Ask the Experts: Meningococcal B

Results (44)

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

MenB is routinely recommended for these groups:

  • People age 10 years and older who have functional or anatomic asplenia (including sickle cell disease)
  • People age 10 years and older who have persistent complement component deficiency (an immune system disorder) or who take a complement inhibitor (examples include eculizumab [Soliris], ravulizumab [Ultomiris], and sutimlimab [Sanofi])
  • People age 10 years and older who are exposed during an outbreak caused by serogroup B
  • Microbiologists who work with meningococcal isolates in a laboratory

For adolescents and young adults not otherwise at increased risk for meningococcal B disease, ACIP recommends that a MenB series may be administered to people 16 through 23 years of age (preferred age 16 through 18 years) on the basis of shared clinical decision-making. The shared clinical decision-making recommendation allows the clinician and patient to decide together based upon the risks and benefits of vaccination for the individual patient.

Last reviewed: November 15, 2024


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Last reviewed: May 9, 2023

The terminology change from “Category B” to “shared clinical decision-making” was done to describe more clearly the intent of the recommendation that the patient should be informed of the option to be vaccinated against meningococcal serogroup B disease and that the decision to vaccinate against MenB should be made by the provider and patient together. ACA requires coverage of vaccines as indicated on the recommended immunization schedule, including vaccines with shared clinical decision-making recommendations. The Vaccines for Children (VFC) program also covers vaccines recommended for shared clinical decision-making.

Last reviewed: November 15, 2024

To assist with the shared clinical decision-making around the option to vaccinate against meningococcal serogroup B disease and the timing of vaccination, CDC has provided some specific considerations about the disease and the vaccine that the patient and provider may weigh:

  • Serious nature of invasive meningococcal serogroup B infection, with a high risk of death and permanent complications
  • Low level of serogroup B disease in the United States, with an average of 34 cases each year among people age 16 through 23 years between 2015 and 2018, declining to 17 cases in 2022.
  • Increased risk among college students, especially those who are freshmen, attending a 4-year university, living in on-campus housing, or participating in sorority and fraternity life
  • Protection of MenB vaccine against most strains of meningococcal serogroup B bacteria
  • Estimated relatively short duration of MenB vaccine protection, with antibody levels waning within 1–2 years of completing the primary series; however, if a booster is indicated (e.g., during an outbreak) antibody titers rise in one to two weeks after booster dose administration
  • Evidence to date suggests no impact of MenB vaccine on meningococcal B carriage (may protect an individual from invasive disease but is unlikely to impact transmission of the bacteria to others)
Last reviewed: November 15, 2024

MenB vaccines were approved based on the serologic response to the vaccine. Because meningococcal B disease is so rare, no data are available on vaccine effectiveness against clinical disease or duration of protection against clinical disease. Short term protection refers to the known duration of the antibody response. Available data indicate that protective antibody levels wane in most recipients within 1–2 years of completion of the primary series. Antibody levels rise sharply within 1-2 weeks of a booster dose.

Last reviewed: November 15, 2024

Several small outbreaks of meningococcal serogroup B disease have occurred on college campuses since 2013. However, the disease incidence in college students remains very low (0.03 cases per 100,000 college students age 18 to 24 years in 2020). ACIP does not routinely recommend MenB vaccine for college students. However, the recommendation for shared clinical decision-making applies to all college students age 16 through 23 years who may choose to receive MenB vaccine to reduce their risk of meningococcal serogroup B disease. In addition, some colleges and universities require MenB vaccination for incoming students.

If a college student completes the MenB vaccine series at least 6 months to 1 year before being identified as at risk during an outbreak, a single booster dose of the same brand can boost levels of protective antibodies within 1-2 weeks. The ability to be protected quickly during an outbreak by a single booster dose may be an important consideration for college students, families, and administrators when deciding about getting the MenB vaccine primary series.

Last reviewed: November 15, 2024

Both MenB vaccine products, Trumenba (MenB-Fhbp, Pfizer) and Bexsero (MenB-4C, GSK) are routinely given as a 2-dose series with doses administered at least 6 months apart. A 3-dose schedule is recommended for people who need rapid protection against MenB due to an increased risk of MenB disease. For the 3-dose schedule, dose 2 is given 1-2 months after dose 1 and dose 3 at least 6 months after dose 1.

Penbraya (MenABCWY, Pfizer) contains MenB-Fhbp (Trumenba) and is given as two doses, 6 months apart, when vaccination against all 5 serogroups is needed. For adolescents and adults not at increased risk (who need only one dose of MenACWY vaccine), if Penbraya is used, Trumenba should be administered to complete the 2-dose MenB series. 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) when both vaccines would be given on the same clinic day and at least 6 months have elapsed since most recent Penbraya dose.

In August 2024, FDA revised the licensed schedule for Bexsero to be the same as the schedule and dosing intervals of the other MenB vaccine product, Trumenba. The change was made due to evidence of a small, but significant, improvement in the immune response to Bexsero when 2 doses were given 6 months apart, instead of 1 month apart, as previously licensed. As with Trumenba, a third dose of Bexsero is due, at least 4 months after the second dose and 6 months after the first, if dose 2 is given less than 6 months after dose 1. No additional doses are recommended for people who previously completed the 2-dose Bexsero series using a 1-month interval as licensed and recommended at the time.

Last reviewed: November 15, 2024

In August 2024, FDA revised the licensed schedule for Bexsero to be the same as the schedule and dosing intervals of the other MenB vaccine product, Trumenba (Pfizer). The change was made due to evidence of a small, but significant, improvement in the immune response to Bexsero when 2 doses were given 6 months apart, instead of 1 month apart, as previously licensed. No additional doses are recommended for people who completed the 2-dose Bexsero series using a 1-month interval, as licensed and recommended at the time.

A 3-dose schedule of Bexsero (dose 2 given 1-2 months after dose 1, and dose 3 given at least 6 months after dose 1 and 4 months after dose 2) is recommended for people who require accelerated protection from meningococcal B disease (those at increased risk).

Under the current Bexsero and Trumenba schedules, any MenB vaccine recipient whose second dose is administered less than 6 months after dose 1 should receive a third dose at least 6 months after dose 1 and 4 months after dose 2.

Last reviewed: November 15, 2024

Dose 3 of a 3-dose MenB series should be administered at least 6 months after dose 1 and 4 months after dose 2. In this case, an additional (fourth) dose may be administered at least 4 months after the invalid, early dose 3 and 6 months after dose 1. Review the dosing error and the correct schedule with staff and take other appropriate measures to prevent this error from occurring in the future.

Last reviewed: November 15, 2024

Healthy adolescents who are not at increased risk for meningococcal B disease should receive 2 doses of Trumenba (MenB-FHbp, Pfizer) or Bexsero (MenB-4C, GSK) administered at 0 and 6 months. If the second dose is given at an interval of less than 6 months, a third dose should be given at least 4 months after the 2nd dose.

For people age 10 years and older at increased risk for meningococcal B disease, 3 doses of Trumenba or Bexsero should be administered at 0, 1–2, and 6 months. The 3-dose series should be used for all people with functional or anatomic asplenia, people with persistent complement component deficiency (an immune system disorder) or those who take a complement inhibitor (examples include eculizumab [Soliris], ravulizumab [Ultomiris], and sutimlimab [Sanofi]), microbiologists who work with meningococcal isolates in a laboratory, and people exposed during serogroup B outbreaks.

Penbraya (MenABCWY, Pfizer) contains MenB-Fhbp (Trumenba) and is FDA-licensed for ages 10 through 25 years as a two-dose series, given 6 months apart, for vaccination against all 5 serogroups. For adolescents or adults not at increased risk for meningococcal disease, if Penbraya is used for dose 1 of MenB, Trumenba should be administered for the second dose of MenB. For people age 10 years or older (including those older than age 25 years) at increased risk of meningococcal disease, ACIP recommends that Penbraya may be used for additional MenACWY and MenB doses (including booster doses) when both vaccines 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

No. The 3-dose series (at 0, 1–2 and 6 months) is intended to rapidly induce immunity to serogroup B meningococcal bacteria. If a microbiologist or other person at increased risk has received 2 doses of Trumenba or Bexsero separated by 6 months, then their primary vaccine series is considered complete. This microbiologist will need his first booster dose 1 year after the final dose of the primary series, then a booster dose every 2 to 3 years, as long as he remains at increased risk. Use the same type of MenB vaccine for all primary series and booster doses.

Last reviewed: November 15, 2024

As of August 2024, both MenB vaccine products, Bexsero (MenB-4C, GSK) and Trumenba (MenB-FHbp, Pfizer) require a minimum of 6 months to complete the MenB vaccination series. There is no way for this student to complete the vaccine series sooner. The student will need to follow up with the university about its policy in this situation.

If accelerated protection is desired for a person who is not at high risk of MenB disease, as in this situation, it is permissible to use the 3-dose MenB schedule (0, 1-2 months, 6 months) so that the student may receive 2 of 3 doses before leaving for college. He would still need a third dose of MenB vaccine (same brand as the first two doses) at least 6 months after dose 1 and at least 4 months after dose 2 to complete the series.

Last reviewed: November 15, 2024

The patient can complete the series with either vaccine. If the patient lacks a high-risk condition for meningococcal B disease and is not at high risk of exposure due to an ongoing outbreak, then simply administer the final dose in the 2-dose series 6 months after the initial dose of the selected product. There needs to be a 6-month interval between two doses of the same brand to complete a MenB series for a person who is not at increased risk.

If the person is at increased risk for meningococcal B disease and needs a 3-dose MenB series, then decide which product (Bexsero or Trumenba) you will use to complete dose 2 and dose 3 of the series. The second dose of the selected brand may be given no sooner than 4 weeks after the previous dose of the same brand AND at least 4 weeks after the last dose of the other brand. Dose 3 should be given no sooner than 6 months after dose 1 of the same brand and 4 months after dose 2 of the same brand.

Last reviewed: November 15, 2024

Immunize.org has prepared a document that provides a summary of the ACIP recommendations for use of MenB. The document is available at www.immunize.org/catg.d/p2035.pdf.

Last reviewed: November 15, 2024

Pneumococcal conjugate vaccine (PCV), Haemophilus influenzae type b (Hib) vaccine, MenACWY, and meningococcal B vaccine should be given at least 14 days before a scheduled splenectomy, if possible. This is done so the patient is protected from these diseases before the spleen is removed; however, doses given during the 14 days before surgery also 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. If PCV20 or PCV21 is given, pneumococcal polysaccharide vaccine (PPSV23) is not needed; if PCV15 is given, administer a dose of PPSV23 at least 8 weeks after the dose of PCV15 if the patient is age 2 years or older.

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

No. The ACIP meningococcal serogroup B vaccine recommendations state that the same vaccine type (either MenB-4C, Bexsero [GSK] or MenB-FHbp, Trumenba [Pfizer]) must be used for all doses in the MenB series, including booster doses. If the brand of a previous dose is unavailable or cannot be determined, restart the primary series with the available brand. The pentavalent MenABCWY product Penbraya (Pfizer) contains MenB-FHbp (the same as Trumenba) as its MenB component; therefore, Penbraya should only be used in series with Trumenba.

Last reviewed: November 15, 2024

Yes. ACIP recommendations for MenB include a booster dose schedule for MenB vaccination of people at high risk for meningococcal serogroup B disease. The first booster dose is recommended one year after completion of the primary series, with a subsequent booster dose administered every 2–3 years thereafter, as long as risk remains. Because MenB vaccine products are not interchangeable, all doses, including booster doses, should be of the same MenB product (either MenB-4C, which is in Bexsero [GSK], or MenB-FHbp which is in Trumenba and Penbraya [Pfizer]). If the brand of the primary series is not known or not available, CDC recommends restarting the primary series with the available product.

Penbraya (MenABCWY, Pfizer) contains MenB-Fhbp (the MenB product in Trumenba) and is given as two doses, 6 months apart, when vaccination against all 5 serogroups is needed. For this 11-year-old child at increased risk of meningococcal disease, Penbraya may be used for MenACWY and MenB (Trumenba) doses (including booster doses) when both vaccines are needed on the same clinic day and at least 6 months have elapsed since the most recent Penbraya dose.

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. Because MenB products are not interchangeable, all MenB doses should contain the same type of MenB vaccine (either MenB-4C, which is in Bexsero [GSK], or MenB-FHbp, which is in Trumenba and Penbraya [Pfizer]). If the brand of the primary series is not known or not available, CDC recommends restarting the primary series with the available product.

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

Recommendations to separate MenACWY and PCV only applied to MenACWY-D (Menactra, Sanofi), which is no longer available in the United States. You may administer PCV vaccines and MenQuadfi, Menveo, or Penbraya (if this MenABCWY is indicated) at the same time. A 10-year-old with persistent complement component deficiency also should be vaccinated against MenB with an appropriate 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.

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

Last reviewed: November 15, 2024

Either Trumenba (MenB-FHbp) or the Bexsero MenB vaccine brand (MenB-4C) may be used for people with HIV infection. People with HIV infection do not appear to be at higher risk for meningococcal serogroup B disease, and ACIP does not specify use of the 3-dose schedule for people with HIV. Booster doses of MenB are not recommended for people with HIV in the absence of another indication for MenB vaccination.

Penbraya (MenABCWY, Pfizer) is an option for people age 10 years and older only when both MenACWY and MenB (Trumenba) vaccines are due at the same visit and at least 6 months have elapsed since the most recent dose of Penbraya. An adolescent with HIV should receive a 2-dose primary MenACWY series (with the doses given 8 weeks apart), followed by MenACWY booster doses every 5 years. If this teen needs the MenACWY primary series vaccination and also chooses to receive Trumenba, Penbraya may only be used for one of the doses because dose 2 in the MenACWY primary series is due 8 weeks after dose 1 and the minimum interval between Penbraya doses is 6 months.

Last reviewed: November 15, 2024

Use of either brand of MenB in persons younger than age 10 years is off-label in the U.S. There is no ACIP recommendation for use of this vaccine for this age group.

Bexsero (MenB-4C) 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/vaccinations/menb-vaccine/ 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.

Last reviewed: November 15, 2024

ACIP recommends that microbiologists who work with meningococcal isolates in a laboratory receive both MenB and MenACWY vaccines. MenB can be given at the same time as any other vaccine. For accelerated protection, you can administer a 3-dose series of Bexsero (MenB-4C) or Trumenba (MenB-FHbp) on a 0-, 1–2-, and 6-month schedule. If dose 2 is delayed and administered 6 months or longer after dose 1, the primary series is complete.

Because protective antibody levels begin to wane within 1–2 years after completing the primary series, ACIP recommends a booster dose of MenB one year after completing the primary series, followed by a booster dose every 2–3 years thereafter, as long as risk remains. MenB vaccine brands work differently and are not interchangeable. All doses, including booster doses, should be of the same type (either MenB-FHbp or MenB-4C). If the primary series type is not known or is not available, restart the primary series with the available brand.

Microbiologists may receive a dose of MenABCWY (Penbraya, Pfizer) as an alternative to separate administration of MenACWY and MenB (MenB-FHbp, Trumenba) when both vaccines 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

MenB is not specifically recommended for immunosuppressed people. However, after discussing the pros and cons of vaccination (also known as shared clinical decision-making), people age 16 through 23 years who are not at increased risk for meningococcal B disease, such as this patient, may receive MenB vaccination. ACIP does not specify use of the 3-dose schedule for immunocompromised people who are not at increased risk for meningococcal B disease. Penbraya (MenABCWY, Pfizer) is also an option if both Trumenba and MenACWY vaccines are due at the same visit and it has been at least 6 months since the most recent dose of Penbraya.

Last reviewed: November 15, 2024

ACIP does not recommend MenB vaccination for travel to countries in sub-Saharan Africa or to other countries for which MenACWY vaccine is recommended. Meningococcal disease in these areas is generally not caused by serogroup B.

Last reviewed: November 15, 2024

ACIP recommends booster doses of MenB vaccines for people at increased risk of MenB disease. Booster doses should be administered to people in the following groups as long as increased risk remains:

  • People with functional or anatomic asplenia, including sickle cell disease
  • People with persistent complement component deficiency (an immune system disorder)
  • People who take a complement inhibitor (examples include eculizumab [Soliris], ravulizumab [Ultomiris], and sutimlimab [Enjaymo])
  • Microbiologists who routinely work with meningococcal isolates
  • Previously vaccinated people who are at risk during a meningococcal B disease outbreak

Because protective antibody levels produced by the primary series begin to wane within 1–2 years, the first booster dose is recommended one year after completion of the primary series, with subsequent booster doses every 2–3 years as long as increased risk remains. Previously vaccinated people identified by public health as being at risk during a meningococcal B outbreak should receive a booster dose if it has been at least one year since completion of their primary series, though depending upon the specific circumstances, public health may recommend a booster dose as little as 6 months after completion of the primary series.

Last reviewed: November 15, 2024

In August 2024, FDA changed the dosing interval for a 2-dose series of Bexsero (MenB-4C, GSK) from 1 month to 6 months, and recommends that people who receive a second dose of Bexsero less than 6 months after dose 1 receive a third dose at least 6 months after dose 1 and at least 4 months after dose 2. However, no additional primary series doses are recommended for people who previously completed the 2-dose series with the shorter interval, in accordance with the licensed and recommended Bexsero schedule at the time.

In June 2019, ACIP voted to recommend MenB booster doses for people at ongoing increased risk of meningococcal serogroup B disease and the recommendation was published in 2020 (www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6909a1-H.pdf). As long as you use Bexsero (MenB-4C) as the booster dose, this patient should be given a booster dose of Bexsero now and receive subsequent booster doses every 2–3 years.

The two types of MenB vaccine work differently and are not interchangeable. The only time ACIP recommends restarting the primary series is if the brand used for the primary series is not known or is unavailable.

Last reviewed: November 15, 2024

During an outbreak of meningococcal B disease, swift protection of those at risk is prioritized and CDC subject matter experts do not recommend delaying vaccination in order to locate records. Student health services with documentation of MenB vaccination (including brand) of incoming students, either in a state immunization registry or in student health records, will be able to respond most efficiently to an outbreak.

Students whose primary series of MenB vaccine was completed at least 1 year before the outbreak (or as little as 6 months before the outbreak, if recommended by public health) should receive a single booster dose of the same brand of MenB vaccine. If the same brand is unavailable, they should restart the primary series with the available brand. If the brand of the primary series is unknown, administer a dose of the available product and counsel the recipient to request records of the primary series: if the primary series brand is different, then in order to ensure optimal protection, the recipient should be given a booster dose of the primary series product a minimum of 4 weeks after the most recent MenB dose, or they should complete a new 3-dose primary series with the available product for accelerated protection.

Last reviewed: November 15, 2024

Yes. MenB vaccines work differently and receiving mismatched MenB doses might result in inadequate protection. For this reason, documentation of the brand of vaccine is especially important. The two MenB products are MenB-4C (Bexsero, GSK) and MenB-FHbp (in Trumenba and the Penbraya brand of MenABCWY, both by Pfizer). If a patient at high risk requires a booster dose and the brand of the primary series doses cannot be determined or is unavailable, then CDC recommends restarting the primary series with the available brand.

The first MenB booster dose is recommended one year following completion of the primary series, with subsequent MenB booster doses every 2–3 years thereafter, as long as risk remains.

If a record shows that Penbraya (MenABCWY, Pfizer) was administered to a patient subsequent MenB doses should be Trumenba (or Penbraya, if MenABCWY is indicated).

Last reviewed: November 15, 2024


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Last reviewed: April 21, 2023

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: MenB vaccine may be given based upon shared clinical decision-making to people with HIV who are age 16 through 23 years old, preferably between ages 16 and 18 years.

Last reviewed: November 15, 2024

In clinical trials and in postlicensure safety surveillance, the most common local adverse events within 7 days of receiving MenB were injection site pain, swelling or redness and the most common systemic symptoms were headache, fatigue and body aches. In general, these types of self-limited reactions are reported more frequently than with MenACWY vaccination.

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 MenB is an inactivated vaccine it can be administered to persons who are immunosuppressed as a result of disease or medications; however, response to the vaccine might be less than optimal. Data on MenB vaccination during pregnancy is limited. Pregnancy a precaution to MenB vaccination, but MenB may be administered if, in the judgment of the clinician, the benefits outweigh any potential risks.

Last reviewed: November 15, 2024

Few data are available on the effect of MenB vaccines on pregnancy. The manufacturers do not consider pregnancy to be a contraindication to use of MenB. GSK has established a Vaccination in Pregnancy registry. People who receive Bexsero during pregnancy may access information about the GSK Bexsero Pregnancy Registry here: https://pregnancyregistry.gsk.com/bexsero.html. Pfizer also maintains a Vaccination in Pregnancy registry for Trumenba, although specific contact details for this registry are not available. In general, vaccination against MenB should be deferred during pregnancy; however, MenB may be administered if, in the judgment of the clinician, the benefits outweigh any potential risk.

Last reviewed: November 15, 2024

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

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

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

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