What vaccinations are recommended for immunoprophylaxis (prevention through vaccination) to prevent meningitis?

Recommended Vaccinations for Meningitis Prevention

All adolescents should receive MenACWY vaccine at age 11-12 years with a booster at age 16 years, and MenB vaccination should be offered to those aged 16-23 years (preferably 16-18 years) based on shared clinical decision-making. 1

Routine Adolescent Vaccination Schedule

MenACWY (Serogroups A, C, W, Y)

• Primary dose at age 11-12 years 2, 1
• Booster dose at age 16 years if the first dose was given before the 16th birthday 2, 1
• Adolescents who receive their first dose at ages 13-15 years should receive a booster at ages 16-18 years 2
• No booster needed if first dose is given after the 16th birthday, unless the person becomes at increased risk 2
• Catch-up vaccination: May be given to persons aged 19-21 years who haven't received a dose after their 16th birthday 1

MenB (Serogroup B)

• Preferred age: 16-18 years based on shared clinical decision-making 1
• Two vaccine options (not interchangeable):
  • MenB-FHbp (Trumenba): 2 doses at 0 and 6 months 1
  • MenB-4C (Bexsero): 2 doses at least 1 month apart 1
• Critical caveat: The same vaccine product must be used for all doses in the series 2

High-Risk Populations Requiring Enhanced Protection

Persons with Immunocompromising Conditions

Two-dose primary series of MenACWY is required (not just one dose) for persons aged ≥2 years with: 1

• Persistent complement component deficiencies
• Complement inhibitor use (e.g., eculizumab, ravulizumab)
• Anatomic or functional asplenia
• HIV infection

MenB vaccination is also recommended for these high-risk groups aged ≥10 years 1

Booster schedule for high-risk individuals: 3

• If first dose given at age <7 years: booster at 3 years, then every 5 years thereafter
• If first dose given at age ≥7 years: booster every 5 years

Special Timing Considerations for High-Risk Groups

For complement inhibitor users: 2

• Vaccinate at least 2 weeks before starting complement inhibitor therapy
• If therapy cannot be delayed, administer antimicrobial prophylaxis (e.g., penicillin) alongside vaccination and continue for 2 weeks after vaccine administration
• Consider antimicrobial prophylaxis for the duration of complement inhibitor therapy

For elective splenectomy: 2

• Administer vaccines at least 2 weeks before surgery when possible
• If not possible, give as soon as the patient's condition is stable post-operatively

For children with asplenia or HIV: 2

• Use MenACWY-CRM (Menveo), not MenACWY-D (Menactra), before age 2 years to avoid interference with pneumococcal conjugate vaccine (PCV13)
• If MenACWY-D must be used, wait at least 4 weeks after completing all PCV doses

College Students

College freshmen living in residence halls should receive at least 1 dose of MenACWY within 5 years before college entry 1

International Travelers

Travel to Meningitis Belt (Sub-Saharan Africa)

Vaccination is recommended for travel during the dry season (December-June) 2

Ages 2-23 months: 2

• MenACWY-D (≥9 months): 2 doses ≥12 weeks apart (may be given ≥8 weeks apart for travelers)
• OR MenACWY-CRM: age-specific schedule (4 doses at 2,4,6, and 12 months if starting at 2 months)

Ages ≥2 years: 2

• Single dose of MenACWY

Booster doses for travelers with continued risk: 2

• Age <7 years: booster at 3 years after primary vaccination, then every 5 years
• Age ≥7 years: booster at 5 years after primary vaccination, then every 5 years

Outbreak Settings

MenACWY vaccines for outbreaks caused by serogroups A, C, W, or Y 1

MenB vaccines for outbreaks caused by serogroup B 1

Age-specific schedules apply based on outbreak serogroup (see Tables in guidelines) 2

Available Vaccine Products

MenACWY Vaccines (Interchangeable)

• MenACWY-D (Menactra, Sanofi Pasteur) 1
• MenACWY-CRM (Menveo, GlaxoSmithKline) 1
• MenACWY-TT (MenQuadfi, Sanofi Pasteur) 1

MenB Vaccines (NOT Interchangeable)

• MenB-FHbp (Trumenba, Pfizer) 1
• MenB-4C (Bexsero, GlaxoSmithKline) 1

Pentavalent Vaccine

• MenACWY-TT/MenB-FHbp (Penbraya, Pfizer) may be used when both MenACWY and MenB are indicated at the same visit for persons aged ≥10 years 4

Critical Pitfalls to Avoid

Vaccine interchangeability error: MenB vaccines are NOT interchangeable 2. If the vaccine product is unknown after one dose, restart the series with either product. If two different MenB products were given, select one product and give an additional dose at the appropriate interval (minimum 4 weeks between doses).

Timing with other vaccines: MenACWY-D should be given before or at the same time as DTaP in children to avoid interference 2. If given after DTaP, wait 6 months unless the child needs immediate protection due to travel or outbreak.

Syncope prevention: Observe patients seated or lying down for 15 minutes after vaccination, especially adolescents, to prevent injury from fainting 1

Waning immunity: Vaccine effectiveness decreases over time, with MenACWY-D showing 79% effectiveness at <1 year but declining to 61% at 3-8 years post-vaccination 5. This evidence supports the booster dose recommendation at age 16 years.

Inadequate protection in complement-deficient patients: Although vaccination may not adequately prevent meningococcal infections in persons with certain complement deficiencies or those using complement inhibitors, these persons should still be vaccinated due to possible benefit 2. Consider antimicrobial prophylaxis as an adjunct.