Bexsero Dosing Schedule
Bexsero (MenB-4C) is administered as a 2-dose series at 0 and 6 months for healthy adolescents aged 16-23 years, or as a 3-dose series at 0,1-2, and 6 months for persons aged ≥10 years at increased risk for meningococcal disease. 1
Age and Licensing Restrictions
- Bexsero is FDA-licensed only for persons aged 10-25 years in the United States 2, 3
- Use outside this age range is considered off-label 3
- There are no recommendations for use in children under 10 years of age 3
Dosing by Risk Category
Healthy Adolescents and Young Adults (Ages 16-23 Years)
For individuals not at increased risk, administer 2 doses at 0 and 6 months based on shared clinical decision-making 1, 4
- This updated recommendation (October 2024) extends the interval from the previous ≥1 month to 6 months 1
- The 6-month interval provides improved immunogenicity compared to shorter intervals 1
High-Risk Persons (Ages ≥10 Years)
For persons at increased risk, administer 3 doses at 0,1-2, and 6 months 1, 4
High-risk categories include 4:
- Persistent complement deficiencies (C3, C5-C9, properdin, factor H, or factor D)
- Anatomical or functional asplenia
- Patients using complement inhibitors (eculizumab/Soliris or ravulizumab/Ultomiris)
- Microbiologists routinely exposed to Neisseria meningitidis isolates
- Persons at risk during serogroup B meningococcal disease outbreaks
The 3-dose schedule provides earlier protection and maximizes short-term immunogenicity 4, 5
Booster Dosing for High-Risk Persons
For persons at continued increased risk, administer a single booster dose 1 year after completion of the primary series, then every 2-3 years thereafter 4
Critical Implementation Details
Minimum Intervals
- The absolute minimum interval between any 2 doses is 4 weeks 5
- However, the recommended interval for the 2-dose series is now 6 months 1
Vaccine Interchangeability
- Bexsero and Trumenba (MenB-FHbp) are NOT interchangeable 5, 2
- The same vaccine product must be used for all doses in a series 5
Concomitant Administration
- Bexsero may be administered concomitantly with other age-appropriate vaccines at a different anatomic site 5
Common Pitfalls to Avoid
- Do not confuse Bexsero with MenACWY vaccines, which have different age indications and can be used in infants starting at 2 months 2
- Do not use the old 0 and ≥1 month schedule for the 2-dose series; the updated recommendation is 0 and 6 months 1
- Do not administer to children under 10 years of age outside of approved research protocols, as there is no regulatory approval or guideline support 3
- Be aware that prefilled Bexsero syringes contain natural rubber latex in the caps, which is a precaution for latex-allergic individuals 3
Special Considerations for Complement Inhibitor Users
- Meningococcal vaccines should be administered at least 2 weeks before the first dose of complement inhibitor therapy, unless the risk of delaying complement therapy outweighs the risk of meningococcal disease 4