The meningococcal serogroups that most often cause meningococcal disease Meningococcal Diseases Meningococci (Neisseria meningitidis) are gram-negative diplococci that cause meningitis and meningococcemia. Symptoms, usually severe, include headache, nausea, vomiting, photophobia... read more 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.
(See also Overview of Immunization Overview of Immunization Immunity can be achieved Actively by using antigens (eg, vaccines, toxoids) Passively by using antibodies (eg, immune globulins, antitoxins) A toxoid is a bacterial toxin that has been modified... read more .)
For serogroups ACWY (quadrivalent):
Meningococcal conjugate vaccines (MCV4): MenACWY-D (Menactra®), MenACWY-CRM (Menveo®), or MenACWY-TT (MenQuadfiTM)
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. A summary of changes to the 2021 adult immunization schedule is available here.
Indications for Meningococcal Vaccine
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 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 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 Asplenia By structure and function, the spleen is essentially 2 organs: The white pulp, consisting of periarterial lymphatic sheaths and germinal centers, acts as an immune organ. The red pulp, consisting... read more (including sickle cell disease Sickle Cell Disease Sickle cell disease (a hemoglobinopathy) causes a chronic hemolytic anemia occurring almost exclusively in people with African ancestry. It is caused by homozygous inheritance of genes for hemoglobin... read more )
Complement inhibitor use (eg, eculizumab, ravulizumab)
Work in a microbiology laboratory involving routine exposure to isolates of Neisseria meningitidis
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 of Meningococcal Vaccine
The main contraindication for meningococcal vaccines is
A severe allergic reaction (eg, anaphylaxis Anaphylaxis Anaphylaxis is an acute, potentially life-threatening, IgE-mediated allergic reaction that occurs in previously sensitized people when they are reexposed to the sensitizing antigen. Symptoms... read more ) 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 Preparations Pneumococcal disease (eg, otitis media, pneumonia, sepsis, meningitis) is caused by some of the > 90 serotypes of Streptococcus pneumoniae (pneumococci). Vaccines are directed against... read more ) should not be given during the same visit but should be separated by ≥ 4 weeks.
Dose and Administration of Meningococcal Vaccine
The dose is 0.5 mL IM for MenACWY and 0.5 mL subcutaneous for MPSV4.
Two doses of MenACWY, given ≥ 8 weeks 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 MenACWY 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.
Based on a shared clinical decision-making discussion, adolescents and young adults aged 16 to 23 years (preferred age 16 to 18 years) who are not at increased risk of meningococcal disease are given two doses of MenB-4C at least 1 month apart or a 2-dose series of MenB-FHbp 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.
People ≥ 10 years of age with certain high-risk conditions (including people with anatomical or functional asplenia, persistent complement component deficiency, complement inhibitor use [eg, eculizumab, ravulizumab], microbiologists routinely exposed to N. meningitidis), and people identified to be at increased risk because of a meningococcal disease outbreak caused by serogroup B are given a 2-dose series of MenB-4C ≥ 1 month apart or a 3-dose series of MenB-FHbp at 0, 1 to 2, and 6 months (if dose 2 was given at least 6 months after dose 1, dose 3 is not needed).
Adverse Effects of Meningococcal Vaccine
Adverse effects are usually mild. They include pain and redness at the injection site, fever, headache, and fatigue.
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.
Advisory Committee on Immunization Practices (ACIP): Meningococcal ACIP Vaccine Recommendations
Centers for Disease Control and Prevention (CDC): Meningococcal Vaccination: Information for Healthcare Professionals