What is the recommended meningococcal (Men) vaccine schedule for healthy infants?

Meningococcal Vaccine Schedule for Healthy Infants

Healthy infants do not require routine meningococcal vaccination in infancy—the standard recommendation is to begin vaccination at age 11-12 years with a booster at age 16 years. 1, 2

Routine Schedule for Healthy Children

• No meningococcal vaccine is recommended for healthy infants under 10 years of age 1
• The first dose should be administered at age 11-12 years using MenACWY (quadrivalent conjugate vaccine covering serogroups A, C, W, and Y) 1, 2
• A booster dose is required at age 16-18 years (at least 8 weeks after the first dose) 1, 2
• Adolescents who receive their first dose at or after age 16 years do not need a booster dose 1, 2

High-Risk Infants Requiring Early Vaccination

Only infants at increased risk for meningococcal disease should receive vaccination in infancy. High-risk conditions include: 1

• Persistent complement component deficiencies (C3, C5-C9, properdin, factor D, factor H)
• Functional or anatomic asplenia
• Travel to or residence in hyperendemic/epidemic meningococcal disease areas
• Community outbreak situations

Vaccine Options and Schedules for High-Risk Infants

For infants aged 2-18 months at high risk:

Option 1: Hib-MenCY-TT (MenHibrix)

• 4-dose series at 2,4,6, and 12-15 months 1
• Can be administered as early as 6 weeks of age 1
• Covers serogroups C and Y only (does NOT cover A and W) 1
• Should not be co-administered with other Hib-containing vaccines 1
• Important limitation: Not recommended for travel to hyperendemic areas because it lacks serogroups A and W coverage 1

Option 2: MenACWY-CRM (Menveo)

• Age 2-6 months: 4 doses at 2,4,6, and 12 months 1, 2, 3
• Age 7-23 months: 2 doses with the second dose at least 12 weeks after the first and after the 1st birthday 1, 2, 3
• Covers all four serogroups (A, C, W, Y) 1, 4
• Preferred for travel to hyperendemic areas 1

Option 3: MenACWY-D (Menactra)

• Age 9-23 months: 2 doses administered 12 weeks apart 1, 5
• Cannot be used before 9 months of age 5
• Critical timing consideration: Should be given either before or at the same time as DTaP to avoid immune interference 2
• For children with asplenia or HIV: Must wait until after age 2 years and after completion of all PCV13 doses (at least 4 weeks after final PCV dose) to prevent immune interference 1, 2, 3

Booster Doses for High-Risk Children

Children who received primary vaccination in infancy require ongoing boosters: 1

• First booster: 3 years after primary series completion (for those vaccinated before age 7 years) 1
• Subsequent boosters: Every 5 years thereafter for those who remain at persistent risk 1
• Children who received primary series at age 7 years or older should receive boosters every 5 years 1

Critical Pitfalls to Avoid

Vaccine interference issues:

• MenACWY-D given one month after DTaP reduces meningococcal antibody responses—give simultaneously or MenACWY-D first 5
• In children with asplenia or HIV, MenACWY-D before age 2 years interferes with PCV13 responses—delay until after age 2 and completion of PCV series 1, 2, 3
• MenACWY-CRM does not have this PCV interference and can be used at any age ≥2 months 3

Coverage gaps:

• Hib-MenCY-TT only covers serogroups C and Y—inadequate for travel to meningitis belt countries where serogroup A predominates 1
• No currently licensed vaccine in the US covers serogroup B in infants, which causes the majority of infant meningococcal disease 4
• Bexsero (MenB vaccine) is only FDA-licensed for ages 10-25 years in the United States 6

Product interchangeability:

• Different MenACWY products can be used interchangeably if the original product is unavailable, though this is based on limited data 1
• MenB vaccines (Bexsero and Trumenba) are NOT interchangeable—the same product must be used for all doses 6