccine A Dosing Schedule for Children

For meningococcal vaccine A (MenA) in children, the recommended schedule is two doses when administered as part of quadrivalent conjugate vaccines (MenACWY), with specific timing based on age and risk factors. 1

General Recommendations for MenA Vaccination

Routine Vaccination for Healthy Children

• For healthy children, MenACWY (which includes serogroup A) is routinely recommended at age 11-12 years with a booster dose at age 16-18 years 1
• Children who receive their first dose at age 13-15 years should receive a booster at age 16-18 years (at least 8 weeks or up to 5 years after the first dose) 1
• Adolescents who receive their first dose at or after 16 years of age do not need a booster dose 1

High-Risk Children (Under Age 2)

• For infants and children at increased risk for meningococcal disease (complement deficiencies, asplenia, etc.), the following schedules apply:
  • MenACWY-CRM (Menveo): If first dose at age 2 months, administer 4 doses at 2,4,6, and 12 months 1
  • MenACWY-CRM: If first dose at age 3-6 months, follow catch-up schedule with doses at intervals of 8 weeks until age ≥7 months, then an additional dose at age ≥7 months, followed by a dose at least 12 weeks later and after the 1st birthday 1
  • MenACWY-CRM: If first dose at age 7-23 months, administer 2 doses with the second dose at least 12 weeks after the first and after the 1st birthday 1
  • MenACWY-D (Menactra): For children ≥9 months, administer 2 doses at least 12 weeks apart 1

High-Risk Children (Age 2 and Older)

• For children age 2 years and older with persistent risk factors:
  • Primary vaccination: 2 doses of MenACWY-D, MenACWY-CRM, or MenACWY-TT administered at least 8 weeks apart 1
  • Booster doses: For children <7 years, give a single booster dose 3 years after primary series and every 5 years thereafter; for children ≥7 years, give a booster every 5 years 1

Special Considerations

Vaccine Selection and Timing

• Conjugate vaccines (MenACWY) are preferred over polysaccharide vaccines (MPSV4) for all age groups due to their T-cell dependent mechanism that provides more robust immunity and memory 1
• MenACWY-D should be given either before or at the same time as DTaP to avoid interference with the immune response to meningococcal vaccine 1
• For children with functional or anatomic asplenia or HIV infection, MenACWY-D should not be administered before age 2 years to avoid interference with pneumococcal conjugate vaccine (PCV) 1

Immunogenicity Evidence

• Research shows that a single dose of MenACWY-TT at 12 months or two doses at 9 and 12 months both produce protective antibody levels against serogroup A, though persistence of antibodies against serogroup A may wane more quickly than other serogroups 2
• Studies indicate that when followed by a booster dose, a single priming dose can be as effective as or even superior to a two-dose priming schedule 3

Outbreak Situations

• During outbreaks attributable to serogroup A, children aged 2-23 months should receive MenACWY-D (if ≥9 months) with 2 doses at least 12 weeks apart, or MenACWY-CRM according to age-specific schedules 1
• For children aged 2-9 years during outbreaks, a single dose of MenACWY-D, MenACWY-CRM, or MenACWY-TT is recommended 1

Pitfalls and Caveats

• MenA is not the most common serogroup causing disease in US infants (serogroup B is more common), so vaccination against MenA alone will not protect against all meningococcal disease 4
• Antibody persistence for serogroup A tends to wane faster than for other serogroups, with studies showing only 20.6-25.9% of children maintaining protective antibody levels one year after vaccination 2
• When administering MenACWY-D to children with asplenia or HIV, ensure it is given at least 4 weeks after completion of all PCV doses to avoid immune interference 1