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Meningococcal Vaccine

By

Margot L. Savoy

, MD, MPH, Lewis Katz School of Medicine at Temple University

Last full review/revision Oct 2020| Content last modified Oct 2020
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The meningococcal serogroups that most often cause meningococcal 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):

  • 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):

  • MenB-4C (Bexsero®) and MenB-FHbp (Trumenba®)

For more information, see the Advisory Committee for Immunization Practices' (ACIP) Meningococcal ACIP Vaccine Recommendations and Centers for Disease Control and Prevention (CDC): Meningococcal Vaccination.

Indications

The quadrivalent conjugate meningococcal vaccine is a routine childhood vaccination given to adolescents, preferably at age 11 or 12 years, with a booster dose at age 16 years (see Table: Recommended Immunization Schedule for Ages 7–18 Years). It is also recommended for younger children who are at high risk of infection (see Table: Recommended Immunization Schedule for Ages 0–6 Years). For more information, see also the ACIP's Infant Meningococcal Vaccination: ACIP Recommendations and Rationale.

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

  • Anatomic or functional asplenia (including sickle cell disease)

  • Complement inhibitor use (eg, eculizumab, ravulizumab)

  • Research in a microbiology laboratory involving routine exposure to isolates of Neisseria meningitidis

  • Military recruitment

  • Travel to or residence in endemic areas

  • First year of residence in a college dormitory if students are ≤ 21 years and have not already received a dose on or after their 16th birthday

  • Exposure to an outbreak attributable to a vaccine serogroup

If 1st-year college students aged ≤ 21 years 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 years), including those with HIV infection.

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

Revaccination with MenACWY every 5 years 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, HIV infection, or persistent complement component deficiencies; those who take eculizumab or ravulizumab; microbiologists routinely exposed to N. meningitidis).

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

MenB-4C or MenB-FHbp is indicated for people ≥ 10 years with certain high-risk conditions (including people with functional asplenia or complement deficiencies, those who take eculizumab or ravulizumab, microbiologists routinely exposed to N. meningitidis, and those at risk because of a meningococcal disease outbreak attributed to serogroup B). Meningococcal serogroup B vaccines are not routinely recommended by the Centers for Disease Control and Prevention for all adolescents. However, they may be given based on individual clinical decision to anyone aged 16 to 23 years; the preferred age for vaccination is 16 to 18 years.

Contraindications and Precautions

The main contraindication for meningococcal vaccines is

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

The main precaution with meningococcal vaccines is

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

Meningococcal conjugate vaccines may be given to pregnant women who are at increased risk of serogroups A, C, W, or Y meningococcal disease. Meningococcal serogroup B vaccines are recommended to be deferred during pregnancy unless women are at increased risk of serogroup B disease and the benefits of vaccination are thought to outweigh potential risks.

For children with functional or anatomic asplenia, MenACWY and pneumococcal conjugate vaccine (PCV13) should not be given during the same visit but should be separated by ≥ 4 weeks.

Dose and Administration

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

Two doses of MenACWY, given ≥ 2 months apart and followed by a booster every 5 years, are required for adults who have anatomic or functional asplenia, HIV infection, or persistent complement component deficiencies or who take eculizumab or ravulizumab. Adolescents (aged 11 to 18 years) with HIV infection are routinely vaccinated with a 2-dose primary series, given 8 weeks 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), a booster dose is given every 5 years.

Two doses of MenB-4C are given at least 1 month apart or a 2-dose series of MenB-FHbp is given at 0 and 6 months (if dose 2 was given less than 6 months after dose 1, a 3rd dose should be given at least 4 months after dose 2). The same MenB must be used for all doses.

Adverse Effects

Adverse effects are usually mild. They include pain and redness at the injection site, fever, headache, and fatigue.

More Information

The following are some English-language resources that may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

Drugs Mentioned In This Article

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SOLIRIS
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