At what age can pediatric patients be affected by meningitis and are there any vaccines available for patients 10 years old and below to prevent it?

Meningitis Risk and Vaccination in Pediatric Patients

Age Groups Affected by Meningitis

Meningitis can affect children at any age from birth onward, with the highest rates occurring in infants under 1 year of age, particularly those 0-6 months old, followed by a second peak in adolescents aged 16-23 years. 1

Age-Specific Risk Patterns

• Neonates and infants (0-12 months): The highest incidence in the first 5 years of life occurs in infants aged 0-6 months, with infants under 1 year having particularly elevated rates of meningococcal disease 1

• Young children (1-5 years): Children aged ≤59 months (under 5 years) have higher average annual rates of meningococcal disease compared to older children, though approximately 60% of disease in this age group is caused by serogroup B, which is not covered by standard MenACWY vaccines 1

• School-age children (6-10 years): Bacterial meningitis is relatively uncommon in this age group, accounting for only about 4% of all pediatric bacterial meningitis cases 2

• Adolescents (11-19 years): This age group experiences a second peak in meningococcal disease incidence, with adolescents and young adults accounting for nearly 30% of all meningitis cases in the United States 3, 4

Available Vaccines for Children 10 Years and Below

Yes, meningococcal vaccines are available for children 10 years old and below, but they are NOT routinely recommended for healthy children in this age group—only for those at increased risk for meningococcal disease. 1

Vaccine Options by Age Group

For Children 2 Months to 10 Years

Three vaccines are licensed but not routinely recommended for this age group 1:

• MenACWY-D (Menactra): Licensed for ages 9 months-55 years, protects against serogroups A, C, W, and Y 1

• MenACWY-CRM (Menveo): Licensed for ages 2-55 years, protects against serogroups A, C, W, and Y 1

• HibMenCY-TT (MenHibrix): Licensed for ages 6 weeks-18 months, protects against serogroups C and Y plus Haemophilus influenzae type b 1

For Children 10 Years Old

• MenB vaccines (Bexsero and Trumenba): Both are licensed starting at age 10 years and protect specifically against serogroup B meningococcus 1, 5

• MenACWY vaccines: Continue to be available for high-risk children 1

Who Should Receive Vaccination in the 2-10 Year Age Group

ACIP does not recommend routine vaccination of children aged ≤10 years. 1 However, vaccination is strongly recommended for children with specific risk factors 1:

High-Risk Medical Conditions Requiring Vaccination

• Persistent complement component deficiencies (inherited or chronic deficiencies in C3, C5-C9, properdin, factor D, or factor H) 1, 6

  • These children require a 2-dose primary series administered 8-12 weeks apart, as they need higher antibody levels to achieve protection in the absence of effective complement-mediated bacterial clearance 1, 6

• Anatomic or functional asplenia (including sickle cell disease) 1

  • A 2-dose primary series is recommended to increase the likelihood of sufficient immune response 1

• HIV infection 1

  • A 2-dose primary series is recommended 1

• Children receiving eculizumab (a complement inhibitor medication) 1

• Microbiologists who routinely work with N. meningitidis (relevant for older children/adolescents in training) 1

• Children in outbreak settings 1

Dosing Schedules for High-Risk Children

• Ages 2-23 months at increased risk: Can receive either a 2-dose primary series of MenACWY vaccines or a 4-dose series of HibMenCY-TT 1

• Ages 2-10 years at increased risk: Receive a 2-dose primary series of MenACWY vaccine 1

• Booster doses: Children who received their primary vaccination before age 7 should receive a booster dose 3 years later; those vaccinated at age 7 or older should receive boosters every 5 years if they remain at increased risk 1, 6

Important Clinical Caveats

The decision not to routinely vaccinate healthy children under 10 years is based on several factors 1:

• Many infants aged 0-6 months (the highest-risk group) are too young to have received the minimum 2-3 doses needed for protection 1

• Approximately 60% of meningococcal disease in children under 5 years is caused by serogroup B, which is not prevented by the standard MenACWY vaccines available for young children 1

• A universal infant vaccination program would only prevent approximately 40-50 cases (about 25% of cases in children under 5 years) annually 1

For children age 10 and above, MenB vaccines become available, but these are also primarily recommended for high-risk individuals, with shared clinical decision-making for healthy adolescents preferably at ages 16-18 years 1, 5

Pathogen-Specific Considerations

The causative organisms vary by age 2, 7:

• Haemophilus influenzae type b: Historically common in children aged 6 years or older (40% of cases), though rates have decreased with routine Hib vaccination 2

• Neisseria meningitidis: Accounts for 36% of bacterial meningitis in older children, with serogroup B being most common in young children and serogroup W increasingly common in adolescents 2, 4

• Streptococcus pneumoniae: Accounts for 24% of cases in older children 2