What are the indications for Men B (Meningococcal B) vaccine?

Meningococcal B (MenB) Vaccine Indications

MenB vaccine is routinely recommended (Category A) for persons aged ≥10 years at increased risk for serogroup B meningococcal disease, and may be administered based on shared clinical decision-making for healthy adolescents and young adults aged 16-23 years (preferred age 16-18 years) who are not at increased risk. 1

Routine Vaccination (Category A Recommendation)

MenB vaccine is strongly recommended for the following high-risk groups aged ≥10 years: 1

High-Risk Medical Conditions

• Persons with anatomical or functional asplenia (including sickle cell disease) - these patients have a 40-70% case fatality rate from meningococcal disease 1
• Persons with persistent complement component deficiencies (inherited or chronic deficiencies of C3, C5-C9, properdin, factor D, or factor H) 1
• Persons receiving eculizumab (complement inhibitor therapy) 1

Occupational Risk

• Microbiologists routinely exposed to isolates of Neisseria meningitidis 1

Outbreak Settings

• Persons at risk during a serogroup B meningococcal disease outbreak 1

Shared Clinical Decision-Making (Category B Recommendation)

Healthy adolescents and young adults aged 16-23 years (with preferred age of 16-18 years) may receive MenB vaccine based on individual clinical decision-making to provide short-term protection against most strains of serogroup B disease. 1 This is not a routine recommendation but rather an option to discuss with patients. 1

Important Context for This Age Group

• Approximately 50-60 cases of serogroup B disease occur annually in adolescents and young adults aged 11-24 years in the United States 1
• College students actually have a lower risk of serogroup B disease than the general population of similar age 1
• First-year college students living in residence halls are recommended to receive MenACWY but not routinely recommended for MenB 1

Vaccine Dosing Schedules

Two MenB vaccines are available and are not interchangeable - the same product must be used for all doses: 1

For High-Risk Persons (≥10 years)

• MenB-FHbp (Trumenba): 3-dose series at 0,1-2, and 6 months 1, 2
• MenB-4C (Bexsero): 3-dose series at 0,1-2, and 6 months 2

For Healthy Adolescents (Shared Clinical Decision-Making)

• MenB-FHbp (Trumenba): 2-dose series at 0 and 6 months 1, 3
• MenB-4C (Bexsero): 2-dose series at 0 and 6 months 2

Booster Doses

For persons at continued increased risk, a booster dose should be administered if ≥1 year has elapsed since completion of the primary series (though a ≥6-month interval may be considered by public health professionals during outbreaks). 1

Important Caveats and Pitfalls

Age Considerations

• MenB vaccines are FDA-licensed for ages 10-25 years, but ACIP recommends use in persons ≥26 years at increased risk (considered off-label) because there is no theoretical safety difference 1

NOT Indicated For

• Travel to hyperendemic or epidemic areas - MenB vaccine is not recommended for travel to any area of the world because disease in these regions is generally not caused by serogroup B 1
• Military recruits - MenACWY is recommended, but MenB is not 1
• HIV infection alone - HIV is not an indication for routine MenB vaccination 1

Pregnancy

MenB vaccination should be deferred during pregnancy unless the woman is at increased risk, in which case benefits should be weighed against potential risks after consultation with her healthcare provider. 1

Administration

• MenB vaccines may be administered simultaneously with MenACWY vaccine but at a different anatomical site 1
• No routine revaccination schedule exists for persons not at continued increased risk 1