Meningococcal Vaccine

By William D. Surkis, MD, Clinical Associate Professor of Medicine;Director, Internal Medicine Residency Program, Jefferson Medical College;Lankenau Medical Center ; Jerome Santoro, MD, Clinical Professor of Medicine;Chief, Department of Medicine, Jefferson Medical College;Lankenau Medical Center

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For more information, see Meningococcal ACIP Advisory Committee for Immunization Practices) Vaccine Recommendations and Infant Meningococcal Vaccination update.

The meningococcal serogroups that most often cause disease in the US are serogroups B, C, and Y. Serogroups A and W cause disease outside the US. Current vaccines are directed against some but not all of these serogroups.

For serogroups ACWY (quadrivalent):

Meningococcal conjugate vaccines (MCV4): MenACWY-D (Menactra®) or MenACWY-CRM (Menveo®)
Meningococcal polysaccharide vaccine (MPSV4 [Menomune®])

For serogroups CY (bivalent):

A Hib-MenCY-TT (MenHibrix®), in which tetanus toxoid and Haemophilus influenzae type b capsular polysaccharide are conjugated with meningococcal serogroup C and Y polysaccharides

For serogroup B (monovalent):

Meningococcal serogroup B vaccine (a recombinant vaccine composed of two LP2086 antigens)

Indications

The meningococcal vaccine is a routine childhood vaccination given to adolescents, preferably at age 11 or 12 yr, with a booster dose at age 16 yr (see Table: Recommended Immunization Schedule for Ages 7–18 yr). It is also recommended for younger children who are at high risk of infection (see Table: Recommended Immunization Schedule for Ages 0–6 yr).

MenACWY conjugate vaccines are recommended for adults who have conditions that increase risk of meningococcal infection, such as

Anatomic or functional asplenia
Persistent complement component deficiencies
Research in a microbiology laboratory involving routine exposure to isolates of N. meningitidis
Military recruitment
Travel to or residence in endemic areas
First year of residence in a college dormitory if students are ≤ 21 yr and have not already received a dose on or after their 16th birthday
Exposure to an outbreak attributable to a vaccine serogroup

If 1st-yr college students aged ≤ 21 yr received only 1 dose of vaccine before their 16th birthday, they should be given a booster dose before enrollment.

MenACWY is recommended for all adolescents (aged 11 to 18 yr), including those with HIV infection. But otherwise, it is indicated only when people with HIV infection are at increased risk for other reasons.

MenACWY is preferred for people aged 11 to 55 yr and for those > 55 yr who were vaccinated previously with MenACWY and require revaccination or who may require multiple doses of vaccine.

Revaccination with MenACWY every 5 yr is recommended for adults who were previously vaccinated with MenACWY or MPSV4 and who remain at increased risk of infection (eg, adults with anatomic or functional asplenia or persistent complement component deficiencies, microbiologists).

MPSV4 is preferred for people > 55 yr who have not received MenACWY previously and who require only a single dose (eg, travelers).

The new meningococcal serogroup B vaccine is indicated for certain people aged 10 to 25 yr; the specific indications have not yet been published, but it will probably be given with meningococcal vaccine on a similar schedule.

Contraindications and Precautions

The main contraindication is

A severe allergic reaction (eg, anaphylaxis) after previous dose or to a vaccine component

The main main precaution is

Moderate or severe illness with or without a fever (vaccination is postponed until illness resolves if possible)

Dose and Administration

The dose is 0.5 mL IM for MenACWY and 0.5 mL sc for MPSV4.

Two doses of MenACWY, given ≥ 2 mo apart and followed by a booster every 5 yr, are required for adults with anatomic or functional asplenia or persistent complement component deficiencies. Adolescents (aged 11 to 18 yr) with HIV infection are routinely vaccinated with a 2-dose primary series, given 8 wk apart.

A single dose of meningococcal vaccine is given to microbiologists who are routinely exposed to isolates of N. meningitidis, military recruits, people at risk during an outbreak attributable to a vaccine serogroup, and those who travel to or live in endemic areas. If risk continues (eg, for microbiologists who continue working with N. meningitidis), booster doses are needed.