What is MenACWY (Meningococcal Conjugate Vaccine)?

What is MenACWY (Meningococcal Conjugate Vaccine)?

MenACWY is a quadrivalent meningococcal conjugate vaccine that protects against invasive meningococcal disease caused by serogroups A, C, W, and Y of Neisseria meningitidis. 1

Vaccine Formulations

Three MenACWY conjugate vaccines are licensed in the United States, each using different carrier proteins:

• MenACWY-D (Menactra, Sanofi Pasteur): Uses diphtheria toxoid as the carrier protein, licensed for ages 9 months through 55 years 1
• MenACWY-CRM (Menveo, GlaxoSmithKline): Uses diphtheria CRM197 protein as the carrier, licensed for ages 2 months through 55 years 1
• MenACWY-TT (MenQuadfi, Sanofi Pasteur): Uses tetanus toxoid as the carrier protein, licensed for ages ≥2 years 1

All three formulations are interchangeable for primary vaccination and booster doses. 1

Routine Vaccination Schedule

Adolescents (Ages 11-23 Years)

The primary dose should be administered at age 11-12 years, with a booster dose at age 16 years if the first dose was given before the 16th birthday. 1

• Adolescents who received their first dose at or after age 16 do not need a booster unless they become at increased risk for meningococcal disease 2
• Catch-up vaccination 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 must receive at least 1 dose within 5 years before college entry, with preferred timing on or after their 16th birthday 1, 2

Children and Adults

• Ages 2 months-10 years: Not routinely recommended except for those at increased risk 1
• Ages ≥24 years: Not routinely recommended except for those at increased risk 1

High-Risk Populations Requiring Vaccination

MenACWY is indicated for persons at increased risk, including those with:

• Persistent complement component deficiencies (C3, C5-C9, properdin, factor H, or factor D): Require a 2-dose primary series administered ≥8 weeks apart 1
• Complement inhibitor use (eculizumab or ravulizumab): Should receive vaccine at least 2 weeks before first dose of complement inhibitor 1
• Anatomic or functional asplenia: Require a 2-dose primary series ≥8 weeks apart 1
• HIV infection: Require a 2-dose primary series administered 8-12 weeks apart 1
• Microbiologists routinely exposed to N. meningitidis: Single dose recommended 1
• Travelers to hyperendemic or epidemic areas (such as the meningitis belt of sub-Saharan Africa or during Hajj pilgrimage): Single dose recommended 1, 2

Booster Dose Recommendations

High-Risk Individuals

Persons with persistent complement deficiencies, complement inhibitor use, or asplenia require boosters every 5 years after their primary series. 2

• Children aged <7 years at increased risk: Booster at 3 years after primary vaccination, then every 5 years thereafter 1, 2
• Children and adolescents aged ≥7 years at increased risk: Booster at 5 years after primary vaccination, then every 5 years thereafter 1, 2

International Travelers

Travelers should receive a booster dose if the last dose was administered 3-5 or more years previously, depending on age at most recent dose. 2

Administration Details

• Dose volume: 0.5 mL administered intramuscularly 1
• Can be administered concomitantly with other vaccines at different injection sites 1
• Important timing consideration: MenACWY-D should be given either before or at the same time as DTaP in children to avoid interference with immune response 1

Clinical Efficacy and Impact

The MenACWY vaccination program has demonstrated substantial effectiveness:

• Incidence of serogroup CWY disease among adolescents aged 11-15 years decreased by 27.8% annually during the post-primary dose period 3
• Among adolescents aged 16-22 years, incidence decreased by 35.6% annually in the post-booster dose period 3
• An estimated 222 cases of meningococcal disease due to serogroups C, W, or Y were averted through vaccination during the evaluation period 3
• High proportions (89.9-98.2%) of participants maintained protective antibody titers 4 years after a booster dose 4

Important Clinical Considerations

Vaccine Interchangeability

All MenACWY formulations are interchangeable for both primary vaccination and booster doses, allowing flexibility in vaccine administration. 1

Limitations

MenACWY does not protect against serogroup B meningococcal disease, which accounts for more than half of invasive meningococcal disease cases in adolescents and young adults in the United States. 5 Separate MenB vaccination should be considered based on shared clinical decision-making for persons aged 16-23 years. 1

Safety Profile

• Observe patients for 15 minutes after vaccination to prevent syncope-related injuries, particularly in adolescents 1
• Local and systemic reactions following booster doses are comparable to reactions after primary doses 1
• No significant safety concerns have been identified in post-licensure surveillance 1

Common Pitfalls to Avoid

• Failing to administer the age 16 booster in adolescents who received their primary dose before age 16 leaves them vulnerable during peak risk years 2
• Not recognizing patients with complement deficiencies or asplenia who require a 2-dose primary series and more frequent boosters increases their risk of invasive disease 2
• Overlooking the need for vaccination in international travelers to endemic regions may result in inadequate protection 2
• Administering MenACWY-D before completion of PCV13 series in children with asplenia or HIV can interfere with immune response to both vaccines 1