At what age should the first dose of the meningococcal B (MenB) vaccine be administered?

Meningococcal B Vaccine First Dose Timing

For healthy adolescents not at increased risk, the first dose of meningococcal B vaccine should be administered between ages 16-23 years, with the preferred age being 16-18 years, based on shared clinical decision-making between the provider and patient/family. 1

Routine Vaccination for Healthy Adolescents

• MenB vaccination is NOT routinely recommended for all adolescents - it requires a shared clinical decision-making discussion rather than being a universal recommendation 1
• The preferred age window is 16-18 years, though vaccination can occur anytime between 16-23 years 1
• Two vaccine options exist with different schedules for healthy adolescents 1, 2:
  • MenB-FHbp (Trumenba): 2 doses at 0 and 6 months
  • MenB-4C (Bexsero): 2 doses at 0 and 6 months (updated from previous 0 and ≥1 month schedule) 2

Important caveat: If the second dose of MenB-FHbp is given earlier than 6 months after the first dose, a third dose must be administered at least 4 months after the second dose 1

High-Risk Populations (Different Timing)

For persons aged ≥10 years at increased risk for meningococcal disease, vaccination should begin at age 10 years or older when the risk factor is identified 1. High-risk groups include:

• Persons with persistent complement deficiencies 1
• Persons using complement inhibitors (e.g., eculizumab) 1
• Persons with anatomical or functional asplenia (including sickle cell disease) 1
• Microbiologists routinely exposed to Neisseria meningitidis 1
• Persons at risk during serogroup B meningococcal disease outbreaks 1

For high-risk individuals, use a 3-dose schedule 1, 2:

• MenB-FHbp: 3 doses at 0,1-2, and 6 months (provides earlier protection and maximizes short-term immunogenicity)
• MenB-4C: 3 doses at 0,1-2, and 6 months (newly added schedule as of 2024) 2

Key Considerations for Shared Clinical Decision-Making

When discussing MenB vaccination with healthy adolescents aged 16-23 years, consider 1:

• Serious disease consequences: High mortality rates and permanent sequelae (hearing loss, limb loss, neurologic damage) in those who develop invasive disease
• Low disease incidence: Average of only 34 serogroup B cases annually among persons aged 16-23 years in the United States (2015-2018)
• Increased college risk: Higher risk among college freshmen, especially those living in on-campus housing or participating in Greek life
• Short duration of protection: Antibody waning occurs within 1-2 years post-vaccination series completion
• No herd immunity: MenB vaccines provide individual protection but do not affect meningococcal carriage, so no population-level benefit

Critical Pitfalls to Avoid

• The two MenB vaccines are NOT interchangeable - the same product must be used for all doses in the series 1
• MenB vaccines are only licensed for ages 10-25 years in the United States - there are no recommendations for use in children under age 10 1
• Minimum interval between any two doses is 4 weeks if doses need to be repeated 1
• If vaccine product is unknown after one dose, the entire series must be restarted with a known product 1
• Do not confuse with MenACWY vaccine, which has different timing (first dose at age 11-12 years, booster at age 16 years) 1

Special Populations

Pregnancy: MenB vaccination should be deferred until after pregnancy unless the woman is at increased risk, in which case the benefit may outweigh potential risks after consultation 1

Age ≥26 years: Not routinely recommended; only for those at increased risk (off-label use) 1