Meningococcal Vaccination Recommendations

Routine Adolescent Vaccination

All adolescents should receive one dose of MenACWY vaccine at age 11-12 years, followed by a mandatory booster dose at age 16 years. 1, 2, 3

MenACWY (Serogroups A, C, W, Y) Schedule

Primary dose at age 11-12 years with any MenACWY vaccine (Menactra, Menveo, or MenQuadfi) 1, 2, 3
Booster dose at age 16 years if the first dose was given before the 16th birthday (minimum 8-week interval between doses) 1, 2
No booster needed if first dose administered at or after age 16 years 1
Catch-up vaccination: Unvaccinated persons aged 13-21 years should receive one dose; if given before age 16, a booster is required at age 16-18 years 1, 2
College freshmen living in residence halls must receive at least one dose within 5 years before enrollment, preferably on or after their 16th birthday 1, 2

MenB (Serogroup B) Schedule

MenB vaccination is based on shared clinical decision-making for healthy adolescents aged 16-23 years (preferred age 16-18 years), NOT routinely recommended at age 11. 1, 2, 3, 4

MenB-FHbp (Trumenba): 2 doses at 0 and 6 months for healthy adolescents; 3 doses at 0,1-2, and 6 months for high-risk individuals 1, 2
MenB-4C (Bexsero): 2 doses at least 1 month apart 1, 2
MenB vaccines are NOT interchangeable—complete the series with the same product 1, 5

Pentavalent Option

MenACWY-TT/MenB-FHbp (Penbraya) may be used when both MenACWY and MenB are indicated at the same visit for persons aged 10-25 years 5
This combination vaccine is particularly useful for high-risk individuals requiring both vaccines 5

High-Risk Populations Requiring Enhanced Protection

Persons with persistent complement deficiencies (including those on complement inhibitors like eculizumab or ravulizumab), anatomic or functional asplenia, or HIV infection require a 2-dose primary MenACWY series and routine MenB vaccination. 1, 2

MenACWY for High-Risk Individuals

Ages 2-23 months:

MenACWY-D (Menactra): 2 doses ≥12 weeks apart (starting at ≥9 months) 1
MenACWY-CRM (Menveo): 4-dose series at 2,4,6, and 12 months if starting at 2 months; 2 doses if starting at 7-23 months 1

Ages ≥2 years:

2-dose primary series with any MenACWY vaccine, doses separated by 8-12 weeks 1

Critical timing consideration: For children with asplenia or HIV, MenACWY-D must not be given until at least 4 weeks after completing all pneumococcal conjugate vaccine (PCV) doses to avoid immune interference 1

MenB for High-Risk Individuals

Ages ≥10 years:

MenB-FHbp: 3 doses at 0,1-2, and 6 months (accelerated schedule for earlier protection) 1
MenB-4C: 2 doses ≥1 month apart 1

Booster Doses for Persistent Risk

MenACWY boosters:

Ages <7 years: First booster 3 years after primary series, then every 5 years 1
Ages ≥7 years: Booster every 5 years 1

MenB boosters:

Single booster dose 1 year after primary series completion, then every 2-3 years while risk persists 1

Travel-Related Vaccination

Travelers to the meningitis belt in sub-Saharan Africa or areas with epidemic meningococcal disease require MenACWY vaccination. 1, 2

Travel Vaccination Schedule

Ages 2-23 months:

MenACWY-D: 2 doses ≥12 weeks apart (may be accelerated to ≥8 weeks for imminent travel) 1
MenACWY-CRM: Age-appropriate schedule as above 1

Ages ≥2 years:

Single dose of any MenACWY vaccine 1, 2

Booster doses for continued travel risk:

Ages <7 years: 3 years after primary dose, then every 5 years 1, 2
Ages ≥7 years: 5 years after primary dose, then every 5 years 1, 2

Outbreak Response

During meningococcal outbreaks, vaccination recommendations depend on the causative serogroup. 1, 2

Serogroup A, C, W, or Y Outbreaks

Single dose of MenACWY for all at-risk individuals in the outbreak population 1
Booster doses if previously vaccinated and ≥3 years (ages <7) or ≥5 years (ages ≥7) since last dose 1

Serogroup B Outbreaks

MenB-FHbp: 3 doses at 0,1-2, and 6 months 1
MenB-4C: 2 doses ≥1 month apart 1
Booster if previously vaccinated: Single dose if ≥1 year after primary series (≥6 months may be considered) 1

Vaccine Interchangeability and Products

All MenACWY vaccines are interchangeable for primary vaccination and booster doses. 2

Available MenACWY vaccines:

MenACWY-D (Menactra, Sanofi Pasteur) 1, 2
MenACWY-CRM (Menveo, GlaxoSmithKline) 1, 2
MenACWY-TT (MenQuadfi, Sanofi Pasteur) 1, 2

Available MenB vaccines (NOT interchangeable):

MenB-FHbp (Trumenba, Pfizer) 1, 2, 6
MenB-4C (Bexsero, GlaxoSmithKline) 1, 2, 6

Pentavalent vaccine:

MenACWY-TT/MenB-FHbp (Penbraya, Pfizer) for ages 10-25 years 5

Contraindications and Safety

Severe allergic reaction to a previous dose or vaccine component is the only absolute contraindication. 2

Critical Safety Measures

Syncope prevention: Observe all vaccinated persons (especially adolescents) seated or lying down for 15 minutes post-vaccination to prevent injury from fainting 2
Co-administration: MenACWY can and should be given simultaneously with other adolescent vaccines (Tdap, HPV) at the same visit 3
Anaphylaxis: Rare but possible; ensure emergency equipment is available 2

Common Pitfalls to Avoid

Do not delay the age 16 booster—vaccine effectiveness wanes significantly, and adolescents remain at high risk 3
Do not confuse MenB shared clinical decision-making with optional—providers should actively discuss MenB with all adolescents aged 16-23 years, as lack of provider recommendation is the primary reason for non-receipt 3, 7
Do not mix MenB vaccine brands—they are not interchangeable and must be completed with the same manufacturer's product 1, 5
Do not give MenACWY-D to children with asplenia or HIV before completing PCV series—wait at least 4 weeks after final PCV dose 1

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