Immunoprophylaxis for Meningitis Prophylaxis
Primary Vaccination Recommendations
Routine meningococcal vaccination with quadrivalent conjugate vaccine (MenACWY) should be administered to all adolescents at age 11-12 years with a booster at age 16 years. 1
Meningococcal Vaccination Strategy
Adolescents aged 11-12 years should receive MenACWY at their preadolescent health-care visit, with a booster dose at age 16 years to maintain protection during the highest-risk period of late adolescence and early adulthood 2, 1
High-school entry vaccination (approximately age 15 years) is recommended for those who have not previously received MenACWY as an effective strategy to reduce disease incidence 2
College freshmen living in dormitories should receive meningococcal vaccination due to their increased risk from close living quarters 2, 1
High-Risk Populations Requiring Vaccination
Persons with the following conditions require a 2-dose primary series of MenACWY administered 8-12 weeks apart: 1
- Persistent complement component deficiencies (these individuals have 1,000-10,000 times higher risk of meningococcal disease) 1
- Anatomic or functional asplenia 2, 1
Single-dose vaccination is recommended for: 2, 1
- Military recruits
- International travelers to high-risk areas (particularly the "meningitis belt" of sub-Saharan Africa during dry season, December-June)
- Microbiologists routinely exposed to Neisseria meningitidis isolates
- Terminal complement deficiency
Serogroup-Specific Vaccination
Serogroup B vaccination should be considered when 2 or more cases of serogroup B disease occur within the same household, even if the interval exceeds 30 days or strains differ 2
Unvaccinated contacts of cases caused by vaccine-preventable non-B serogroups (A, C, W, Y) should be offered vaccination 2
Index cases under age 25 years who are unimmunized should receive vaccination according to the national schedule regardless of the causative serogroup 2
Serogroup C booster should be offered to previously immunized cases of confirmed serogroup C disease around the time of hospital discharge 2
Haemophilus influenzae Type b (Hib) Vaccination
All previously unvaccinated household contacts under age 10 years should receive Hib vaccination when H. influenzae type b is confirmed as the cause of meningitis. 2, 3
The Hib conjugate vaccine has demonstrated 98% efficacy and dramatically reduced invasive Hib disease incidence 4
Vaccination is particularly critical for children under 2 years who are susceptible to encapsulated bacteria due to immature polysaccharide antigen response 4
Pneumococcal Considerations
Close contacts of pneumococcal meningitis are not at increased risk and do not require antibiotic prophylaxis or specific immunoprophylaxis. 2
- Clusters in institutional settings (e.g., elderly care homes) should be discussed with local health protection authorities 2
Post-Exposure Vaccination Timing
Vaccination should be administered concurrently with chemoprophylaxis but does not replace the need for antibiotic prophylaxis in close contacts. 2
An increased risk of meningococcal disease persists for at least 6 months in contacts despite prophylaxis, and general practice records should be flagged accordingly 2
Chemoprophylaxis should be administered as soon as possible (ideally within 24 hours) and has limited value if given more than 14 days after exposure 1
Outbreak Control Vaccination
Wider vaccination may be offered when 2 or more cases of probable/confirmed invasive meningococcal disease due to the same vaccine-preventable strain occur in the same educational or residential setting within a 4-week period. 2
Critical Epidemiologic Context
Understanding disease epidemiology helps target vaccination efforts appropriately:
Serogroups B, C, and Y each cause approximately one-third of meningococcal cases in the United States 1
Over 50% of cases in infants under 1 year are caused by serogroup B, for which vaccines have only recently become available 1
Despite appropriate antibiotic treatment, the case-fatality ratio remains 10-14%, and 11-19% of survivors experience significant sequelae including neurologic disability, limb loss, and hearing loss 1
Common Pitfalls
Do not delay vaccination while waiting for serotype confirmation in contacts of meningococcal disease caused by vaccine-preventable serogroups 2
Do not assume vaccination alone provides immediate protection for close contacts—chemoprophylaxis remains essential for immediate risk reduction 2
Do not overlook the index case for vaccination needs, particularly unimmunized individuals under age 25 years 2
Do not provide pneumococcal prophylaxis to routine contacts, as they are not at increased risk 2