Version May 2024
Meningococcal disease, prevention:
Primary immunization:
Routine: Patients 12 to 24 years of age: IM: 0.5 mL as a single dose. Note: Routinely administered at 12 years of age, regardless if previously immunized as an infant or child. Administer either monovalent meningococcal conjugate vaccine (Men-C-C) or quadrivalent meningococcal conjugate vaccine (Men-C-ACYW); refer to provincial/local schedules.
Postexposure management (close contacts) or outbreak control (off-label use) (NACI 2020): IM:
Unvaccinated: 0.5 mL/dose immediately after exposure (monovalent or quadrivalent vaccine may be used, depending on specific serogroup involved in exposure or outbreak).
Previously vaccinated: If vaccinated at <1 year of age or if at high risk for invasive meningococcal disease, revaccinate with 0.5 mL/dose if ≥4 weeks since last dose; otherwise revaccinate if at least 1 year since last dose (monovalent or quadrivalent vaccine may be used, depending on specific serogroup involved in exposure or outbreak).
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
(For additional information see "Meningococcal serogroup C conjugate vaccine (United States: Not available): Pediatric drug information")
Note: Meningococcal group C vaccines are not available in the United States.
Meningococcal group C disease prevention:
Canadian labeling:
Menjugate:
Primary immunization:
Infants 2 to 12 months: IM: 0.5 mL/dose; administer 3 doses with at least 1 month between each dose.
Children and Adolescents: IM: 0.5 mL/dose as a single dose.
Booster immunization: Children and Adolescents: IM: Administer booster doses after completion of primary series by following NACI recommendations.
NeisVac-C:
Primary immunization:
Infants 2 to <4 months: IM: 0.5 mL/dose; administer 2 doses at least 2 months apart (second dose should be administered at >5 months of age).
Infants ≥4 months, Children, and Adolescents: IM: 0.5 mL/dose as a single dose.
Booster immunization: Children: IM: 0.5 mL as a single booster ≥6 months after completion of primary series (usually recommended at 12 to 13 months of age). The need for a booster dose in individuals who received a single primary dose at ≥12 months of age has not been established.
NACI recommendations for routine immunization (NACI 2020): Note: Consult province and territory-specific recommendations.
Infants ≥2 months: IM: Administer to healthy infants according to province- and territory-specific schedules.
Children ≤11 years: IM: 0.5 mL as a single dose at 12 months of age regardless of previous immunization status. Unvaccinated children <5 years should also receive a dose; unvaccinated children 5 to 11 years may be considered for a dose.
Children ≥12 years and Adolescents: IM: 0.5 mL as a single dose, regardless of previous vaccination status. Routinely recommended at 12 years of age. Note: This can be completed with meningococcal group c conjugate vaccine or with quadrivalent meningococcal (ACYW) conjugate vaccine.
Postexposure management (close contacts) or outbreak control:
NACI recommendations (NACI 2020):
Infants 2 to <12 months:
Unvaccinated: IM: 0.5 mL/dose immediately after exposure; then complete routine series.
Previously vaccinated: IM: Revaccinate with 0.5 mL/dose if ≥4 weeks since last dose; then complete routine series if necessary.
Children and Adolescents:
Unvaccinated: IM: 0.5 mL/dose immediately after exposure (monovalent vaccine recommended for children 1 to 10 years; monovalent or quadrivalent vaccine may be used in individuals ≥11 years).
Previously vaccinated: IM: If vaccinated at <1 year of age or if at high risk for invasive meningococcal disease, revaccinate with 0.5 mL/dose if ≥4 weeks since last dose; otherwise revaccinate if at least 1 year since last dose (monovalent vaccine recommended for children 1 to 10 years; monovalent or quadrivalent vaccine may be used in individuals ≥11 years).
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Adverse reactions are from monotherapy studies in children, adolescents, and adults unless otherwise stated.
>10%:
Gastrointestinal: Change in appetite (children: 6% to 16%), diarrhea (children: 8% to 18%), nausea (adolescents and adults: 16%)
Local: Erythema at injection site (16% to 31%), induration at injection site (7% to 24%), pain at injection site (≤84%), swelling at injection site (adults: 20%), tenderness at injection site (adults: ≤84%)
Nervous system: Chills (adolescents and adults: 13%), drowsiness (children: 9% to 19%), headache (adolescents and adults: 12% to 34%), irritability (children: 10% to 30%), local alterations in temperature sensations (children: 5% to 15%; adolescents and adults: 47%), malaise (adolescents and adults: 5% to 25%)
Neuromuscular & skeletal: Arthralgia (adolescents and adults: 16%), myalgia (adolescents and adults: 2% to 29%)
1% to 10%:
Dermatologic: Skin rash (children: 4% to 9%)
Gastrointestinal: Vomiting (children: 5% to 9%; adults: 2%)
Local: Warm sensation at injection site (children: ≤1%; adolescents and adolescents: 8%)
Nervous system: Excessive crying (children: 1% to 4%)
Miscellaneous: Fever (2% to 9%)
<1%:
Hematologic & oncologic: Lymphadenopathy (adults)
Respiratory: Flu-like symptoms (adults)
Postmarketing:
Cardiovascular: Facial edema, peripheral edema, swelling of injected limb, syncope
Dermatologic: Erythema multiforme, erythema of skin, pruritus, Stevens-Johnson syndrome, urticaria
Gastrointestinal: Decreased appetite
Genitourinary: Nephrotic syndrome (relapse)
Hematologic & oncologic: Immune thrombocytopenia, petechia, purpuric disease
Hypersensitivity: Anaphylactic shock, anaphylaxis, angioedema, hypersensitivity reaction (including severe hypersensitivity reactions)
Nervous system: Abnormal sensory symptoms, burning sensation, dizziness, fatigue, hypersomnia, hypoesthesia, hypotonia, meningism, paresthesia, seizure, sleep disorder
Neuromuscular & skeletal: Asthenia, joint stiffness, limb pain, muscle rigidity, neck pain, neck stiffness
Ophthalmic: Photophobia, visual disturbance
Respiratory: Apnea, bronchospasm, dyspnea, nasal congestion, wheezing
Miscellaneous: Febrile seizure, hypotonic/hyporesponsive episode
Hypersensitivity to any component of the formulation, including tetanus toxoid (NeisVac-C only) or diphtheria toxoid (CRM197) (Menjugate only).
Concerns related to adverse effects:
• Anaphylactoid/hypersensitivity reactions: Immediate treatment (including epinephrine 1 mg/mL) for anaphylactoid and/or hypersensitivity reactions should be available during vaccine use (ACIP [Kroger 2021]).
• Shoulder injury related to vaccine administration: Vaccine administration that is too high on the upper arm may cause shoulder injury (eg, shoulder bursitis or tendinopathy) resulting in shoulder pain and reduced range of motion following injection. Use proper injection technique for vaccines administered in the deltoid muscle (eg, injecting in the central, thickest part of the muscle) to reduce the risk of shoulder injury related to vaccine administration (Cross 2016; Foster 2013).
• Syncope: Syncope has been reported with use of injectable vaccines and may result in serious secondary injury (eg, skull fracture, cerebral hemorrhage); typically reported in adolescents and young adults and within 15 minutes after vaccination. Procedures should be in place to avoid injuries from falling and to restore cerebral perfusion if syncope occurs (ACIP [Kroger 2021]; NACI 2016).
Disease-related concerns:
• Acute illness: The decision to administer or delay vaccination because of current or recent febrile illness depends on the severity of symptoms and the etiology of the disease. Defer administration in patients with moderate or severe acute illness (with or without fever); Menjugate labeling contraindicates use during an acute severe febrile illness. Vaccination should not be delayed for patients with mild acute illness (with or without fever) (ACIP [Kroger 2021]; NACI 2020).
• Bleeding disorders: Use with caution in patients with a history of bleeding disorders (including thrombocytopenia); bleeding/hematoma may occur from IM administration; if the patient receives antihemophilia or other similar therapy, IM injection can be scheduled shortly after such therapy is administered (ACIP [Kroger 2021]).
• Meningococcal infections: Not to be used to treat meningococcal infections or to provide immunity against N. meningitidis serogroups other than serogroup C.
Concurrent drug therapy issues:
• Anticoagulant therapy: Use with caution in patients receiving anticoagulant therapy; bleeding/hematoma may occur from IM administration (ACIP [Kroger 2021]).
Special populations:
• Altered immunocompetence: Patients with certain complement deficiencies and patients receiving treatment that inhibits terminal complement activation (eg, eculizumab) are at an increased risk for invasive meningococcal infection, including postvaccination. Consider deferring immunization during periods of severe immunosuppression (eg, patients receiving chemo/radiation therapy or other immunosuppressive therapy [including high-dose corticosteroids]); may have a reduced response to vaccination. In general, household and close contacts of persons with altered immunocompetence may receive all age appropriate vaccines. Inactivated vaccines should be administered ≥2 weeks prior to planned immunosuppression when feasible; inactivated vaccines administered during chemotherapy should be readministered after immune competence is regained (ACIP [Kroger 2021]; IDSA [Rubin 2014]).
• Pediatric: Apnea has been reported following IM vaccine administration in premature infants; consider monitoring respiratory status for 48 to 72 hours after administration. In general, vaccination should not be withheld or delayed due to respiratory concerns. Preterm infants should be vaccinated at the same chronological age as full-term infants (ACIP [Kroger 2021]; NACI 2020).
• Older adult: Vaccine has not been studied in elderly patients (≥65 years of age).
Other warnings/precautions:
• Antipyretics: Antipyretics have not been shown to prevent febrile seizures; antipyretics may be used to treat fever or discomfort following vaccination (ACIP [Kroger 2021]). One study reported that routine prophylactic administration of acetaminophen prior to vaccination to prevent fever decreased the immune response of some vaccines; the clinical significance of this reduction in immune response has not been established (Prymula 2009).
• Appropriate administration: [Canadian Boxed Warning]: Do not administer IV or SUBQ; for IM administration only.
• Diphtheria infection: Menjugate is not intended for immunization against diphtheria. Vaccinations with diphtheria toxoid should still be administered as regularly scheduled.
• Effective immunity: Vaccination may not result in effective immunity in all patients. Response depends upon multiple factors (eg, type of vaccine, age of patient) and may be improved by administering the vaccine at the recommended dose, route, and interval. Vaccines may not be effective if administered during periods of altered immune competence (ACIP [Kroger 2021]).
• Tetanus infection: NeisVac-C is not intended for immunization against tetanus. Tetanus vaccination should still be administered as regularly scheduled.
Not available in the US
May be product dependent
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Suspension, Intramuscular:
Menjugate: Meningococcal group C oligosaccharide 10 mcg per 0.5 mL [conjugated to CRM-197 12.5 to 25 mcg] (0.5 mL) [contains diphtheria toxoid crm-197]
Suspension Prefilled Syringe, Intramuscular:
NeisVac-C: 10 mcg/0.5 mL (0.5 mL)
IM: Administer into the deltoid area. Do not administer IV or SUBQ. Shake vaccine prior to use. Do not administer if particulate matter or discoloration is noted. Do not mix with other vaccines or injections; separate needles and syringes should be used for each injection. To prevent syncope related injuries, patients should be vaccinated while seated or lying down (ACIP [Kroger 2021]).
For patients at risk of hemorrhage, the vaccine should be administered IM if, in the opinion of a physician familiar with the patient's bleeding risk, the vaccine can be administered by this route with reasonable safety. If the patient receives antihemophilia or other similar therapy, IM vaccination can be scheduled shortly after such therapy is administered. A fine needle (≤23 gauge) can be used for the vaccination and firm pressure applied to the site (without rubbing) for at least 2 minutes. The patient or family should be instructed concerning the risk of hematoma from the injection. Patients on anticoagulant therapy should be considered to have the same bleeding risks and treated as those with clotting factor disorders (ACIP [Kroger 2021]).
IM: Administer into the anterolateral thigh in infants and the deltoid area in children and adolescents. Do not administer IV, SubQ, or intradermally. NeisVac-C should be shaken well prior to administration to obtain a homogenous suspension; Menjugate should be shaken gently. Do not administer if particulate matter or discoloration is noted. Do not mix with other vaccines or injections; separate needles and syringes should be used for each injection. To prevent syncope-related injuries, adolescents should be vaccinated while seated or lying down (ACIP [Kroger 2021]).
For patients at risk of hemorrhage, the vaccine should be administered IM if, in the opinion of a physician familiar with the patient's bleeding risk, the vaccine can be administered by this route with reasonable safety. If the patient receives antihemophilia or other similar therapy, IM vaccination can be scheduled shortly after such therapy is administered. A fine needle (23-gauge or smaller) can be used for the vaccination and firm pressure applied to the site (without rubbing) for at least 2 minutes. The patient should be instructed concerning the risk of hematoma from the injection. Patients on anticoagulant therapy should be considered to have the same bleeding risks and treated as those with clotting factor disorders (ACIP [Kroger 2021]).
Note: Not approved in the United States.
Meningococcal disease prevention: Active immunization against invasive meningococcal disease caused by Neisseria meningitidis serogroup C in persons ≥2 months of age.
The Canadian National Advisory Committee on Immunization (NACI) recommends the following (NACI 2020):
Routine vaccination: Note: For individuals at high risk for meningococcal disease, quadrivalent meningococcal conjugate vaccine may be preferred; see guidelines (NACI 2020).
- Healthy infants 2 to <12 months of age (per provincial/territorial schedules).
- Healthy children 12 to 23 months of age (routinely at 12 months of age, regardless if previously immunized as an infant).
- Unvaccinated children <11 years of age.
- Individuals 12 to 24 years of age (routinely at 12 years of age, regardless if previously immunized as an infant or child). Note: Administer either monovalent conjugate meningococcal vaccine (Men-C-C) or quadrivalent conjugate meningococcal vaccines (Men-C-ACYW).
Postexposure and outbreak control: In addition to chemoprophylaxis, consider vaccination or revaccination for certain close contacts of a case of invasive meningococcal disease; may be used for outbreak control if the disease is caused by a serogroup C.
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Acetaminophen: May diminish the therapeutic effect of Vaccines. Management: Consider avoiding routine prophylactic use of acetaminophen before or during vaccine administration when possible. Acetaminophen is still recommended to treat fevers and/or pain that occurs after vaccination. Risk D: Consider therapy modification
Anti-CD20 B-Cell Depleting Therapies: May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Give inactivated vaccines at least 2 weeks prior to initiation or 6 months after anti-CD20 B-cell depleting therapies. If vaccinated prior to B cell recovery, consider assessing immune response to vaccination. Risk D: Consider therapy modification
Cladribine: May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Give inactivated vaccines at least 2 weeks prior to initiation of cladribine when possible. Patients vaccinated less than 14 days before initiating or during cladribine should be revaccinated at least 3 months after therapy is complete. Risk D: Consider therapy modification
Corticosteroids (Systemic): May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Administer vaccines at least 2 weeks prior to immunosuppressive corticosteroids if possible. If patients are vaccinated less than 14 days prior to or during such therapy, repeat vaccination at least 3 months after therapy if immunocompetence restored. Risk D: Consider therapy modification
Elivaldogene Autotemcel: May enhance the adverse/toxic effect of Vaccines. Specifically, there may be a greater risk for contracting an infection from any live vaccine. Elivaldogene Autotemcel may diminish the therapeutic effect of Vaccines. Management: Administration of vaccines is not recommended in the 6 weeks before myeloablative conditioning, and until hematologic recovery after elivaldogene autotemcel treatment. Risk X: Avoid combination
Fingolimod: May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Vaccine efficacy may be reduced. Complete all age-appropriate vaccinations at least 2 weeks prior to starting fingolimod. If vaccinated during fingolimod therapy, revaccinate 2 to 3 months after fingolimod discontinuation. Risk D: Consider therapy modification
Immunosuppressants (Cytotoxic Chemotherapy): May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Give inactivated vaccines at least 2 weeks prior to initiation of chemotherapy when possible. Patients vaccinated less than 14 days before initiating or during chemotherapy should be revaccinated at least 3 months after therapy is complete. Risk D: Consider therapy modification
Immunosuppressants (Miscellaneous Oncologic Agents): May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Give inactivated vaccines at least 2 weeks prior to initiation of immunosuppressants when possible. Patients vaccinated less than 14 days before initiating or during therapy should be revaccinated at least 3 after therapy is complete. Risk D: Consider therapy modification
Immunosuppressants (Therapeutic Immunosuppressant Agents): May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Give inactivated vaccines at least 2 weeks prior to initiation of immunosuppressants when possible. Patients vaccinated less than 14 days before initiating or during therapy should be revaccinated at least 2 to 3 months after therapy is complete. Risk D: Consider therapy modification
Methotrexate: May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Administer vaccines at least 2 weeks prior to methotrexate initiation, if possible. If patients are vaccinated less than 14 days prior to or during methotrexate therapy, repeat vaccination at least 3 months after therapy if immunocompetence restored. Risk D: Consider therapy modification
Propacetamol: May diminish the therapeutic effect of Vaccines. Management: Consider avoiding routine prophylactic use of propacetamol before or during vaccine administration when possible. Propacetamol is still recommended to treat fevers and/or pain that occurs after vaccination. Risk D: Consider therapy modification
Siponimod: May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Avoid administration of vaccines (inactivated) during treatment with siponimod and for 1 month after discontinuation due to potential decreased vaccine efficacy. Risk D: Consider therapy modification
Teplizumab: May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Vaccination with inactivated or non-replicating vaccines is not recommended in the 2 weeks prior to teplizumab therapy, during treatment, or for 6 weeks following completion of therapy. Risk D: Consider therapy modification
Although not studied in pregnancy, there is no reason to suspect adverse pregnancy outcomes will occur. According to the Canadian National Advisory Committee on Immunization, the use of conjugated meningococcal vaccines may be considered for use in pregnant women at increased risk of infection, travel to high-risk areas, or if indicated as postexposure prophylaxis against a vaccine-preventable strain or during an outbreak (NACI 2018).
It is not known if this vaccine is present in breast milk following maternal immunization.
Although not studied in breastfeeding women, there is no reason to suspect adverse outcomes will occur. According to the Canadian National Advisory Committee on Immunization, the use of conjugated meningococcal vaccines may be considered for use in breastfeeding women when otherwise indicated. Breastfed infants should be vaccinated according to the recommended schedules (NACI 2018).
Monitor for anaphylaxis and syncope for at least 15 minutes following administration (ACIP [Kroger 2021]; NACI 2016). If seizure-like activity associated with syncope occurs, maintain patient in supine or Trendelenburg position to reestablish adequate cerebral perfusion.
Induces immunity against meningococcal disease via the formation of bactericidal antibodies directed toward the polysaccharide capsular components of Neisseria meningitidis serogroup C.
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