What is the recommended meningitis vaccination schedule for a 65-year-old adult with potential high-risk conditions, such as compromised immune system or history of splenectomy?

Meningitis Vaccination Schedule for a 65-Year-Old Adult

For a healthy 65-year-old adult without high-risk conditions, routine meningococcal vaccination is NOT recommended. 1

For Healthy Adults Age 65

• No routine meningococcal vaccination is indicated for immunocompetent adults age 65 or older who do not have specific risk factors. 1
• The meningococcal vaccine recommendations focus primarily on younger adults (16-23 years) and those with specific high-risk conditions, regardless of age. 1

For High-Risk Adults Age 65 (With Specific Conditions)

If your 65-year-old patient has ANY of the following high-risk conditions, they SHOULD receive meningococcal vaccination:

Anatomical or Functional Asplenia or Persistent Complement Component Deficiencies

• Administer 2 doses of MenACWY vaccine at least 2 months apart 1
• Revaccinate with MenACWY every 5 years as long as the risk remains 1
• Additionally, administer either:
  • 2-dose series of MenB-4C (Bexsero), OR
  • 3-dose series of MenB-FHbp (Trumenba) 1
• The two MenB vaccine products are NOT interchangeable—use the same product for all doses 1

Microbiologists Routinely Exposed to Neisseria meningitidis

• Administer a single dose of MenACWY vaccine 1
• Revaccinate with MenACWY every 5 years if exposure risk continues 1
• Additionally, administer either:
  • 2-dose series of MenB-4C, OR
  • 3-dose series of MenB-FHbp 1

Persons at Risk Due to a Meningococcal Disease Outbreak

• Administer a single dose of MenACWY vaccine if the outbreak is attributable to serogroups A, C, W, or Y 1
• Administer either a 2-dose series of MenB-4C or 3-dose series of MenB-FHbp if the outbreak is attributable to serogroup B 1

Vaccine Selection for Adults Age 65

• For adults aged ≥56 years who have not received MenACWY previously and require only a single dose (such as outbreak situations), MPSV4 vaccine is preferred 1
• For adults aged ≥56 years who were previously vaccinated with MenACWY and need revaccination or multiple doses, MenACWY vaccine is preferred 1
• MenB vaccines are FDA-approved for ages 10-25 years, but ACIP recommends their use in persons aged ≥10 years who are at increased risk, as there is no theoretical safety difference in older adults 1

Important Caveats

• HIV infection alone is NOT an indication for routine meningococcal vaccination 1
• If an HIV-infected person of any age requires vaccination for another reason, administer 2 doses of MenACWY vaccine at least 2 months apart 1
• There is currently no recommendation for MenB revaccination after the initial series 1
• MenB vaccine may be administered concomitantly with MenACWY vaccine, but at a different anatomical site if feasible 1
• Travel is NOT an indication for meningococcal vaccination in this age group 1

Common Pitfalls to Avoid

• Do not routinely vaccinate healthy 65-year-olds without specific risk factors—this wastes resources and is not evidence-based 1
• Do not confuse meningococcal vaccination with pneumococcal vaccination—they are entirely different vaccines for different pathogens
• Do not mix MenB vaccine products—complete the series with the same product used for the first dose 1
• Do not assume all immunocompromised patients need meningococcal vaccine—only specific conditions (asplenia, complement deficiencies) warrant vaccination 1