What meningitis vaccination is recommended for a 28-year-old female?

Meningococcal Vaccination for a 28-Year-Old Female

A healthy 28-year-old female without specific risk factors does not require routine meningococcal vaccination, as standard ACIP recommendations target adolescents (ages 11-12 with a booster at 16) and high-risk populations. However, vaccination should be administered if she has specific risk factors or circumstances that warrant protection.

Risk-Based Assessment

The decision to vaccinate depends entirely on identifying specific indications:

High-Risk Medical Conditions Requiring Vaccination

If she has any of the following conditions, she requires both MenACWY and MenB vaccination 1:

• Persistent complement deficiencies (C3, C5-C9, properdin, factor H, or factor D)
• Complement inhibitor use (eculizumab or ravulizumab)
• Functional or anatomic asplenia (including sickle cell disease)
• HIV infection

For these high-risk conditions, the vaccination schedule is 1:

• MenACWY: 2-dose primary series given ≥8 weeks apart, with boosters every 5 years if risk continues
• MenB-FHbp (Trumenba): 3 doses at 0,1-2, and 6 months, OR MenB-4C (Bexsero): 2 doses ≥1 month apart
• Boosters for MenB every 2-3 years if risk continues (though this is off-label, as MenB vaccines are only FDA-licensed for ages 10-25 years) 1

Situational Indications for Vaccination

She requires vaccination if 1:

• Travel to or residence in countries where meningococcal disease is hyperendemic or epidemic (e.g., sub-Saharan African meningitis belt, Hajj pilgrimage)

  • Give 1 dose of MenACWY; boosters every 5 years if exposure continues

• Microbiologist routinely exposed to Neisseria meningitidis

  • Same vaccination schedule as high-risk medical conditions above

• Outbreak exposure to a vaccine-preventable serogroup

  • Give 1 dose of MenACWY for serogroups A, C, W, Y outbreaks 1
  • For serogroup B outbreaks: MenB-FHbp (3 doses) or MenB-4C (2 doses) 1

• First-year college student living in residential housing (if not previously vaccinated)

  • Give 1 dose of MenACWY 1

No Indication for Routine Vaccination

If she is a healthy adult without the above risk factors, no meningococcal vaccination is indicated 1. The routine adolescent vaccination series (given at ages 11-12 and 16) provides protection that typically extends into early adulthood, and there is no recommendation for routine adult vaccination beyond age 21 unless specific risks are present.

Important Caveats

• Age and licensing considerations: MenB vaccines are FDA-licensed only for ages 10-25 years 1. At age 28, MenB vaccination would be off-label, though it may still be administered for high-risk conditions based on clinical judgment.

• MenACWY vaccines remain on-label through age 55 for most formulations 1.

• Vaccine products are not interchangeable: If starting a MenB series, the same manufacturer's product must be used for all doses (either all MenB-FHbp or all MenB-4C) 1, 2.

• Pregnancy considerations: If she is pregnant or planning pregnancy, vaccination decisions should weigh the risk of meningococcal disease exposure against limited safety data, though MenACWY-CRM has shown no safety concerns in pregnant women 3.

Practical Algorithm

1. Screen for high-risk medical conditions (complement deficiency, asplenia, HIV, complement inhibitor use) → If yes: Give MenACWY 2-dose series + MenB series 1

2. Assess occupational/travel risk (microbiologist, travel to endemic areas) → If yes: Give MenACWY 1 dose (consider MenB for microbiologists) 1

3. Check college housing status (first-year residential student) → If yes: Give MenACWY 1 dose 1

4. Evaluate outbreak exposure → If yes: Give vaccine matching outbreak serogroup 1

5. If none of the above apply → No vaccination needed 1