What is the recommended dosing schedule, contraindications, and alternative options for Penmenvy (meningococcal ABCWY) vaccine in vaccine‑naïve individuals aged 10‑25 years?

Penmenvy (MenACWY-CRM/MenB-4C) Pentavalent Meningococcal Vaccine

Recommended Dosing Schedule

For vaccine-naïve individuals aged 10-25 years, Penmenvy should be administered as a 2-dose series at 0 and 6 months when both MenACWY and MenB vaccination are indicated at the same visit. 1

Standard Dosing Regimen

• Primary series: 2 doses administered 6 months apart (0,6 months schedule) 1
• Licensed age range: 10-25 years only 1
• Important note: Penmenvy combines MenACWY-CRM and MenB-4C components in a single vaccine 1

When Penmenvy Is Indicated

Healthy adolescents and young adults (ages 16-23 years):

• May use Penmenvy when shared clinical decision-making favors MenB vaccination (preferred age 16-18 years) 1
• This represents Category B recommendation (individual clinical decision-making) rather than routine universal recommendation 2

Persons aged ≥10 years at increased risk for meningococcal disease:

• Persistent complement deficiencies (C3, C5-C9, properdin, factor H, factor D) 2, 1
• Complement inhibitor use (eculizumab/Soliris, ravulizumab/Ultomiris) 2, 1
• Functional or anatomic asplenia 1
• HIV infection 3
• Microbiologists routinely exposed to Neisseria meningitidis 4
• Outbreak exposure to vaccine-preventable serogroups 3
• Travel to hyperendemic/epidemic areas 3, 4

Critical Vaccine Interchangeability Rule

Different manufacturers' serogroup B-containing vaccines are NOT interchangeable. 1, 5

• If Penmenvy is used for the first dose, MenB-4C (Bexsero, GSK) must be used for any subsequent MenB doses needed 1
• Cannot switch between MenB-4C and MenB-FHbp (Trumenba, Pfizer) within a series 3, 1
• This is a critical safety and efficacy consideration that must be documented in the patient's record 1

Contraindications

Absolute contraindications:

• Severe allergic reaction (anaphylaxis) to any component of Penmenvy 1
• Severe allergic reaction after a previous dose of any meningococcal vaccine containing similar components 1

Precautions (defer vaccination):

• Moderate or severe acute illness with or without fever 1
• Mild illness is NOT a contraindication to vaccination 1

Alternative Vaccination Options

For Routine Adolescent Vaccination (Ages 11-18 Years)

Standard approach for vaccine-naïve individuals:

• MenACWY: Single dose at age 11-12 years, booster at age 16 years 2
• MenB (optional, based on shared clinical decision-making): Either MenB-FHbp (2 doses at 0,6 months) or MenB-4C (2 doses ≥1 month apart) at ages 16-23 years 2

Alternative Pentavalent Vaccine

Penbraya (MenACWY-TT/MenB-FHbp, Pfizer):

• Licensed October 2023 for ages 10-25 years 5
• Same indications as Penmenvy 5
• If Penbraya is used, subsequent MenB doses must be MenB-FHbp (Trumenba, Pfizer) 5
• 2-dose series at 0 and 6 months 5

Separate Component Vaccines

MenACWY options (all interchangeable):

• MenACWY-D (Menactra, Sanofi Pasteur): Ages 9 months-55 years 2
• MenACWY-CRM (Menveo, GSK): Ages 2 months-55 years 2
• MenACWY-TT (MenQuadfi, Sanofi Pasteur): Ages ≥2 years 2

MenB options (NOT interchangeable):

• MenB-FHbp (Trumenba, Pfizer): 2 doses at 0,6 months for healthy adolescents; 3 doses at 0,1-2,6 months for high-risk individuals 2
• MenB-4C (Bexsero, GSK): 2 doses ≥1 month apart 2

Special Populations Requiring Modified Schedules

High-Risk Individuals Aged ≥10 Years

For persistent complement deficiencies or complement inhibitor use:

• MenACWY component: 2-dose primary series ≥8 weeks apart 2
• MenB component: MenB-FHbp 3 doses (0,1-2,6 months) OR MenB-4C 2 doses ≥1 month apart 2
• Boosters if risk continues: MenACWY every 5 years; MenB every 2-3 years 2

For anatomic/functional asplenia or HIV infection:

• Same 2-dose MenACWY primary series ≥8 weeks apart 2
• Same MenB dosing as above 2
• Same booster schedule 2

College Students

First-year students living in residential housing:

• Need at least 1 dose of MenACWY within 5 years before college entry 2
• Preferred timing: On or after 16th birthday 2
• If only 1 dose given before age 16, administer booster before enrollment 2
• If first dose after 16th birthday and <5 years ago, no additional dose needed 2
• Penmenvy could be used if MenB vaccination is also desired 1

Important Clinical Considerations

Timing with Complement Inhibitors

• Meningococcal vaccines should be administered at least 2 weeks before the first dose of complement inhibitor therapy 2
• Exception: Only delay if the risk of delaying complement therapy outweighs meningococcal disease risk 2

Off-Label Use Limitations

• Penmenvy is only FDA-licensed for ages 10-25 years 1
• Vaccination at age 26 or older would be off-label 3
• Most MenACWY vaccines are licensed only through age 55 years 4

Immunogenicity Data

• Penmenvy demonstrated 77.9-84.1% breadth of immune response against 110 diverse MenB strains 6
• Non-inferiority to both 4CMenB and MenACWY-CRM was demonstrated 6
• Robust immune responses observed for all five serogroups (A, B, C, W, Y) 7, 6

Safety Profile

• Reactogenicity mostly mild to moderate and transient 6
• Similar adverse event frequencies compared to 4CMenB alone 6
• No safety concerns identified in clinical trials 6
• Well tolerated in MenACWY-primed individuals 7

Common Pitfalls to Avoid

• Do not mix manufacturers for serogroup B-containing vaccines within a series 1, 5
• Do not assume all meningococcal vaccines are interchangeable—only MenACWY products are interchangeable with each other 2
• Do not forget that healthy adolescents aged 16-23 years require shared clinical decision-making for MenB vaccination, not automatic administration 2
• Do not delay vaccination in high-risk individuals—they require immediate 2-dose primary series, not single-dose routine schedule 2
• Do not overlook booster requirements for high-risk individuals who remain at continued risk 2