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Meningococcal Disease

Ask the Experts: Diseases & Vaccines

Meningococcal Disease

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Meningococcal Disease
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For People with Risk Factors Contraindications and Precautions
Disease Issues
Please tell us about meningococcal disease.
Meningococcal disease is a bacterial infection caused by Neisseria meningitidis. Meningococcal disease usually presents clinically as meningitis (about 50% of cases), bacteremia (38% of cases), or bacteremic pneumonia (9% of cases). N. meningitidis colonizes mucosal surfaces of the nasopharynx and is transmitted through direct contact with large-droplet respiratory tract secretions from patients or asymptomatic carriers. Meningococcal disease can be severe. The overall case-fatality ratio is10%–15%, and 20% of survivors have long-term sequelae such as neurologic disability, limb or digit loss, and hearing loss.
N. meningitidis is classified into at least 13 serogroups based on characteristics of the polysaccharide capsule. Most invasive disease (such as meningitis and sepsis) is caused by serogroups A, B, C, W, and Y. However, the relative importance of serogroups depends on geographic location and other factors such as age. Serogroups B, C, and Y are most frequent causes of disease in the U.S., each accounting for about one third of reported cases. Serogroup A is common in Sub-Saharan Africa but is rare in the U.S.
Nasopharyngeal carriage rates are highest in adolescents and young adults who serve as reservoirs for transmission of N. meningitidis. Invasive disease is an infrequent consequence of nasopharyngeal colonization.
How common is meningococcal disease?
The incidence of meningococcal disease has declined annually since a peak of disease in the late 1990s. Even before routine use of a meningococcal conjugate vaccine (MenACWY) in adolescents was recommended in 2005, the overall annual incidence of meningococcal disease had decreased 64%, from 1.1 cases per 100,000 population in 1996 to 0.4 cases per 100,000 population in 2005. Since 2005, declines have occurred among all age groups and in all vaccine-containing serogroups. In addition, incidence of disease caused by serogroup B, a serogroup not included in MenACWY, declined for reasons that are not known.
During 2005–2011, an estimated 800–1,200 cases of meningococcal disease occurred annually in the United States, representing an incidence of 0.3 cases per 100,000 population. A total of 586 cases was reported in 2013, an incidence of 0.18 cases per 100,000 population. Serogroups B, C, and Y were each responsible for about one-third of reported cases.
What are the risk factors for meningococcal disease?
For all meningococcal serogroups risk factors include age, functional or anatomic asplenia, persistent complement component deficiency (an immune system disorder) including that caused by eculizumab (Soliris, Alexion Pharmaceuticals) used for treatment of atypical hemolytic uremic syndrome or paroxysmal nocturnal hemoglobinuria (the drug binds to C5 and inhibits the terminal complement pathway), and occupation as a microbiologist in a laboratory that works with meningococcal isolates.
Certain groups are at increased risk for meningococcal serogroups A, C, W, and Y but not serogroup B. These risk factors include HIV infection, travel to places where meningococcal disease is common (such as certain countries in Africa and in Saudi Arabia), and college students living in a dormitory. Other risk factors for serogroups A, C, W. and Y include having a previous viral infection, living in a crowded household, having an underlying chronic illness, and being exposed to cigarette smoke (either directly or second-hand).
Vaccine Recommendations
What meningococcal vaccines are available in the United States?
Since 2005, 2 types of meningococcal vaccines have been available in the United States that protect against meningococcal serogroups A, C, W, and Y: 1) meningococcal polysaccharide vaccine (MPSV4; Menomune, Sanofi Pasteur), which is made up of polysaccharide (sugar molecules) from the surface of the meningococcal bacteria; and 2) meningococcal conjugate vaccines (MenACWY; Menactra, Sanofi Pasteur; Menveo, GSK) in which the polysaccharide is chemically bonded ("conjugated") to a protein to produce better protection. MenACWY is more effective in young children than the original polysaccharide vaccine.
More recently, vaccines have become available that offer protection from meningococcal serogroup B. These vaccines are composed of proteins also found on the surface of the bacteria. Neither type of vaccine contains live meningococcal bacteria.
MPSV4 and MenACWY provide no protection against serogroup B disease, and meningococcal serogroup B vaccines (MenB) provide no protection against serogroup A, C, W, or Y disease. For protection against all 5 serogroups of meningococcus, it is necessary to receive MenACWY or MPSV4 and MenB.
Trade Name Type of Vaccine Serogroups Included Year Licensed Approved Ages
Menomune Polysaccharide A, C, W, Y 1981 2 years and older
Menactra Conjugate A, C, W, Y 2005 9 months–55 years*
Menveo Conjugate A, C, W, Y 2010 2 months–55 years*
MenHibrix Conjugate C, Y and Hib 2012 6 weeks–18 months
Trumenba Protein B 2014 10–25 years+
Bexsero Protein B 2015 10–25 years+
*May be given to people age 56 years or older (consult ACIP recommendations at www.cdc.gov/mmwr/pdf/rr/rr6202.pdf).
+May be given to people age 26 years or older (consult ACIP recommendations at www.cdc.gov/mmwr/pdf/wk/mm6422.pdf).
Where can I find the most current meningococcal vaccine recommendations?
The most current recommendations for meningococcal polysaccharide and conjugate vaccines, which include serogroups A, C, W, and Y, were published in March 2013. This document is available on the MMWR website at www.cdc.gov/mmwr/pdf/rr/rr6202.pdf. Recommendations for use of MenB vaccine among persons at increased risk were published in June 2015 and are available at www.cdc.gov/mmwr/pdf/wk/mm6422.pdf, pages 608–12. MenB vaccine recommendations for adolescents and young adults were published in October 2015 and are available at www.cdc.gov/mmwr/pdf/wk/mm6441.pdf, pages 1171–6.
Who is recommended to be vaccinated against meningococcal disease?
Certain groups should receive both meningococcal conjugate vaccines:
(MenACWY Menactra, Sanofi Pasteur; Menveo, GSK) and MenB vaccines (Trumenba, Pfizer; Bexsero, GSK). Others are recommended to receive MenACWY only. MPSV4 (Menomune, Sanofi Pasteur) is recommended only for certain people older than 55 years.
MenACWY is recommended for these groups:
All children and teens, ages 11 through 18 years
  People age 2 months and older with functional or anatomic asplenia (MenHibrix may be used for children age 6 weeks through 18 months in this group)
  People age 2 months and older who have persistent complement component deficiency (an immune system disorder, including people taking eculizumab [Soliris]) (MenHibrix may be used for children age 6 weeks through 18 months in this group)
  People younger than 22 years of age if they are or will be a first-year college student living in a residential hall
  People age 2 months and older who are at risk during an outbreak caused by a vaccine serogroup (MenHibrix may be used for children age 6 weeks through 18 months in this group)
  People age 2 months and older who reside in or travel to certain countries in sub-Saharan Africa as well as to other countries for which meningococcal vaccine is recommended (e.g., travel to Mecca, Saudi Arabia, for the annual Hajj)
  Microbiologists who work with meningococcus bacteria in a laboratory
MenB is routinely recommended for these groups:
People age 10 years and older who have functional or anatomic asplenia
  People age 10 years and older who have persistent complement component deficiency, including people taking eculizumab (Soliris)
  People age 10 years and older who are at risk during an outbreak caused by a vaccine serogroup, such as on college campuses
  Microbiologists who work with meningococcus bacteria in a laboratory
For adolescents and young adults, ACIP recommends that a MenB vaccine series may be administered to people 16 through 23 years of age with a preferred age of vaccination of 16 through 18 years. This Category B recommendation allows the clinician to make a MenB vaccine recommendation based on the risk and benefit for the individual patient.
ACIP now designates a vaccine recommendation as either Category “A” or “B.” My interpretation is that an A recommendation means the vaccine is routinely recommended for all people in an age or risk group, and a B recommendation is for use at the clinician’s discretion. Does the Affordable Care Act (ACA) require health plans (non-grandfathered) to provide benefit coverage on Category B recommended vaccines?
Your understanding of A and B recommendations is correct. ACA requires coverage of vaccines with both A and B recommendations. The Vaccines For Children program also covers vaccines with a Category B recommendation.
Should college students be vaccinated against meningococcal disease?
MenACWY vaccine is recommended for previously unvaccinated first-year college students who are age 21 years and younger, who are or will be living in a residence hall. Some colleges and universities require incoming freshmen and others to be vaccinated with MenACWY; some may also require that a dose of MenACWY have been given since the age of 16 years.
Although several small MenB outbreaks have occurred on college campuses since 2013, college students in general are not at higher risk of MenB then persons of the same age who are not college students. Consequently, ACIP does not routinely recommend MenB vaccination for college students. However, college students may choose to receive MenB vaccine to reduce their risk of serogroup B meningococcal disease.
What is the schedule for MenACWY vaccine?
All adolescents should receive a dose of MenACWY at 11 or 12 years of age. A second (booster) dose is recommended at 16 years of age. Adolescents who receive their first dose at age 13 through 15 years should receive a booster dose at age 16 through 18 years. The minimum interval between MenACWY doses is 8 weeks. Adolescents who receive a first dose after their 16th birthday do not need a booster dose unless they become at increased risk for meningococcal disease. Colleges may not consider a second dose given even a few days before age 16 years as valid, so keep that in mind when scheduling patients.
What is the schedule for MenB vaccine?
Trumenba (Pfizer) is either a 2-dose series with doses administered at least 6 months apart or a 3-dose series with the second and third doses administered 2 and 6 months after the first dose. Bexsero (GSK) is a 2-dose series with doses given at least 1 month apart.
What are the minimum intervals between doses of Trumenba and Bexsero?
Neither ACIP nor the CDC meningococcal subject matter experts have addressed this issue. Given the lack of guidance, we must assume that the routine intervals are also the minimum intervals (see previous question). It is important to use these intervals when scheduling doses. However, if these intervals are violated, CDC recommends that the dose can be counted and does not need to be repeated.
I have a patient who was given Trumenba in August. Two months later she was given a dose of Bexsero. How should I proceed with her MenB vaccination series? We stock both vaccines.
The ACIP meningococcal serogroup B vaccine recommendations (www.cdc.gov/mmwr/pdf/wk/mm6441.pdf, pages 1171–6) state that the same vaccine must be used for all doses in the MenB series. So the clinician needs to complete a series with one or the other vaccine. If a person has already received 1 dose of Bexsero and one of Trumenba, then pick a brand and finish a recommended schedule with that brand. Ignore the extra dose of the other product. The next dose in the series (either Trumenba or Bexsero) should be separated from the previous dose of Bexsero by at least 1 month.
Which previously vaccinated college students need a booster dose of MenACWY?
A booster dose should be given to first-year college students age 21 years and younger who are or will be living in a residence hall if the previous dose was given before the age of 16 years.
Can you provide a comprehensive overview of the MenACWY recommendations, including those for vaccinating younger children and older adults who have risk factors?
IAC has prepared a table that provides a summary of the ACIP recommendations for use of meningococcal vaccine for people of all ages, including recommendations published by ACIP in MMWR in March 2013. The table is available at www.immunize.org/catg.d/p2018.pdf.
Menveo (MenACWY-CRM, GSK) is approved by the FDA for use in children as young as 2 months of age. What is the ACIP recommendation for use of this vaccine?
MenACWY-CRM is approved for people age 2 months through 55 years. It is the first quadrivalent meningococcal conjugate vaccine approved for children younger than age 9 months. For children beginning the vaccination series at age 2 months the schedule is 4 doses at age 2, 4, 6, and 12–15 months. Fewer doses are recommended for children beginning the vaccination series at age 7 months or older (see the Menveo product information for details).
ACIP recommends the use of MenACWY-CRM, in high-risk children 2 through 23 months of age (children with persistent complement deficiency, functional or anatomic asplenia, who travel to or reside in regions where meningitis is epidemic or hyperendemic, or who are at risk during a community outbreak attributable to a vaccine serogroup). Three meningococcal conjugate vaccines are now approved and recommended for high-risk children: MenHibrix (Hib-MenCY, GSK) for children 6 weeks through 18 months of age, Menveo for children 2 months and older, and Menactra (MenACWY-D, sanofi) for children 9 months and older. These recommendations were published in MMWR on June 20, 2014 and are available at www.cdc.gov/mmwr/pdf/wk/mm6324.pdf, pages 527-30.
ACIP recommends that adolescents who receive the first dose of meningococcal conjugate vaccine at age 13 through 15 years receive a one-time booster dose at age 16 through 18 years. Given how hard it is to get teens into a medical office, is it okay to give the doses close together if the opportunity arises or should we try to space it out as far as possible (age 18)?
If the first dose is given at age 13 through 15 years, you can give the booster dose as early as age 16 years, with a minimum interval of 8 weeks from the previous dose. So even if the patient was vaccinated at age 15 years 11 months, you could wait at least 8 weeks and then give the booster at age 16 years 1 month (or later) if you chose to do so.
The ACIP recommendations for meningococcal vaccine published in March 2013 advise using MenACWY in certain adults older than age 55 years. Please provide details of this recommendation.
Previously, ACIP recommended only the quadrivalent meningococcal polysaccharide vaccine (MPSV4; Menomune, sanofi) for use in adults age 56 years and older. The most recent recommendations, recommend the use of either MenACWY vaccine (Menactra or Menveo) in adults age 56 years and older who (1) were vaccinated previously with MenACWY and now need revaccination or (2) are recommended to receive multiple doses (for example, adults with asplenia or microbiologists working with Neisseria meningitidis). Both MenACWY vaccine products are licensed for use in people through age 55 years, which means that the use of these vaccines in people age 56 and older is off-label but ACIP-recommended. It is also acceptable to use MenACWY if MPSV4 is not available. The document is available at www.cdc.gov/mmwr/pdf/rr/rr6202.pdf.
Are the two quadrivalent meningococcal conjugate vaccines (MenACWY) interchangeable?
MCV-D (Menactra) is not approved for children younger than 9 months so only MenACWY-CRM (Menveo) should be used for children age 2 through 8 months. For persons age 9 months and older the quadrivalent vaccines are interchangeable.
What are the ACIP recommendations for use of MenHibrix, the combination meningococcal serogroups C and Y and Haemophilus influenzae type b vaccine?
Licensed in June 2012, MenHibrix (HibMenCY, GSK) is indicated for active immunization to prevent invasive disease caused by Neisseria meningitidis serogroups C and Y and Haemophilus influenzae type b. This vaccine does not protect against meningococcal serogroups A, B, and W.
ACIP recommends that infants at increased risk for meningococcal disease be vaccinated with 4 doses of HibMenCY at age 2, 4, 6, and 12 through 15 months. This includes infants with recognized persistent complement pathway deficiency and infants with anatomic or functional asplenia, including sickle cell disease. HibMenCY can be used in infants age 2 through 18 months who live in communities with serogroup C or Y meningococcal disease outbreaks. HibMenCY is not appropriate for children living or travelling internationally because it does not contain serotypes A or W.
IAC has developed a handy reference table that summarizes ACIP's recommendations for meningococcal vaccination of children and adults. It's available at www.immunize.org/catg.d/p2018.pdf.
We anticipate that parents will be seeking serology to prove immunity to meningococcal disease in lieu of vaccination required for school attendance. Would a positive meningococcal titer (serology) in a person who has not had meningococcal disease nor vaccination be accepted as evidence of immunity for school requirements?
According to the meningococcal subject matter experts at CDC the only test for which there is a correlate of immunity is a serum bactericidal assay (SBA). This test is mostly used for research and is not likely to be commercially available. An IgG EIA that might be available at a commercial laboratory is not useful for determining immunity. So there is no practical serologic test for determining immunity to meningococcus. Serologic testing is not recommended except perhaps in a research setting.
For People with Risk Factors Back to top
Three meningococcal conjugate vaccines are approved for children younger than 2 years of age. Which children should be vaccinated before their second birthday?
MenACWY-CRM (Menveo, Novartis) and HibMenCY (MenHibrix, GSK) are approved for children as young as age 2 months. MenACWY-D (Menactra, sanofi) is approved for children age 9 months and older. ACIP does not recommend routine meningococcal vaccination for all children younger than 2 months. ACIP recommends that only high-risk children be vaccinated. ACIP defines high-risk children age 2 through 23 months as (1) those with persistent complement component deficiency, (2) those with functional or anatomic asplenia, (3) those traveling to or residing in an area of the world where meningococcal disease is epidemic or (4) are at risk during a community outbreak attributable to a vaccine serogroups.
For children with functional or anatomic asplenia, MenACWY-D (Menactra) should not be administered to children until the PCV13 vaccination series is completed. Children who remain at increased risk for meningococcal disease should receive a booster dose 3 years after the primary series.
Which people age 2 years and older are recommended to receive a 2-dose primary series of MenACWY?
For people who are age 2 through 55 years, a 2-dose series of MCV4, spaced 2 months apart, is recommended if they have functional or anatomic asplenia, persistent complement component deficiency (including C3, C5-C9, properdin, factor H, and factor D and people taking eculizumab [Soliris]), and people with HIV infection. People with these high risk medical conditions also need a booster dose of MenACWY every 5 years.
Do any of the bacterial vaccines that are recommended for people with functional or anatomic asplenia need to be given before splenectomy? Do the doses count if they are given during the 2 weeks prior to surgery?
Pneumococcal conjugate vaccine (PCV13, Prevnar 13, Pfizer), Haemophilus influenzae type b vaccine (Hib), meningococcal conjugate vaccine (MenACWY), and meningococcal B vaccine should be given 14 days before splenectomy, if possible. Doses given during the 2 weeks (14 days) before surgery can be counted as valid. If the doses cannot be given prior to the splenectomy, they should be given as soon as the patient's condition has stabilized after surgery. Pneumococcal polysaccharide vaccine (PPSV23, Pneumovax, Merck) should be administered 8 weeks after the dose of PCV13 for people 2 years of age and older.
Why delay meningococcal vaccination for infants with functional or anatomic asplenia until the pneumococcal conjugate vaccine series is completed?
In addition to being at increased risk for meningococcal disease children with functional or anatomic asplenia are also at increased risk invasive disease caused by Streptococcus pneumoniae. Data show that the MenACWY-D vaccine (Menactra, sanofi) may interfere with the immunologic response to PCV13 if these two vaccines are given too close together. So ACIP recommends that MenACWY-D not be administered until at least 4 weeks after completion of the age-appropriate PCV13 series. MenACWY-CRM (Menveo) and HibMenCY (MenHibrix) do not affect the immune response to pneumococcal vaccine so can be given at any time before or after PCV13.
Can we vaccinate a 2-year-old boy with functional or anatomic asplenia who has not completed a series of PCV13?
If the child is receiving MenACWY-D (Menactra) you should first be certain that he is up to date with PCV13 vaccine. At least 4 weeks should elapse after completion of the PCV13 series before giving the MenACWY-D. There is no similar space consideration if MenACWY-CRM (Menveo) is used; this vaccine may be given simultaneously with PCV13 or at any interval since receipt of PCV13.
Adults who are asplenic need PCV13 and MenACWY. Does the recommendation to separate PCV13 and MenACWY-D (Menactra) apply to adults as well as children?
Studies that showed possible interference when PCV7 and Menactra were given simultaneously where done in children and not adults. This was then extrapolated to use of PCV13 and Menactra in children. This interference was not noted with Menveo.
At this time, there are no data to support a similar recommendation for adults. However, to be prudent, if MenACWY-D is being used, you should space it 4 weeks after PCV13. Menveo can be administered at any time before, simultaneous with or after PCV13.
I have a pediatric patient who has functional asplenia. I gave her a dose of Menactra (MenACWY-D) when she was 3 years old. Do I need to give her a booster at some time?
Because she has functional asplenia, she is due for the second dose of the primary series (assuming 8 weeks have passed since the first primary series dose). Because she has a high risk medical condition she will need periodic booster doses. If she is younger than age 7 years when she receives the second dose of her primary series she should receive her first booster dose 3 years after completing the primary series. She should then receive a booster dose every five years thereafter. If she is age 7 years or older when she receives the second primary dose she should receive her first booster dose 5 years after the completing the primary series and every five years thereafter.
If someone is older than 55 years and had their spleen removed, are they recommended for meningococcal polysaccharide vaccine or meningococcal conjugate vaccine?
Meningococcal conjugate vaccines (MenACWY) are licensed for persons through age 55 years. For persons older than 55 years with a high-risk medical condition (such as asplenia), the Advisory Committee on Immunization Practices (ACIP) recommends off-label use of MenACWY. Asplenic persons should receive a primary series of two doses of MenACWY separated by eight weeks, followed by a dose every five years thereafter. These recommendations are available at www.cdc.gov/mmwr/pdf/rr/rr6202.pdf, page 15.
We have a 68-year-old who has been asplenic since 2009. She had one dose of meningococcal polysaccharide vaccine (MPSV4, Menomune, Sanofi Pasteur) in 2009, but no subsequent dose. She is now due for a booster. Should she receive 2 doses of MenACWY, 2 months apart, to catch up, or just one dose?
This situation is not addressed in the most recent ACIP guidelines for meningococcal conjugate vaccine. It is the CDC meningococcal subject matter expert’s opinion that this patient should receive 2 doses of MenACWY separated by at least 8 weeks, followed by a booster dose of MenACWY every 5 years thereafter. The concern is that having had only MPSV4 previously, she may not have an adequate booster response to a single dose of MenACWY.
I have a patient with paroxysmal nocturnal hemoglobinuria who is being treated with Soliris (eculizumab). Should he receive meningococcal vaccine?
Eculizumab binds to C5 and inhibits the terminal complement pathway. Persons with persistent complement component deficiency are at increased risk for meningococcal disease. This person should receive a series of both quadrivalent meningococcal conjugate (MenACWY; 2 doses separated by at least 8 weeks) and a 2 or 3 dose series (depending on brand) of meningococcal serogroup B vaccine.
Are people who are HIV-positive in a risk group for meningococcal disease?
Yes. Accumulating evidence indicates that HIV infection increases the risk of meningococcal disease. ACIP recommends routine MenACWY vaccination of people with HIV infection. This group should receive a 2-dose primary series of MenACWY administered 2 months apart followed by booster doses every 5 years. ACIP does not recommend routine MenB vaccination of people with HIV infection.
I have an HIV-positive 64-year-old patient who received meningococcal conjugate vaccine last week. Was this the correct vaccine for this patient or should he have gotten MPSV4 due to his age? Also, should this patient get another dose in 2 months?
Quadrivalent meningococcal conjugate vaccine (MenACWY) was the correct vaccine in this situation. The 2013 ACIP recommendations on meningococcal vaccination recommend the use of meningococcal conjugate vaccine in adults age 56 years and older who (1) were vaccinated previously with MenACWY and now need revaccination, or (2) are recommended to receive multiple doses. A person with HIV infection should receive 2 doses of MenACWY separated by 8–12 weeks. Both MenACWY vaccines are licensed for use in people through age 55 years, which means that the use of these vaccines in people age 56 and older is off-label but recommended by ACIP.
We have a two-month-old male with his second episode of meningococcemia (group B). He is still undergoing an evaluation for primary immunodeficiency, but we are planning to proceed with immunizations, including meningococcal ACWY-CRM vaccine, but wanted to provide meningococcal B as well. Given that in the U.S., meningococcal B vaccine is only approved in children age 10 years and older, can we use it in the infant age group?
Use of either meningococcal serogroup B vaccine in persons younger than age 10 years is off-label in the U.S. There is currently no ACIP recommendation for use of this vaccine for this age group. However, Bexsero brand meningococcal B vaccine has been studied among infants and is approved for infants by the European Medicines Agency (the European version of the U.S. Food and Drug Administration). It is routinely recommended for infants in the United Kingdom (see www.nhs.uk/conditions/vaccinations/pages/meningitis-b-vaccine.aspx for details). A clinician may choose to use a vaccine off-label if, in their opinion, the benefit of the vaccine exceeds the risk from the vaccine. Product information for Bexsero can be found on the European Medicines Agency website at www.ema.europa.eu/ema.
Booster Doses Back to top
Should all adolescents receive a routine booster dose of MenACWY?
ACIP recommends people age 11 or 12 years be routinely vaccinated with quadrivalent meningococcal conjugate vaccine (MenACWY) and receive a booster dose at age 16 years. Adolescents who receive the first dose at age 13 through 15 years should receive a one-time booster dose, preferably at age 16 through 18 years, which are the years before the peak in incidence of meningococcal disease among adolescents occurs. Teens who receive their first dose of meningococcal conjugate vaccine at or after age 16 years do not need a booster dose, as long as they have no risk factors.
Why does ACIP recommend a routine booster dose of MenACWY for adolescents age 16 years and older?
In 2005, ACIP recommended routine MenACWY vaccination for all adolescents at age 11 or 12 years to protect them from meningococcal disease as older teens. The peak age for meningococcal disease is 16 through 21 years. In 2005, ACIP reasoned that higher MenACWY vaccination rates could be achieved if administering the dose was coupled with giving the Td booster dose at the 11 or 12-year-old visit (the Td dose for 11 or 12-year-olds was replaced by Tdap in 2006). Subsequent studies indicated that the protection provided by MenACWY wanes within 5 years following vaccination. For this reason, in 2010, ACIP recommended an MenACWY vaccine booster dose to provide continuing protection during the peak years of vulnerability (see www.cdc.gov/mmwr/pdf/wk/mm6003.pdf).
If someone received meningococcal polysaccharide vaccine (MPSV4) at age 5 years (such as for international travel) and a dose of MenACWY at age 11 or 12 years, will they still need a booster dose of MenACWY vaccine at age 16 years?
Yes. Any meningococcal vaccination given prior to the tenth birthday (either with MenACWY or MPSV4) does NOT count toward routinely recommended doses.
If someone received MPSV4 or MenACWY at age 9 years, will two additional doses of MenACWY be needed?
Yes. Doses of quadrivalent meningococcal vaccine (either MPSV4 or MenACWY) given before 10 years of age do not count as part of the series. If a child received a dose of either MPSV4 or MenACWY before age 10 years, they should receive a dose of MenACWY at 11 or 12 years and a booster dose at age 16 years.
Which people with risk factors should receive subsequent boosters of MenACWY?
When the first meningococcal conjugate vaccine (Menactra) was licensed in 2005, data were lacking on long-term efficacy and the need for additional vaccination. Since that time, studies indicate that antibody level declines over time. Consequently, ACIP recommended routine boosters of MenACWY for people at highest risk for meningococcal infection in 2009 (see www.cdc.gov/mmwr/pdf/wk/mm5837.pdf). This group includes people (1) with persistent complement component deficiency including people taking eculizumab (Soliris), (2) with anatomic or functional asplenia, (3) with HIV infection, (4) who have frequent prolonged exposure (such as microbiologists routinely working with Neisseria meningitidis, and travelers to or residents of areas with high rates of meningococcal disease [such as the African meningitis belt]).
Children at continued high risk who received the first dose (or primary series) of MenACWY before age 7 years should receive the next dose 3 years after the first dose. People at continued high risk who received the first dose (or primary series) of meningococcal vaccine at age 7 years or older should receive the next dose 5 years after the first dose. MenACWY is licensed through age 55 years, However, ACIP recommends off-label use of MenACWY for adults 56 and older who were vaccinated previously with MenACWY and are recommended for revaccination, or for whom multiple doses are anticipated.
Should people with continued high risk of meningococcal disease receive additional doses of meningococcal vaccine beyond the 3- or 5-year booster described above?
Yes, people should receive additional booster doses (every 5 years) if they continue to be at highest risk for meningococcal infection.
A 19-year-old student who received 1 dose of MenACWY at age 12 years will be attending a community college this fall. Does she need a booster dose of MenACWY?
Yes, but only if she will be living in residential housing. Adults age 19 through 21 years who meet these criteria and who received the previous dose of MenACWY before age 16 years, need a booster dose.
What do you do if an adult patient is in a high-risk situation for meningococcal disease (for example travel to sub-Saharan Africa) and doesn't know whether they received MenACWY or MPSV4 in the past. Should we vaccinate them?
Yes. The ACIP recommendation is to vaccinate when vaccination is indicated and when you don't have adequate documentation.
Which groups should receive a booster dose of MenB vaccine?
ACIP does not currently recommend booster doses of MenB vaccine for any group.
Administering Vaccine Back to top
By what route should meningococcal vaccines be administered?
All meningococcal conjugate vaccines should be administered by the intramuscular route. MPSV4 should be given by the subcutaneous route. MenB is given by the intramuscular route.
We mistakenly gave a patient the diluent for Menveo (Novartis) meningococcal conjugate vaccine without adding it to the powdered vaccine. Since vaccine antigen is present in the diluent as well as in the powder, what should we do now?
Menveo's liquid vaccine component (the diluent) contains the C, W-135, and Y serogroups, and the lyophilized vaccine component (the freeze-dried powder) contains serogroup A. Because the patient received only the diluent, he or she is not protected against invasive meningococcal disease caused by Neisseria meningitidis serogroup A.
Invasive disease with N. meningitidis serogroup A is very rare in the United States, but is more common in some other countries, particularly the African meningitis belt. If the recipient (of the C-Y-135 "diluent" only) is certain not to travel outside the United States then the dose does not need to be repeated. However, if the recipient plans to travel outside the United States the dose should be repeated with either correctly reconstituted Menveo, or with a dose of Menactra brand MenACWY. There is no minimum interval between the incorrect dose and the repeat dose.
Can MenACWY and MenB vaccines be given at the same visit?
Yes. MenACWY and MenB vaccines can be given at the same visit or at any time before or after the other.
Contraindications and Precautions Back to top
I understand that a prior history of Guillain-Barrè syndrome (GBS) is no longer a precaution for giving meningococcal conjugate vaccine. Please tell me more about this.
A history of GBS had previously been a precaution for Menactra (Sanofi Pasteur) brand MenACWY vaccine. Findings from two studies that examined more than 2 million doses of Menactra given since 2005 showed no evidence of an increased risk of GBS. Consequently, ACIP recommended in 2010 to remove the precaution for use of Menactra in people with a history of GBS. This precaution did not apply to other meningococcal vaccines.
 
This page was updated on July 22, 2016.
This page was reviewed on July 2, 2016.
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