What meningitis vaccine should be given to students?

Meningococcal Vaccination for Students

Students should receive the quadrivalent meningococcal conjugate vaccine (MenACWY) with at least one dose before college entry, preferably administered on or after their 16th birthday. 1

Primary Recommendation for College Students

First-year college students living in residence halls must receive at least 1 dose of MenACWY before college entry. 1 The timing is critical:

• If the student received only one dose before age 16, they require a booster dose before enrollment. 1, 2
• The preferred timing for the most recent dose is on or after the 16th birthday. 1
• For students aged ≤21 years, documentation of meningococcal conjugate vaccine receipt within the past 5 years is recommended for enrollment. 1, 2

This recommendation is based on case-control studies demonstrating that first-year college students living in residence halls have a 3.6-fold increased risk of meningococcal disease compared to other students (matched OR: 3.6; CI = 1.6–8.5). 1

Standard Adolescent Vaccination Schedule

The routine vaccination schedule for all adolescents, including those who will become students, follows this algorithm: 1, 2

• First dose at age 11-12 years 2
• Booster dose at age 16 years 2
• If first dose given at age 13-15 years, booster at age 16-18 years 2
• If first dose given at or after age 16 years, no booster needed unless increased risk develops 2

Serogroup B Meningococcal Vaccine Consideration

MenB vaccination is NOT routinely recommended but may be considered for healthy adolescents aged 16-23 years (preferred ages 16-18 years) through shared clinical decision-making. 1, 3 This is a Category B recommendation, meaning it is permissive rather than routine. 1

Key points about MenB vaccination: 1, 3

• Requires discussion between provider and patient/family about serious disease consequences, low incidence, increased college risk, short protection duration, and lack of herd immunity 3
• The two MenB vaccines (MenB-FHbp and MenB-4C) are NOT interchangeable—the same product must be used for all doses 3
• MenB-FHbp requires 2 doses for healthy adolescents or 3 doses for high-risk individuals 1
• MenB-4C requires 2 doses for all groups 1

Critical Timing Considerations

Vaccine effectiveness wanes significantly over time, which is why booster timing matters. 4 Real-world effectiveness data shows:

• 79% effectiveness at <1 year post-vaccination 4
• 69% effectiveness at 1 to <3 years 4
• 61% effectiveness at 3 to <8 years 4

This waning immunity is precisely why the booster at age 16 is critical—it ensures protection during the highest-risk college years. 2, 4

Common Pitfalls to Avoid

Failure to verify vaccination status before college entry leaves students vulnerable during peak risk years. 2 Specific errors include:

• Not recognizing that a single dose given before age 16 requires a booster before college enrollment 1, 2
• Assuming any meningococcal vaccine dose provides adequate protection without checking the timing and type 2
• Confusing MenACWY (routine for students) with MenB (permissive/shared decision-making only) 1, 3
• Using different MenB vaccine products for different doses in the same series 3

High-Risk Students Requiring Modified Schedules

Students with certain medical conditions require enhanced vaccination schedules: 1, 2

• Complement deficiencies or functional/anatomic asplenia: 2-dose primary MenACWY series 8-12 weeks apart, plus boosters every 5 years 2
• HIV infection: 2-dose primary series 8-12 weeks apart 1
• Eculizumab use: 2-dose primary series plus 3-dose MenB series 3

These high-risk students also require MenB vaccination starting at age 10 years or when risk is identified, not as shared decision-making but as a Category A recommendation. 1, 3

Practical Implementation

For ease of program implementation and compliance, colleges should require documentation showing: 1

• Receipt of meningococcal conjugate vaccine within 5 years before enrollment for students aged ≤21 years 1
• If documentation shows only pre-16th birthday vaccination, proof of booster administration 1, 2

Thirty-six states and the District of Columbia have mandates requiring either meningococcal disease education or proof of vaccination for college attendance. 1