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Overview of meningococcal vaccine recommendations for persons age 2 years and older who are at increased risk of meningococcal disease in the United States

Overview of meningococcal vaccine recommendations for persons age 2 years and older who are at increased risk of meningococcal disease in the United States
This algorithm is meant for use with UpToDate content on meningococcal vaccination. Refer to UpToDate content for additional details, including recommendations for routine vaccinations in adolescents, vaccine administration, contraindications and precautions, and the indications for timing and frequency of booster doses.
The number of doses in the MenACWY primary series depends upon the target group:
  • 2 doses ≥8 weeks apart for those with immunodeficiency that increases the risk of meningococcal disease: complement component deficiency, use of C5 inhibitors, anatomic or functional asplenia, and HIV infection.
  • 1 dose for those at increased exposure or risk of exposure to N. meningitidis: microbiologists routinely exposed to N. meningitidis, those who traveled to/reside in hyperendemic/epidemic area, those with exposure during an outbreak, college freshmen, and military recruits.
The MenB primary series varies with the MenB formulation:
  • MenB-FHbp (Trumenba): 3 doses at 0, 1 to 2, and 6 months
  • MenB-4C (Bexsero): 2 doses ≥1 month apart
MenACWY: quadrivalent meningococcal conjugate vaccine; MenB: meningococcal serogroup B vaccine.
* The decision to vaccinate during an outbreak is determined on a case-by-case basis in consultation with public health officials. In some patients (eg, those with high-risk exposures, those aged <10 years during an outbreak due to serogroup B), chemoprophylaxis may be warranted.
¶ For those aged 16 to 23 years, MenB may be given in the context of shared decision-making (to avoid a missed opportunity for routine immunization).
Δ In the United States, MenB is not licensed for those <10 years of age. However, some experts choose to vaccinate children at substantial risk for meningococcal disease (eg, those receiving C5 inhibitors) with MenB-4C before age 10 years.
◊ For those aged 11 to 18 years, MenACWY may be indicated for routine administration.
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