Meningococcal Vaccination for Older Adults (≥65 Years)
Routine meningococcal vaccination is not recommended for healthy adults aged 65 years and older; vaccination is indicated only for those with specific high-risk conditions or exposures.
Risk-Based Vaccination Indications
High-Risk Medical Conditions
Adults ≥65 years should receive meningococcal vaccination if they have:
Anatomical or functional asplenia: Administer 2 doses of MenACWY at least 2 months apart, plus either a 2-dose series of MenB-4C (≥1 month apart) or a 3-dose series of MenB-FHbp (at 0,1-2, and 6 months). 1
Persistent complement component deficiencies (including those on complement inhibitors like eculizumab): Same vaccination schedule as asplenia—2 doses of MenACWY plus complete MenB series. 1
HIV infection requiring vaccination: Administer 2 doses of MenACWY at least 2 months apart. Note that HIV infection alone is not an indication for routine MenB vaccination. 1, 2
Occupational and Travel Exposures
Microbiologists routinely exposed to Neisseria meningitidis: Single dose of MenACWY with revaccination every 5 years if exposure continues, plus either MenB-4C (2 doses) or MenB-FHbp (3 doses). 1
Travelers to hyperendemic/epidemic regions (e.g., African meningitis belt during December-June): Single dose of MenACWY; revaccinate every 5 years if risk persists. MenB is not recommended for travel as disease in these regions is primarily caused by serogroups A, C, W, and Y. 1
Outbreak exposure: Single dose of MenACWY if outbreak is due to serogroups A, C, W, or Y; complete MenB series if outbreak is due to serogroup B. 1
Vaccine Selection for Older Adults
MenACWY Vaccine Choice
For adults ≥56 years, vaccine selection depends on vaccination history and anticipated need:
MenACWY conjugate vaccine is preferred for those ≥56 years who were previously vaccinated with MenACWY and require revaccination, or for whom multiple doses are anticipated. 1
MPSV4 (polysaccharide vaccine) is preferred for adults ≥56 years who have not received MenACWY previously and require only a single dose (e.g., outbreak response). 1
Revaccination every 5 years is recommended for those who remain at increased risk. 1
MenB Vaccine Options
MenB-4C (Bexsero): 2-dose series administered ≥1 month apart. 1, 3
MenB-FHbp (Trumenba): 3-dose series at 0,1-2, and 6 months for high-risk individuals. 4, 3
The two MenB vaccines are not interchangeable—the same product must be used for all doses in a series. 1, 3
MenB vaccines are FDA-approved for ages 10-25 years, but ACIP recommends their use in persons ≥10 years (including older adults) who are at increased risk, as there is no theoretical safety difference in older populations. 1
Immunogenicity Considerations in Older Adults
Vaccine response may be reduced in adults ≥65 years compared to younger adults:
In a study of adults 56-103 years, MenACWY-TT achieved vaccine response rates of 76.6-81.9% for all four serogroups, with ≥93% achieving protective titers (rSBA ≥1:128). 5
Response rates tended to be lower in those >65 years compared to 56-65 years. 5
Recent data demonstrate that IgM antibodies drive bactericidal activity more than IgG in older adults, particularly for serogroups W and Y. 6
Booster doses transiently increase responses but titers return to pre-booster levels within one year for serogroups C, W, and Y. 6
Common Pitfalls to Avoid
Do not assume all older adults need meningococcal vaccination—it is risk-based only, not routine. 1, 7
Do not mix MenB vaccine products within a series; this is explicitly prohibited. 1, 3
Do not administer MenB for travel indications—it is not recommended as disease in endemic regions is caused by non-B serogroups. 1
Do not forget the 2-dose MenACWY primary series for high-risk conditions (asplenia, complement deficiency)—a single dose is insufficient. 1, 4
Do not routinely vaccinate HIV-infected older adults with MenB—HIV is not an indication for MenB, only for MenACWY (2-dose series). 1, 2
Safety Profile
MenACWY-TT and MenB vaccines are well-tolerated in older adults, with local and general solicited symptoms reported by ≤3% of recipients aged 56+ years. 5 No serious adverse events were considered vaccine-related in clinical trials of older adults. 5