Bexsero (MenB-4C) Vaccination Schedule
Bexsero 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
Dosing by Risk Category
High-Risk Individuals (Category A - Routine Recommendation)
For persons aged ≥10 years at increased risk, administer 3 doses at 0,1-2, and 6 months. 1, 2
High-risk categories include:
- Persistent complement component deficiencies (including C3, C5-C9, properdin, factor D, factor H deficiencies) 3
- Anatomic or functional asplenia (including sickle cell disease) 3
- Patients taking eculizumab (Soliris) or other complement inhibitors 3, 2
- Microbiologists routinely exposed to N. meningitidis isolates 3
- Persons at risk during a serogroup B meningococcal outbreak 3
Healthy Adolescents and Young Adults (Category B - Shared Clinical Decision-Making)
For healthy persons aged 16-23 years (preferred age 16-18 years), administer 2 doses at 0 and 6 months based on shared clinical decision-making. 1, 3
This provides short-term protection against most strains of serogroup B meningococcal disease. 3
Booster Dosing
For persons at continued increased risk, administer a single booster dose 1 year after completing the primary series, then every 2-3 years thereafter. 2
Critical Implementation Details
Minimum Intervals
- The minimum interval between any 2 doses is 4 weeks (though the recommended schedule is 0 and 6 months for the 2-dose series). 2
Vaccine Interchangeability
- Bexsero and Trumenba are NOT interchangeable - the same vaccine product must be used for all doses in a series. 3, 2
Age Restrictions
- Bexsero is FDA-licensed only for persons aged 10-25 years in the United States. 2, 4, 5
- Use outside this age range is off-label, though ACIP recommends it for persons aged ≥10 years at increased risk since there is no theoretical safety difference. 3
Timing with Complement Inhibitors
- Administer Bexsero at least 2 weeks before initiating complement inhibitor therapy (e.g., eculizumab). 2
Concurrent Administration
- Bexsero may be given concomitantly with MenACWY vaccine at a different anatomical site. 3
Special Populations
Pregnancy and Lactation
Defer vaccination in pregnant or lactating women unless they are at increased risk, in which case benefits may outweigh potential risks after consultation with their healthcare provider. 3
HIV Infection
HIV infection alone is not an indication for MenB vaccination - only vaccinate if other high-risk criteria are met. 3
Common Pitfalls to Avoid
- Do not confuse Bexsero with MenACWY vaccines - they protect against different serogroups and have different age indications. 4
- Do not use Bexsero in children under 10 years of age outside of approved research protocols, as it is not FDA-licensed for this age group. 4, 5
- Do not mix vaccine products - if starting with Bexsero, complete the entire series with Bexsero. 3, 2
- Note that prefilled Bexsero syringes contain natural rubber latex in the caps, which is a precaution for latex-allergic individuals. 5