Meningococcal Vaccine

Routine Scheduled Vaccine for all teens in U.S. (Menactra)
1. All 12 year olds
  1. First dose
2. All 16 year olds
  1. Booster, second dose for those who received a dose prior to age 16 years
  2. Catch-up any 16 year olds if not immunized (single dose)
High risk Patients (see risk factors below)
1. See CDC guidelines and risk factors below (vary by population and Vaccine)

Underlying medical condition
1. Anatomic Asplenia or Functional Asplenia (e.g. Sickle Cell Anemia)
2. Terminal complement deficiency
3. Properdin deficiency
4. Human Immunodeficiency Virus (HIV)
5. Complement Inhibitor (eculizumab, ravulizumab)
Close living areas
1. College students in dormitory, fraternity, sorority
2. Military recruits in barracks
Travel to endemic areas
1. Sub-Saharan Africa
2. Himalayas
3. Saudi Arabia (especially Mecca)

Tetravalent Meningococcal Conjugate Vaccine (MCV4)
MCV4 preferred in most cases over MPSV4 (higher immunogenicity)
MenACWY covers strains A, C, W-135, Y (same as Menomune)
1. Serotypes C and Y each account for a third of U.S. meningococcal cases
2. Serotype B accounts for another third (but not included in the MenACWY Vaccine, see below)
3. Serotypes A and W are strains seen worldwide
MenACWY Vaccines do not cover serotype B (same as Menomune)
1. Serotype B accounts for 50% of infant cases
2. Serotype B accounts for <20% of teen cases
3. Serotype B accounts for many of the college cases
4. Reasons for not including serotype B in Vaccine
  1. B has poor immunogenicity in Vaccine
  2. Risk of cross-reactivity with neural tissue
Conjugate Vaccine with DiphtheriaProtein
1. Boosts T-Cell response
2. Lengthens duration of Immunity significantly
Cost: $100 (similar to Menomune)
Storage: 35 to 46 F (2 to 8 C, same as Menomune)

Primary MenACWY Conjugate Vaccines (quadravalent)
1. Menactra Conjugate (MenACWY-D)
  1. FDA approved 2005 for age 9 months to 55 years
2. Menveo Conjugate (MenACWY-CRM)
  1. FDA approved 2010 for age 2 months to 55 years
3. MenQuadfi Conjugate (MenACWY-TT)
  1. FDA approved 2020 for age 2 years and older
MenABCWY Conjugate Vaccines (pentavalent with added MenB coverage as of 2024)
1. See Serotype B Meningococcal Vaccine for indications
2. Precautions
  1. MenB is typically a 3 dose series (2 doses for low risk patients)
  2. MenB Vaccines are not interchangeable (additional doses should be with same MenB product)
3. MenACWY + MenB/Trumenba (Penbraya)
  1. FDA approved for age 10 years and older in 2024
4. MenACWY + MenB/Bexsero
  1. Pending FDA approval in 2025
Other combinations
1. Menhibrix (Hib-MenCY, high risk infants only who are also due for Hib Vaccine)

General dosing protocol if under age 16 years at time of first dose
1. Booster dose before entering high risk environment (e.g. college dormitory, travel to endemic area, lab workers)
General dosing protocol if over age 16 years at time of first dose
1. Single dose with no booster recommended
Indications for a two dose series (with 2 month interval) and no further boosters
1. Human Immunodeficiency Virus infection
Indications for a two dose series (with 2 month interval) and future boosters every 5 years
1. No functioning Spleen or
2. Persistent complement deficiency
Miscellaneous points
1. If Menomune (MPSV4) was given previously, wait at least 3 years before giving Menactra

Menactra has a high seroconversion rate (98%-100%), similar to Menomune
Duration: Menactra >8 years (more than double that of Menomune's 3 year duration)
Universal Immunization has NOT been recommended for non-high risk patients ages 20 to 55 years
1. Very low overall Meningitis risk in this low risk group group
2. Vaccination in this low risk group has not been shown to lower disease Prevalence

No longer associated with Guillain-Barre (despite early reports)
Vaccine has no preservative (single use vial)
1. Does not contain thimerosal (contrast with prior Menomune Vaccine)
Safe in Human Immunodeficiency Virus (HIV)
1. See Immunization in HIV

Serious adverse events are uncommon (<1.3%)
Headache
Fever (in up to 3% of children)
Local reactions such as injection site redness (more common with Menactra than with Menomune)
Syncope