What are the recommendations for meningitis vaccination?

Meningococcal Vaccination Recommendations

The Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination with quadrivalent meningococcal conjugate vaccine (MenACWY) at age 11-12 years with a booster dose at age 16 years, and MenB vaccination between ages 16-23 years based on shared clinical decision-making (preferably at ages 16-18 years). 1

Age-Specific Recommendations

Children and Adolescents

• For ages 11-12 years: One primary dose of MenACWY 1
• Booster dose at age 16 years if first dose was administered before 16th birthday 1
• Catch-up vaccination: MenACWY may be administered to persons aged 19-21 years who have not received a dose after their 16th birthday 1
• College freshmen living in residence halls should receive at least 1 dose of MenACWY within 5 years before college entry 1

Young Adults (16-23 years)

• MenB vaccination based on shared clinical decision-making (preferred age 16-18 years) 1
• MenB-FHbp: 2 doses at 0 and 6 months 1
• MenB-4C: 2 doses at least 1 month apart 1

Children Under 11 and Adults Over 23

• Not routinely recommended unless at increased risk for meningococcal disease 1

Special Populations at Increased Risk

Medical Conditions

• Two-dose primary series of MenACWY for persons aged ≥2 years with:
  • Persistent complement component deficiencies 1
  • Complement inhibitor use 1
  • Anatomic or functional asplenia 1
  • HIV infection 1, 2

International Travelers

• For travelers to the meningitis belt in sub-Saharan Africa or other areas with epidemic meningococcal disease: 1
  • Ages 2-23 months: MenACWY-D (≥9 months): 2 doses ≥12 weeks apart (may be given ≥8 weeks apart for travelers) or MenACWY-CRM according to age-specific schedule 1
  • Ages ≥2 years: Single dose of MenACWY 1
  • Booster doses:
    • Ages <7 years: Single dose 3 years after primary vaccination and every 5 years thereafter 1
    • Ages ≥7 years: Single dose 5 years after primary vaccination and every 5 years thereafter 1

Outbreak Settings

• MenACWY for outbreaks caused by serogroups A, C, W, or Y 1
• MenB for outbreaks caused by serogroup B 1, 3
• Boosters may be recommended if previously vaccinated and at continued risk 1

Vaccine Types and Interchangeability

• MenACWY vaccines are interchangeable for primary vaccination and booster doses 1
• Available MenACWY vaccines:
  • MenACWY-D (Menactra)
  • MenACWY-CRM (Menveo)
  • MenACWY-TT (MenQuadfi) 1
• Available MenB vaccines:
  • MenB-FHbp (Trumenba) 1
  • MenB-4C (Bexsero) 1

Vaccine Effectiveness and Duration of Protection

• MenACWY effectiveness is estimated at 80-85% within 3-4 years after vaccination 4
• Breakthrough cases may occur, particularly in immunosuppressed individuals or when immunity wanes (>3 years after vaccination) 2
• Booster doses are crucial for maintaining protection in high-risk individuals 2

Safety Considerations

• Syncope can occur after vaccination, especially in adolescents
• Patients should be observed seated or lying down for 15 minutes after vaccination to prevent injury from fainting 1
• Anaphylaxis is a rare but possible adverse event 1

Common Pitfalls and Caveats

• Failure to provide booster doses: Many breakthrough cases occur >3 years after vaccination, highlighting the importance of booster doses for those at continued risk 2
• Incomplete vaccination: Ensure adolescents receive both the primary dose and booster dose as recommended 2
• Overlooking high-risk groups: Persons with complement deficiencies, asplenia, or HIV are at significantly higher risk and require more aggressive vaccination schedules 1, 2
• Not recognizing the need for MenB vaccination: MenB vaccines are separate from MenACWY and protect against different strains 1, 3
• Inadequate protection for international travelers: Travelers to high-risk areas need appropriate vaccination and may require boosters if previously vaccinated >3-5 years ago 1

By following these evidence-based recommendations, healthcare providers can significantly reduce the morbidity and mortality associated with meningococcal disease through appropriate vaccination strategies.