Ask the Experts: Meningococcal ACWY

Results (56)

Meningococcal disease is a bacterial infection caused by Neisseria meningitidis. Meningococcal disease usually presents clinically as meningitis (about 50% of cases), bacteremia (30% of cases), or bacteremic pneumonia (15% 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 in the U.S. is 15%, and 10%–20% of survivors have long-term sequelae such as neurologic disability, limb or digit loss, and hearing loss.

N. meningitidis is classified into 12 serogroups based on characteristics of the polysaccharide capsule. Most invasive disease (such as meningitis and sepsis) is caused by serogroups A, B, C, W, X and Y. The relative importance of serogroups depends on geographic location and other factors such as age. Between 2011 and 2020 in the United States, serogroup B caused about 60% of cases among children younger than 5 years old, and serogroups C, W, or Y caused about two out of three cases in people age 11 years or older. Serogroup A is rare in the U.S. Historically, serogroup A was common in the meningitis belt of sub-Saharan Africa, but after the implementation of a meningococcal serogroup A conjugate vaccine campaign, serogroup A disease has been nearly eliminated in the meningitis belt.

Nasopharyngeal carriage rates are highest in adolescents and young adults who serve as reservoirs for transmission of N. meningitidis.

Last reviewed: November 15, 2024

The incidence of meningococcal disease has declined steadily in the U.S. since a peak of reported disease in the late 1990s. Even before routine use of a meningococcal conjugate vaccine against serogroups A, C, W, and Y (MenACWY) was recommended for adolescents 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. In 2021, the rate of meningococcal disease in the United States reached a historic low of 0.06 cases per 100,000 population.

In 2021, the most recent CDC surveillance final report stated that, of U.S. cases with known serogroup, 46 cases were serogroup B (incidence rate of 0.01 cases per 100,000, or 1 case per 10 million population) and 108 cases were serogroups C, Y, or W. The incidence of disease is extremely low in all age groups, but is highest in infants under 1 year (0.56 cases per 100,000), children age 1 through 4 years (0.10 cases per 100,000). Among adolescents age 16–23, the incidence rate was 0.05 cases per 100,000 population, which equals 5 cases per 10 million people age 16–23 in 2021. In total, 209 cases of meningococcal disease were reported in the United States in 2021.

Rates of meningococcal disease in the United States increased in 2023. Much of this increase was due to a sharp increase in serogroup Y disease. In 2023, 415 confirmed and probable meningococcal disease cases were reported in the United States (preliminary data), which is similar to the rate in 2014. People disproportionately affected by the increase include Black people between the ages of 30 and 60 years, and adults with HIV. Adults with HIV are routinely recommended to be vaccinated against meningococcal serogroups A, C, W, and Y.

Last reviewed: November 15, 2024

In addition to risk based on age, non-specific 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).

The following groups are at increased risk for all meningococcal serogroups:

  • People with persistent (genetic) complement component deficiencies (a type of immune system disorder)
  • People who use complement inhibitors such as eculizumab (Soliris, Alexion Pharmaceuticals), ravulizumab (Ultomiris, Alexion Pharmaceuticals), or sutimlimab (Enjaymo, Sanofi) for treatment of atypical hemolytic uremic syndrome or paroxysmal nocturnal hemoglobinuria
  • People with anatomic or functional asplenia
  • Microbiologists routinely exposed to meningococcal isolates in a laboratory
  • People at increased risk during an outbreak of meningococcal disease
  • Military recruits
  • College students

Certain groups are at increased risk of serogroups A, C, W and Y, but not serogroup B:

  • People living with HIV
  • Men who have sex with men (MSM)
  • Travelers to countries where meningococcal disease is endemic or hyperendemic, such as the meningitis belt of sub-Saharan Africa
Last reviewed: November 15, 2024

The vaccines for meningococcal serogroups A, C, W, and Y (MenACWY-TT, MenQuadfi [Sanofi]; MenACWY-CRM, Menveo [GSK]) contain meningococcal conjugate in which the surface polysaccharide is chemically bonded (“conjugated”) to a protein to produce a robust immune response to the polysaccharide. The MenACWY vaccine products are considered interchangeable; the same vaccine product is recommended, but not required, for all doses.

Two meningococcal vaccines were used in the recent past but are no longer available. Menactra (Sanofi) is a discontinued MenACWY conjugate vaccine. The last doses of Menactra expired in 2023. Menactra was considered interchangeable with Menveo or MenQuadfi. An older meningococcal polysaccharide vaccine (MPSV4, Menomune, Sanofi) was available in the United States until the last doses expired in 2017: it was never routinely recommended for children or teens.

Since late 2014, vaccines have become available that offer protection from meningococcal serogroup B disease (MenB; Bexsero by GSK; Trumenba by Pfizer). These vaccines are composed of proteins found on the surface of the bacteria. Bexsero and Trumenba are not interchangeable; the same vaccine product is required for all doses.

A pentavalent MenACWY and MenB vaccine, abbreviated MenABCWY (Penbraya, Pfizer) contains a conjugated MenACWY vaccine mixed with the MenB vaccine contained in Trumenba (Pfizer).

MenACWY vaccines provide no protection against serogroup B disease, and MenB vaccines provide no protection against serogroup A, C, W, or Y disease. For protection against all 5 serogroups of meningococcus, it is necessary to receive both MenACWY and MenB, either as separate vaccines or as the combination MenABCWY vaccine, Penbraya.

Trade Name Type of Vaccine Serogroups Year Licensed Approved Ages
Penbraya Conjugate A, B, C, W, Y 2023 10–25 years*
Menveo (two vial)
Menveo (one vial)		 Conjugate
Conjugate		 A, C, W, Y
A, C, W, Y		 2010
2022		 2 mos.–55 years*
10–55 years*
MenQuadfi Conjugate A, C, W, Y 2020 2 years and older
Trumenba Protein B 2014 10–25 years*
Bexsero Protein B 2015 10–25 years*

*May be given to adults at increased risk older than the FDA-approved upper age limit (see ACIP recommendations, Table 11, page 41, www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6909a1-H.pdf)

Last reviewed: November 15, 2024

The most current comprehensive recommendations from the Advisory Committee on Immunization Practices (ACIP) for meningococcal vaccines is available on the MMWR website at www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6909a1-H.pdf. This document replaces all previously published reports and policy notes.

ACIP recommendations for the use of MenABCWY (Penbraya) were published in the MMWR in April 2024 and are at www.cdc.gov/mmwr/volumes/73/wr/pdfs/mm7315a4-H.pdf.

Last reviewed: November 15, 2024

MenACWY is recommended for these groups:

Routine vaccination of all children and teens, age 11 through 18 years: a single dose at age 11 or 12 years with a booster dose at age 16 years

Routine vaccination of people age 2 months or older at increased risk for meningococcal disease (the primary dosing schedule and booster dose interval varies by age and indication):

  • People with functional or anatomic asplenia
  • People who have persistent complement component deficiency (an immune system disorder) or who take a complement inhibitor (examples include eculizumab [Soliris] and ravulizumab [Ultomiris])
  • People who have HIV infection
  • People who are at risk during an outbreak caused by a vaccine serogroup
  • 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 bacterial isolates in a laboratory
  • First-year college students living in residence halls who are unvaccinated or undervaccinated; these students should receive a dose if they have not had a dose since turning 16 or if it has been more than 5 years since their previous dose
Last reviewed: November 15, 2024

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 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. People 19 through 21 years of age are not recommended routinely to receive MenACWY. However, MenACWY may be administered to people age 19 through 21 years as catch-up vaccination for those who have not received a dose after their 16th birthday.

Last reviewed: November 15, 2024


1:38

View All Video Questions

Last reviewed: May 23, 2023

No. ACIP considers a dose of MenACWY given to a 10-year-old child to be valid for the first dose in the adolescent series. Doses given before age 10 years should not be counted. The child should receive the second (booster) dose at age 16 years as usual.

Last reviewed: November 15, 2024


0:59

View All Video Questions

Last reviewed: May 24, 2023

First-year college students living in residence halls should be vaccinated against meningococcal ACWY disease. Before enrollment, administer a dose of MenACWY vaccine to those previously unvaccinated, to those who have not had a dose of MenACWY since turning 16, and to those whose most recent MenACWY dose (given after turning 16) was not given within the past 5 years. Some schools, colleges, and universities have policies requiring vaccination against meningococcal disease as a condition of enrollment.

Last reviewed: November 15, 2024


1:07

View All Video Questions

Last reviewed: May 23, 2023

Yes. One dose of MenACWY vaccine is recommended for all first-year college students who are or will be living in a residence hall if they are previously unvaccinated, have not received a dose of MenACWY since turning 16, or if their most recent dose (given after turning 16) was not given within the past 5 years.

Last reviewed: November 15, 2024


1:06

View All Video Questions

Last reviewed: May 23, 2023

ACIP does not identify incarceration as an indication for meningococcal ACWY vaccination. Providers are always free to use their clinical judgment in situations not addressed by ACIP.

Last reviewed: November 15, 2024

Residence in a homeless shelter or halfway house is considered a high-risk indication only for hepatitis A vaccination because of the increased risk of hepatitis A exposure and serious illness among people experiencing homelessness or living in temporary housing. In all other respects, recommendations for vaccinating adult residents would be the same as those for all adults on the ACIP adult immunization schedule. Residents with medical conditions identified on Table 2 of the schedule should be vaccinated according to that table.

Any residents 18 or younger should be vaccinated according to the catch-up recommendations on the ACIP child/teen immunization schedule. People age 19 through 21 years are not recommended routinely to receive MenACWY. MenACWY may be administered through age 21 years as a catch-up vaccination for those who have not received a dose after their 16th birthday.

Last reviewed: November 15, 2024

No. There are no acceptable serologic titers that can be used as evidence of protection against meningococcal A, C, W, and Y disease. In addition, the immunologic studies used for licensing purposes (serum bactericidal assay, SBA) are likely different from the serologic titers obtained at a doctor’s office (IgG antibody, for example). It is not clear what sort of testing is shown in the results you sent. However, even if SBA results are available, they cannot be used to assess whether there is a level of protection at the individual level.

Last reviewed: November 15, 2024

Immunize.org has prepared a document that provides a summary of the ACIP recommendations for use of MenACWY for people of all ages. The document is available at www.immunize.org/catg.d/p2018.pdf.

Last reviewed: November 15, 2024

Menveo, in the two-vial presentation that requires reconstitution, is approved for people age 2 months through 55 years. The one-vial formulation that does not require reconstitution was licensed in 2022 for ages 10 through 55 years and should not be used for children younger than age 10. For children beginning the vaccination series at age 2 months the schedule is 4 doses at age 2, 4, 6, and 12 to 15 months. Fewer doses are recommended for children beginning the vaccination series at age 7 months or older. See the Immunize.org document at www.immunize.org/catg.d/p2018.pdf for details.

ACIP recommends the use of Menveo in high-risk children 2 through 23 months of age: children with persistent complement deficiency, including those taking a complement inhibitor such as eculizumab (Soliris) or ravulizumab (Ultomiris), functional or anatomic asplenia, HIV infection, 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. MenQuadfi (MenACWY-TT) may be used for children at increased risk who are age 2 years and older. These recommendations are summarized in Table 3 of the recommendations published by ACIP in MMWR in 2020: www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6909a1-H.pdf.

Last reviewed: November 15, 2024

The meningococcal ACIP recommendations don’t clearly state a minimum interval for MenACWY in this situation. However, the minimum interval for a pediatric MenACWY schedule would presumably be 4 weeks like for other pediatric vaccines on a 2-4-6 schedule. You should try to give a third dose before travel begins.

Last reviewed: November 15, 2024

Since the patient is asplenic, the second dose of the primary series of MenACWY should be given at least 8 weeks after the first dose. He will need a dose of MenACWY every 5 years for the rest of his life. The 3-dose series of MenB (whether Trumenba [Pfizer] or Bexsero [GSK]) should be completed. The first booster dose of MenB will be due one year after completion of the primary series and subsequent booster doses are recommended every 2–3 years for the rest of his life. The same MenB vaccine should be used for all doses in the series, including booster doses. People who receive Trumenba brand MenB vaccine have an option to receive MenABCWY (Penbraya, Pfizer) when both MenACWY and MenB vaccines are due at the same visit, as long as doses of Penbraya are spread out by at least 6 months. The patient has already received one dose of PCV20, in accordance with pneumococcal vaccination recommendations for immunocompromised adults younger than age 50, so no further doses are needed. Based on the patient’s age, only one dose of Hib vaccine is recommended, so no further doses are needed. The patient should receive influenza vaccine annually.

Any of these vaccines can be given at the same appointment.

Last reviewed: November 15, 2024

Yes. Doses of any meningococcal ACWY vaccine given before 10 years of age should not be counted as part of the adolescent MenACWY series. If a child received a dose of MenACWY before age 10 years, they should receive a dose of MenACWY at 11 or 12 years and a booster dose at age 16.

Last reviewed: November 15, 2024

Yes, they should receive a booster dose at age 16. A booster dose of MenACWY is recommended at age 16 years even if 2 (or more) doses of MenACWY vaccine were received before age 16 years. First-year college students living in a residence hall who have not received a dose of MenACWY on or after age 16 years, should also be vaccinated.

Last reviewed: November 15, 2024

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).

Last reviewed: November 15, 2024

Menveo is approved for adults through age 55 years. MenQuadfi was approved in 2020 for ages 2 years and older. If MenACWY is indicated for a person older than age 55 and you do not have MenQuadfi, use Menveo. If meningococcal B vaccination with MenB-FHbp (Trumenba) is needed at the same visit, Penbraya (MenABCWY, Pfizer) is also an option, as long as it has been at least 6 months since the most recent dose of Penbraya.

Last reviewed: November 15, 2024

The “two-vial” formulation of Menveo (MenACWY-CRM, GSK) requires reconstitution of a lyophilized powder with a diluent: it is FDA-licensed for administration to individuals age 2 months through 55 years. The “one-vial” liquid formulation of Menveo licensed in 2022 is essentially the same vaccine, but does not require reconstitution before administration; however, this formulation is currently licensed only for administration to people age 10 through 55 years.

If the “one-vial” formulation is inadvertently administered to a child younger than age 10 years, this incident should be reported to the Vaccine Adverse Event Reporting System (VAERS, https://vaers.hhs.gov) as a vaccine administration error; however, the dose may be counted as valid and should not be repeated. If your facility stocks both one-vial and two-vial Menveo formulations, review practices and protocols and ensure clear labeling of vaccines in storage units to minimize the risk of administering the one-vial formulation to a child younger than age 10 years.

Note that administration of a dose of either Menveo formulation to a patient who is older than the FDA-licensed upper age limit of 55 years should not be reported to VAERS and is not considered an error. This is because ACIP recommendations state that Menveo may be administered to adults age 56 or older when MenACWY vaccination is indicated and MenQuadfi (MenACWY-TT, Sanofi, licensed with no upper age limit) is not available.

Last reviewed: November 15, 2024

Eculizumab (Soliris) and related long-acting compounds, such as ravulizumab (Ultomiris) and sutimlimab (Enjaymo), inhibit the terminal complement pathway. People with persistent complement component deficiency due to an immune system disorder or use of a complement inhibitor are at increased risk for meningococcal disease even if fully vaccinated. This patient should be given a 2-dose primary series of MenACWY vaccine (2 doses separated by at least 8 weeks) and a 3-dose series of MenB vaccine (0, 1-2 months, and 6 months). The patient should receive regular booster doses of MenACWY and MenB as long as he remains at risk: a booster dose of MenACWY every 5 years and a booster dose of MenB one year after completion of the primary series, followed by a booster dose of MenB every 2–3 years thereafter. The same type of MenB vaccine must be used for all doses, including booster doses; MenB products are not interchangeable.

Penbraya (MenABCWY, Pfizer) contains MenB-Fhbp (Trumenba, Pfizer) and is given as two doses, 6 months apart, when vaccination against all 5 serogroups is needed. For people age 10 years or older at increased risk of meningococcal disease, like this patient, Penbraya may be used for MenACWY and MenB (Trumenba) doses (including booster doses) if both vaccines would be given on the same clinic day and at least 6 months have elapsed since most recent Penbraya dose.

Because patients treated with complement inhibitors can develop invasive meningococcal disease despite vaccination, clinicians using these products also may consider antimicrobial prophylaxis for the duration of complement inhibitor therapy.

Last reviewed: November 15, 2024

As of 2024, there are two options for MenACWY vaccination. In 2020, MenQuadfi (Sanofi) was approved for use in all people ages 2 years and older. If MenQuadfi is not available and vaccination is needed, you may administer Menveo.

Last reviewed: November 15, 2024

Only the Menveo two-vial formulation requiring reconstitution (MenACWY-CRM) should be used for children age 2 through 23 months. MenQuadfi (MenACWY-TT) is approved for people age 24 months or older. The one-vial formulation of Menveo that does not require reconstitution is approved for children and adults age 10 through 55 years. Penbraya (MenABCWY), may be an option for people age 10 years or older when both MenACWY and MenB (Trumenba) vaccination is needed at the same visit. Unlike MenB vaccines, when more than one brand of MenACWY vaccine is age-appropriate, they are interchangeable.

Last reviewed: November 15, 2024

For people who are age 2 years or older, a 2-dose series of MenACWY, spaced 8–12 weeks apart, is recommended if they have functional or anatomic asplenia, HIV infection, persistent complement component deficiency (an immune disorder including C3, C5–C9, properdin, factor H, and factor D deficiency), or if they take a complement inhibitor (for example, eculizumab [Soliris], ravulizumab [Ultomiris], or sutimlimab [Enjaymo]). People with these high-risk medical conditions also need booster doses of MenACWY.

Last reviewed: November 15, 2024

ACIP recommends meningococcal vaccination only for high-risk children younger than 11 years. ACIP defines high-risk children age 2 months and older as (1) those with persistent complement component deficiency (an immune system disorder) or who take a complement inhibitor (examples include eculizumab [Soliris], ravulizumab [Ultomiris], and sutimlimab [Enjaymo]), (2) those with functional or anatomic asplenia, (3) those with HIV infection, (4) those traveling to or residing in an area of the world where meningococcal disease is hyperendemic or epidemic or (5) those identified by public health officials as being at risk during a community outbreak attributable to a vaccine serogroup.

Menveo (MenACWY-CRM), in its two-vial formulation requiring reconstitution, is approved for children age 2 months and older; the one-vial formulation that does not require reconstitution may be administered to children age 10 years or older. MenQuadfi (MenACWY-TT) is approved for children age 2 years and older. Children at increased risk for meningococcal disease should receive booster doses as long as they remain at increased risk.

Last reviewed: November 15, 2024

Yes. Menveo (MenACWY-CRM) or MenQuadfi (MenACWY-TT) may be given simultaneously with PCV or at any interval before or after receipt of PCV.

Last reviewed: November 15, 2024

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.

Last reviewed: November 15, 2024

This situation is not addressed in the 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 (Menomune, Sanofi, unavailable since 2017) previously, she may not have an adequate booster response to a single dose of MenACWY.

Last reviewed: November 15, 2024

Recommendations to separate MenACWY and PCV under certain circumstances only applied to MenACWY-D (Menactra, Sanofi), which is no longer available in the United States. So, you may administer any available and recommended MenACWY and PCV vaccines at the same time. A 10-year-old with persistent complement component deficiency also should receive a 3-dose series (the same product for all doses) of MenB vaccine.

As long as the child remains at high risk of meningococcal disease due to complement inhibitor use, booster doses of both MenACWY and MenB are recommended. A MenACWY booster dose should be given every 5 years and a MenB booster dose should be given one year after the completion of the primary series, followed by a booster dose every 2–3 years thereafter. If using MenB-FHbp (Trumenba, Pfizer), you have the option to use MenABCWY (Penbraya, Pfizer) when both MenACWY and MenB vaccinations are due at the same visit, as long as doses of Penbraya are separated by at least 6 months.

Because patients treated with complement inhibitors can develop invasive meningococcal disease despite vaccination, clinicians using Soliris, Ultomiris, Enjaymo, or other complement inhibitors also may consider antimicrobial prophylaxis for the duration of complement inhibitor therapy.

Last reviewed: November 15, 2024

Yes. Studies from the United States, South Africa, and the United Kingdom have shown that people with HIV infection have a risk of invasive meningococcal disease that is 11–24 times higher than the general population. In the United States, this excess risk is specifically for serogroups C, W, and Y. ACIP recommends routine MenACWY vaccination of all HIV-infected people 2 months of age and older. Children younger than age 2 years should be vaccinated using a multidose schedule based upon age (see the Immunize.org document “Meningococcal ACWY Vaccine Recommendations by Age and Risk Factor,” available at www.immunize.org/catg.d/p2018.pdf for details).

People age 2 years and older with HIV infection who have not been previously vaccinated should receive a 2-dose primary series of MenACWY (doses separated by at least 8 weeks). People with HIV infection who have previously received one dose of MenACWY should receive a second dose at the earliest opportunity (at least 8 weeks after the previous dose) and then receive booster doses at the appropriate intervals. ACIP does not recommend routine meningococcal serogroup B vaccination of people with HIV infection.

Last reviewed: November 15, 2024

It is not necessary to restart the MenACWY series. Give the person one dose of MenACWY vaccine now. This dose represents a delayed second dose in the 2-dose primary series recommended for people with HIV infection. The patient will subsequently need booster doses every 5 years.

Last reviewed: November 15, 2024

There is no specific indication for meningococcal vaccine in this patient. Risk–based recommendations are restricted to specific forms of altered immunocompetence (persistent complement component deficiency, functional or anatomic asplenia, use of complement inhibitors such as eculizumab [Soliris], ravulizumab [Ultomiris] or sutimlimab [Enjaymo], and HIV infection) and do not include other forms of altered immunocompetence.

Last reviewed: November 15, 2024

Although second-hand smoke and other environmental conditions have been identified as risk factors for meningococcal disease, ACIP does not include them as indications for MenACWY vaccination. Providers may always use their clinical judgment in situations not addressed by ACIP.

Last reviewed: November 15, 2024

ACIP recommends adolescents age 11 or 12 years should be routinely vaccinated with 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, just before the peak in incidence of meningococcal disease among adolescents occurs. Teens who receive their first dose of MenACWY at or after age 16 years do not need a booster dose, as long as they have no additional risk factors.

Last reviewed: November 15, 2024

In 2005, ACIP recommended routine MenACWY vaccination for all preteens at age 11 or 12 years to protect them from meningococcal disease when its incidence rises in the late teens and early 20s. Subsequent studies indicated that the protection provided by MenACWY waned within 5 years following vaccination. For this reason, in 2010, ACIP recommended a MenACWY booster dose at age 16 to provide continuing protection during the age of increased meningococcal incidence.

Last reviewed: November 15, 2024

A booster dose should be given to first-year college students, regardless of age, who are or will be living in a residence hall if the previous dose was given before the age of 16 years or if their most recent dose (given after the 16th birthday) was not given within the past 5 years.

Last reviewed: November 15, 2024

Yes. Doses of MenACWY given before 10 years of age should not be counted as part of the series. If a child received a dose of 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. A dose of MenACWY administered at age 10 may count as the first adolescent dose normally given at 11 or 12.

Last reviewed: November 15, 2024

ACIP recommends routine booster doses of MenACWY for people two months old or older at ongoing high risk for meningococcal infection (see www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6909a1-H.pdf, Table 3). This group includes people (1) with persistent complement component deficiency (an immune system disorder) or who take a complement inhibitor (examples include eculizumab [Soliris], ravulizumab [Ultomiris], and sutimlimab [Enjaymo]), (2) with anatomic or functional asplenia, (3) with HIV infection, (4) who have higher risk of exposure (including microbiologists who handle Neisseria meningitidis isolates and travelers to or residents of areas with epidemic or hyperendemic meningococcal disease [such as the meningitis belt of sub-Saharan Africa]).

Children at continued high risk who received the last dose of the primary series of MenACWY before age 7 years should receive the next dose 3 years after the most recent dose, then every 5 years as long as risk remains. People at continued high risk who received the last dose of the primary series at age 7 years or older should receive the next dose 5 years after the most recent dose then every 5 years as long as risk remains. Menveo (MenACWY-CRM) is licensed through age 55 years; however, if MenQuadfi (MenACWY-TT, licensed for use at age 2 years and older) is unavailable for an adult age 56 years or older, you may use Menveo.

Last reviewed: November 15, 2024

Yes, people should receive additional booster doses (every 5 years) if they continue to be at increased risk for meningococcal ACWY infection.

Last reviewed: November 15, 2024

The MenACWY booster dose should be given at 14 years (5 years after the primary series) and every 5 years thereafter. The every-5-year booster dose schedule for people with high-risk conditions takes precedence over the routine adolescent schedule.

Last reviewed: November 15, 2024

If the person cannot provide written documentation of the previous vaccination, you should assume they are unvaccinated and vaccinate accordingly.

Last reviewed: November 15, 2024

All meningococcal conjugate vaccines (MenACWY, MenB, MenABCWY) should be administered by the intramuscular route.

Last reviewed: November 15, 2024

The liquid vaccine component (the diluent) of Menveo 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 N. 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. If the recipient (of the C-Y-W135 “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 correctly reconstituted Menveo, the one-vial formulation of Menveo that does not require reconstitution, or with a dose of another brand of MenACWY. There is no minimum interval between the incorrect dose and the repeat dose.

Last reviewed: November 15, 2024

Yes. MenACWY and MenB vaccines can be given at the same visit or at any time before or after the other. The pentavalent MenABCWY vaccine Penbraya (Pfizer) may be administered as an option for people age 10 or older who need both MenB-FHbp (Trumenba, Pfizer) and MenACWY vaccination at the same visit. For people age 10 years or older at increased risk of meningococcal disease, Penbraya may be used for additional MenACWY and MenB doses (including booster doses) if both would be given on the same clinic day and at least 6 months have elapsed since most recent Penbraya dose.

Last reviewed: November 15, 2024

The most common adverse events following MenACWY vaccination were injection site pain, swelling or redness. Other reported symptoms included malaise and headache.

Last reviewed: November 15, 2024

Yes. The National Vaccine Injury Compensation Program includes payment for injuries determined to have occurred following vaccination with a vaccine routinely recommended for children in the United States. The recipient can be of any age, but the vaccine must be routinely recommended for children and teens through age 18 years. MenACWY is routinely recommended for children so it is included in the program. More information about the program and the covered vaccines is at www.hrsa.gov/vaccine-compensation/covered-vaccines/index.html.

Last reviewed: November 15, 2024

As with all vaccines, a severe allergic reaction (for example, anaphylaxis) to a vaccine component or to a prior dose is a contraindication to further doses of that vaccine. A moderate or severe acute illness is a precaution; vaccination should be deferred until the person’s condition has improved. Because MenACWY is an inactivated vaccine, it can be administered to people who are immunosuppressed as a result of disease or medications; however, response to the vaccine might be less than optimal.

Last reviewed: November 15, 2024

Yes. No safety concerns associated with vaccination have been identified in people vaccinated during pregnancy or their infants.

Last reviewed: November 15, 2024

No. People with a history of GBS may receive any age-appropriate MenACWY vaccine.

Last reviewed: November 15, 2024

Store any brand of MenACWY, MenB, or MenABCWY vaccine at refrigerator temperature, between 2° and 8°C (between 36° and 46°F). These vaccines must not be frozen. Vaccine that has been frozen or exposed to freezing temperature should not be used. Do not use after the expiration date.

Last reviewed: November 15, 2024

This page was updated on .

Our Affiliated Sites

For the Public: VaccineInformation.org
For Coalitions: ImmunizationCoalitions.org
65+ Flu Defense
Protect vulnerable, older adult patients from influenza.
Give2MenACWY.org
Improve protection from meningococcal serogroups ACWY.
Mass Vaccination Resources
Access guidance documents, toolkits, and helpful resources.
NAIIS
Home of the National Adult and Influenza Immunization Summit.