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Meningococcal vaccination recommendations for persons age ≥2 years who are at increased risk of meningococcal disease in the United States[1-3]

Meningococcal vaccination recommendations for persons age ≥2 years who are at increased risk of meningococcal disease in the United States[1-3]
Risk factor MenACWY MenB for those ≥10 years of age
Primary dose(s) Booster dose(s) if increased risk persists Primary dose(s) Booster dose(s) if increased risk persists
Immunodeficiency that increases the risk of meningococcal disease
Complement component deficiency (eg, C3, C5-C9, properdin, factor H, factor D) or use of complement inhibitors (eg, eculizumab, ravulizumab)* 2 doses of any MenACWY, ≥8 weeks apart
  • Age <7 years: 3 years after completion of primary series and every 5 years thereafter
  • Age ≥7 years: every 5 years
Either:
  • MenB-4C: 2 doses, ≥4 weeks apart
  • or
  • MenB-FHbp: 3 doses on a 0-, 1- to 2-, and 6-month schedule
1 year after completion of primary series and every 2 to 3 years thereafter.
Anatomic or functional asplenia including sickle cell disease 2 doses of any MenACWY, ≥8 weeks apart
  • Age <7 years: 3 years after completion of primary series and every 5 years thereafter
  • Age ≥7 years: every 5 years
Either:
  • MenB-4C: 2 doses, ≥4 weeks apart
  • or
  • MenB-FHbp: 3 doses on a 0-, 1- to 2-, and 6-month schedule
1 year after completion of primary series and every 2 to 3 years thereafter.
Persons with HIV 2 doses of any MenACWY, ≥8 weeks apart
  • Age <7 years: 3 years after completion of primary series and every 5 years thereafter
  • Age ≥7 years: every 5 years
MenB is not recommended unless it is otherwise indicated (eg, age 16 through 23 years based on shared decision-making).
Increased risk of exposure to meningococcal disease
Microbiologists routinely exposed to meningococcus 1 dose of any MenACWY
  • Every 5 years
Either:
  • MenB-4C: 2 doses, ≥4 weeks apart
  • or
  • MenB-FHbp: 3 doses on a 0-, 1- to 2-, and 6-month schedule
1 year after completion of primary series and every 2 to 3 years thereafter.
Persons who travel to or are residents of countries where meningococcal disease is hyperendemic or epidemicΔ 1 dose of any MenACWY
  • Age <7 years: 3 years after completion of primary series and every 5 years thereafter
  • Age ≥7 years: every 5 years
MenB is not recommended unless it is otherwise indicated (eg, age 16 through 23 years based on shared decision-making).
Unvaccinated or undervaccinated college freshmen living in residence halls 1 dose of any MenACWY
  • No recommendation unless otherwise indicated
Unvaccinated or undervaccinated military recruits 1 dose of any MenACWY
  • Every 5 years depending on assignment§
This table is meant for use with UpToDate content on meningococcal vaccination. Refer to UpToDate content for additional details, including meningococcal vaccination of persons at risk who are <2 years of age, routine meningococcal vaccination of adolescents and young adults, and information about immunizations during meningococcal outbreaks. Some of the recommendations above are considered off-label (eg, administration of a 2-dose primary series for MenACWY, repeated booster doses of MenACWY or MenB).
  • Two MenACWY are licensed in the United States:
    • MenACWY-CRM (Menveo)
    • MenACWY-TT (MenQuadfi)
  • MenACWY-D (Menactra) was discontinued in 2022.
  • Although each of the MenACWY vaccine formulations use a different protein conjugate, the products are considered interchangeable in persons ≥2 years of age. The same vaccine product is recommended, but not required, for all doses.
  • Two MenB vaccines are licensed in the United States:
    • MenB-4C (Bexsero)
    • MenB-FHbp (Trumenba)
  • MenB vaccines are not interchangeable; the same brand must be used for each dose of the primary series and all booster doses.

MenACWY: meningococcal groups A, C, W, and Y conjugate vaccine; MenB: serogroup B meningococcal vaccine; CDC: United States Centers for Disease Control and Prevention.

* Meningococcal vaccines should be administered ≥2 weeks before the first dose of complement inhibitor, unless the risk for delaying complement therapy outweighs the risk for developing meningococcal disease.

¶ Patients at increased risk of exposure who also have an immunodeficiency that increases the risk of meningococcal disease should receive the 2-dose primary series.

Δ Vaccination is recommended for international travelers visiting the parts of sub-Saharan Africa known as the meningitis belt during the dry season (December to June). The CDC issues advisories for other countries during epidemics of vaccine-preventable serogroups. Additional traveler's health information is available from the CDC.

◊ College freshmen living in residence halls should receive ≥1 dose of MenACWY ≤5 years before college entry (preferably at age ≥16 years). If only 1 dose of vaccine was administered before the 16th birthday, a booster dose should be administered before enrollment.

§ Vaccination recommendations for military personnel are made by the United States Department of Defense on the basis of high-risk travel requirements.
References:
  1. Mbaeyi SA, Bozio CH, Duffy J, et al. Meningococcal Vaccination: Recommendations of the Advisory Committee on Immunization Practices, United States, 2020. MMWR Recomm Rep 2020; 69:1.
  2. Immunization Action Coalition. Meningococcal ACWY vaccine recommendations by age and risk factor. https://www.immunize.org/catg.d/p2018.pdf (Accessed on October 26, 2020).
  3. Immunization Action Coalition. Meningococcal B vaccine recommendations by age and risk factor. https://www.immunize.org/catg.d/p2035.pdf (Accessed on October 26, 2020).
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