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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)*¶

or

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

3 doses of either MenB formulation at 0-, 1- to 2-, and 6-months.¥‡

MenB formulations are not interchangeable. A single manufacturer's MenB products must be used for each dose of the primary series and all booster doses.

 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

3 doses of either MenB formulation at 0-, 1- to 2-, and 6-months.¥‡

MenB formulations are not interchangeable. A single manufacturer's MenB products must be used for each dose of the primary series and all booster doses.

 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.
  • Another MenACWY-TT vaccine (Nimenrix) is licensed in some countries outside the United States. In the United States, it is available as a component of the combination vaccine MenACWY-TT/MenB-FHbp (Penbraya), which is approved for use in persons 10 to 25 years of age.
  • 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; is also a component of the combination vaccine MenACWY-TT/MenB-FHbp [Penbraya])

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

* 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.

¥ For persons aged 10 to 25 years who require MenACWY and MenB at the same time, MenACWY-TT/MenB-FHbp (Penbraya) can be used for some of the doses, eg:

  • For those requiring a single dose of MenACWY and the MenB series, MenACWY-TT/MenB-FHbp can be administered for the first dose. Patients should then complete the MenB series with MenB-FHbp (Trumenba) alone at 1- to 2-months and 6-months.
  • For patients who require two doses of MenACWY and the MenB series, MenACWY-TT/MenB-FHbp can be administered for the first dose. They should then receive a dose of MenB-FHbp (Trumenba) alone at 1- to 2-months and then another dose of MenACWY-TT/MenB-FHbp at 6-months.
  • For patients who require a booster dose of MenACWY and MenB-FHbp (Trumenba) at the same time, MenACWY-TT/MenB-FHbp can be used.

Since MenB vaccines are not interchangeable, MenB-4C cannot be substituted for MenB-FHbp and MenACWY-TT/MenB-FHbp cannot replace MenB-4C (Bexsero). MenACWY-TT/MenB-FHbp should not be administered at intervals <6 months.

‡ Sometimes there are unexpected deviations in the schedule.

  • If the second dose was administered ≥6 months after the first dose, a third dose is not needed.
  • If the third dose is administered <4 months after the second dose, the dose should be repeated ≥4 months after the last dose, unless the third dose was administered ≥6 months after the first dose.

† For such persons, a two dose MenB series is sufficient. Refer to the UpToDate table that discusses routine vaccination for healthy children and adolescents.

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).
  4. Schillie S, Loehr J, Chen WH, et al. New dosing interval and schedule for the Bexsero MenB-4C Vaccine: Updated recommendations of the Advisory Committee on Immunization Practices — United States, October 2024. MMWR Morb Mortal Wkly Rep 2024; 73:1124.
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