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Meningococcal vaccination recommendations in the United States by age and/or risk factor

Targeted group by age and/or risk factor	Primary dose(s)	Booster dose(s)
For ages 11 through 18 years
	Give one dose of Menactra or Menveo, preferably at age 11 or 12 years. Discuss serogroup B meningococcus vaccination (Trumenba or Bexsero)*, which may be administered to adolescents and young adults 16 through 23 years of age; the preferred age for vaccination is 16 through 18 years of age (perhaps at the time of Menactra or Menveo booster).	If primary dose was given at age ≤12 years, give Menactra or Menveo booster at age 16 years. If primary dose was given at age 13 to 15 years, give Menactra or Menveo booster at age 16 to 18 years^¶.
For individuals ages 19 through 21 years who are first year college students living in residence halls
	If not yet received a dose of vaccine, give one dose of Menactra or Menveo. Discuss serogroup B meningococcus vaccination (Trumenba or Bexsero)*, which may be administered to adolescents and young adults 16 through 23 years of age; the preferred age for vaccination is 16 through 18 years of age.	Give Menactra or Menveo booster if previous dose given at age younger than 16 years.
Patients with HIV infection
For age <2 years	Give four doses of Menveo (at ages 2, 4, 6, and 12 to 15 months) or give two doses of Menactra^Δ (at age 9 to 23 months, 12 weeks apart).	Give additional dose of Menveo or Menactra three years after primary series. Booster doses should be repeated every five years thereafter.
For age ≥2 years	Give two doses of Menveo or Menactra 8 to 12 weeks apart.	For individuals age <7 years at previous dose, give additional dose of Menveo or Menactra three years after primary series. If the most recent dose was received before age 7 years, a booster dose should be readministered three years later. Booster doses should be repeated every five years thereafter. For individuals age ≥7 years at previous dose, give additional dose of Menveo or Menactra five years after primary series; booster doses should be repeated every five years thereafter.
Travelers to or residents of countries where meningococcal disease is hyperendemic or epidemic^◊
For age 2 months through 18 months	Give Menveo at ages 2, 4, 6, and 12 to 15 months.	If risk continues, give initial booster after three years followed by boosters every five years.
For children age 7 months through 23 months who have not initiated a series of Menveo	Give Menveo (if age 7 to 23 months)^§or Menactra (if age 9 to 23 months); administer two doses separated by three months^¥.
For age 2 years through 55 years	Give one dose of Menactra or Menveo.	Boost every five years with Menactra or Menveo^‡,†.
For age 56 years and older	Give one dose of Menactra or Menveo**.	Boost every five years with Menactra or Menveo^†.
People with prolonged increased risk for exposure (eg, military recruits, microbiologists routinely working with Neisseria meningitidis)
For age 10 years and older	Give one dose of Menactra or Menveo**^,¶¶. Give either Trumenba (three doses administered at 0, 1 to 2, and 6 months) or Bexsero (two doses administered at least one month apart)^¶¶.	Boost every five years with Menactra or Menveo^†. Boost with one dose MenB (Trumenba or Bexsero) one year after primary series; revaccinate every 2 to 3 years if risk remains.
People present during outbreaks caused by a meningococcal vaccine serogroup^¶¶,ΔΔ
For age 2 months through 18 months	Give Menveo at ages 2, 4, 6, and 12 to 15 months.
For children age 7 months through 23 months who have not initiated a series of Menveo	Give Menveo (if age 7 to 23 months)^§ or Menactra (if age 9 to 23 months); administer two doses separated by 3 months^¥.
For age 2 years through 9 years	Give one dose of Menactra or Menveo.
For age 10 years through 55 years	Give one dose of Menactra or Menveo^¶¶. Give either Trumenba (three doses administered at 0, 1 to 2, and 6 months) or Bexsero (two doses administered at least one month apart)^¶¶.
For age 56 years and older	Give one dose of Menactra or Menveo**^,^¶¶. Give either Trumenba (three doses administered at 0, 1 to 2, and 6 months) or Bexsero (two doses administered at least one month apart)^¶¶.
People with persistent complement component deficiencies^◊◊
For age 2 months through 18 months	Give Menveo at ages 2, 4, 6, and 12 to 15 months.	Give Menactra or Menveo booster after three years followed by boosters every five years thereafter.
For children age 7 months through 23 months who have not initiated a series of Menveo	Give Menveo (if age 7 to 23 months)^§ or Menactra (if age 9 to 23 months); administer two doses separated by three months.
For age 2 years through 9 years	Give two doses of Menactra or Menveo two months apart.	Boost every five years with Menactra or Menveo^‡,§§.
For age 10 years through 55 years	Give two doses of Menactra or Menveo two months apart and either Trumenba (three doses administered at 0, 1 to 2, and 6 months) or Bexsero (two doses administered at least one month apart)^¶¶.	Boost every five years with Menactra or Menveo^‡,§§. Boost with one dose MenB (Trumenba or Bexsero) one year after primary series; revaccinate every 2 to 3 years if risk remains.
For age 56 years and older	Give two doses of Menactra or Menveo two months apart and either** Trumenba (three doses administered at 0, 1 to 2, and 6 months) or Bexsero (two doses administered at least one month apart)^¶¶.	Boost every five years with Menactra or Menveo^§§. Boost with one dose MenB (Trumenba or Bexsero) one year after primary series; revaccinate every 2 to 3 years if risk remains.
People with functional or anatomic asplenia, including sickle cell disease
For age 2 months through 18 months	Give Menveo at ages 2, 4, 6, and 12 months.	Give Menactra or Menveo booster after three years followed by boosters every five years thereafter.
For children age 19 months through 23 months who have not initiated a series of Menveo	Give two doses of Menveo three months apart.
For age 2 years through 9 years	Give two doses of Menactra or Menveo two months apart^¥¥.	Boost every five years with Menactra or Menveo^‡,§§.
For age 10 years through 55 years	Give two doses of Menactra or Menveo two months apart^¥¥ and either Trumenba (three doses administered at 0, 1 to 2, and 6 months) or Bexsero (two doses administered at least one month apart)^¶¶.	Boost every five years with Menactra or Menveo^‡,§§. Boost with one dose MenB (Trumenba or Bexsero) one year after primary series; revaccinate every 2 to 3 years if risk remains.
For age 56 years and older	Give two doses of Menactra or Menveo two months apart and either** Trumenba (three doses administered at 0, 1 to 2, and 6 months) or Bexsero (two doses administered at least one month apart)^¶¶.	Boost every five years with Menactra or Menveo^§§. Boost with one dose MenB (Trumenba or Bexsero) one year after primary series; revaccinate every 2 to 3 years if risk remains.

This table was adapted from the recommendations of the United States Centers for Disease Control and Prevention's (CDC's) Advisory Committee on Immunization Practices (ACIP) for the use of meningococcal vaccines^[1-7].
The quadrivalent meningococcal conjugate vaccines (MenACWY) are Menactra (MenACWY-DT) and Menveo (MenACWY-CRM); these have replaced the quadrivalent meningococcal polysaccharide vaccine Menomune (MPSV4). MenHibrix (HibMenCY), a combination conjugate vaccine against meningococcus serogroups C and Y and Haemophilus influenzae type b, was discontinued in 2017. Trumenba (MenB-FHbp) and Bexsero (MenB-4C) are meningococcus serogroup B vaccines.

* Trumenba (two-dose series; second dose given six months after first dose; if the second dose is administered earlier than six months after the first dose, a third dose should be administered at least four months after the second dose) or Bexsero (two-dose series; second dose given at least one month after the first dose) may be given concomitantly with quadrivalent meningococcal conjugate vaccines but at different anatomic sites if feasible. The same meningococcus serogroup B vaccine should be given for all doses.
¶ The minimum interval between doses of Menactra or Menveo is eight weeks.
Δ If Menactra is used, it should be administered at least four weeks after completion of all pneumococcal conjugate vaccine doses and either before or concomitantly with DTaP.
◊ Prior receipt of MenHibrix is not sufficient for children traveling to the Hajj or African meningitis belt as it doesn't provide protection against serogroups A or W135.
§ If using Menveo, dose 2 should be given no younger than age 12 months.
¥ If a child age 7 through 23 months will enter an endemic area in less than three months, give doses as close as two months apart.
‡ If primary dose(s) given when younger than age 7 years, give initial booster after three years, followed by boosters every five years.
† Booster doses are recommended if the person remains at increased risk.
** Only the quadrivalent meningococcal polysaccharide vaccine (Menomune; MPSV4) has been approved by the US Food and Drug Administration for individuals ≥56 years of age; however, the quadrivalent meningococcal polysaccharide vaccine was discontinued in 2017. In addition, a quadrivalent meningococcal conjugate vaccine (Menactra or Menveo) is preferred by the ACIP for individuals in this age group who are expected to require revaccination, since limited data demonstrate a higher antibody response after a subsequent dose of a quadrivalent meningococcal conjugate vaccine compared with a subsequent dose of the quadrivalent meningococcal polysaccharide vaccine. Refer to the associated UpToDate topic review for additional details.
¶¶ During outbreaks, seek advice of local public health authorities to determine if vaccination is recommended and to determine which formulation(s) should be given.
ΔΔ Given the outbreak of meningococcal disease (first reported in 2012) in men who have sex with men (MSM) in New York City and Los Angeles, we recommend meningococcal vaccination with Menactra or Menveo for MSM, if their residence, travel, or social interactions put them in close contact with other MSM from New York City or Los Angeles^[8-12].
◊◊ Patients with persistent complement component deficiencies include those with the following deficiencies: C3, C5 to C9, properdin, factor H, and factor D as well as those receiving eculizumab (a monoclonal antibody used for treatment of complement-mediated hemolytic uremic syndrome and paroxysmal nocturnal hemoglobinuria). Patients warranting treatment with eculizumab should be immunized with meningococcal vaccines (both ACYW135 and serogroup B) at least two weeks prior to administering the first dose of eculizumab, if feasible.
§§ If the person received a one-dose primary series, give booster at the earliest opportunity, then boost every five years.
¥¥ Individuals with functional or anatomic asplenia should complete an age-appropriate series of the pneumococcal conjugate vaccine (PCV13) before vaccination with Menactra. Menactra should not be administered until two years of age and for at least four weeks after the completion of all pneumococcal conjugate vaccine doses; otherwise it may interfere with the protection by the pneumococcal conjugate vaccine. Menveo may be given at any time before or after PCV13.

Data from:

Cohn AC, MacNeil JR, Clark TA, et al. Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2013; 62:1.
Strikas RA. Advisory Committee on Immunization Practices recommended immunization schedules for persons aged 0 through 18 years - United States, 2015. MMWR Morb Mortal Wkly Rep 2015; 64:93.
Kim DK, Riley LE, Harriman KH et al. Advisory Committee on Immunization Practices. Recommended immunization schedule for adults aged 19 years or older, United States, 2017. Ann Intern Med 2017; 166:209.
Committee on Infectious Diseases. Updated recommendations on the use of meningococcal vaccines. Pediatrics 2014; 134:400.
Folaranmi T, Rubin L, Martin SW, et al. Use of serogroup B meningococcal vaccines in persons aged ≥10 years at increased risk for serogroup b meningococcal disease: Recommendations of the Advisory Committee on Immunization Practices, 2015. MMWR Morb Mortal Wkly Rep 2015; 64:608.
MacNeil JR, Rubin LG, Patton M, et al. Recommendations for Use of Meningococcal Conjugate Vaccines in HIV-Infected Persons - Advisory Committee on Immunization Practices, 2016. MMWR Morb Mortal Wkly Rep. 2016 Nov 4;65(43):1189-1194.
ACIP endorses individual choice on meningitis B vaccine. http://www.cidrap.umn.edu/news-perspective/2015/06/acip-endorses-individual-choice-meningitis-b-vaccine (Accessed June 25, 2015).
Notes from the field: serogroup C invasive meningococcal disease among men who have sex with men - New York City, 2010-2012. MMWR Morb Mortal Wkly Rep 2013; 61:1048.
New York State Department of Health. New York State Department of Health expands vaccination recommendation in response to meningococcal disease outbreak among high risk HIV positive men in New York City. http://www.health.ny.gov/press/releases/2012/2012-10-05_meningitis.htm (Accessed on October 26, 2012).
Commonwealth of Massachusetts Department of Public Health. Health Advisory: Meningococcal vaccine recommendations for men who have sex with men. October 25, 2012. http://www.mass.gov/eohhs/docs/dph/cdc/immunization/alerts-meningococcal-msm.pdf (Accessed on October 26, 2012).
NYC Health. 2014 Alert #28 - Update: Invasive meningococcal disease in men who have sex with men. https://a816-health29ssl.nyc.gov/sites/NYCHAN/Lists/AlertUpdateAdvisoryDocuments/HAN%20IMD%20in%20MSM%20Sept%202014.pdf (Accessed on April 13, 2015).
County of Los Angeles Public Health. Public Health issues new vaccination recommendations for men who have sex with men (MSM) at-risk for invasive meningococcal disease http://www.publichealth.lacounty.gov/docs/PressReleaseIMDRecommend-4-2-14.pdf (Accessed on April 15, 2015).

Adapted from the Immunization Action Coalition (www.immunize.org).

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