Meningococcal Vaccination for Adolescents: Information for Healthcare Professionals

Meningococcal vaccination is recommended for all adolescents. Follow the recommended immunization schedule to ensure that your patients get the meningococcal vaccines that they need.

• All 11 to 12 year olds should be vaccinated with a single dose of meningococcal conjugate vaccine.
• Since protection wanes, a booster dose is recommended at age 16 years so adolescents continue to have protection during the ages when they are at highest risk of meningococcal disease.
• Meningococcal vaccines for serogroup B were licensed by the Food and Drug Administration (FDA) in 2014 and 2015.
• All adolescents and young adults (16 through 23 years of age) may also be vaccinated with a serogroup B meningococcal vaccine, preferably at 16 through 18 years of age. However, CDC recommends that certain adolescents and young adults should be vaccinated with a serogroup B meningococcal vaccine. They include those identified as being at increased risk because of a serogroup B meningococcal disease outbreak and people with certain medical conditions.

 

Meningococcal Vaccines

Adolescents are at increased risk for meningococcal disease.

Anyone can get meningococcal disease, but adolescents and young adults 16 through 23 years of age (not just those in college) are at increased risk for meningococcal disease. Meningococcal bacteria can cause severe disease, including meningitis, bacteremia, and septicemia, resulting in permanent disabilities and even death.

There are two types of meningococcal vaccines available in the United States. Each type helps protect against different serogroups of meningococcal disease.

Meningococcal conjugate vaccines are designed to protect against four serogroups (A, C, W, and Y), while serogroup B meningococcal vaccines help protect against one serogroup (B). There are currently no meningococcal vaccines that can help protect against all common serogroups that cause most meningococcal disease.

You can administer both types of meningococcal vaccines at the same time. You can also administer them with other vaccines recommended for adolescents.

Meningococcal and other vaccines may be administered during the same visit, but at a different anatomic site if feasible.

CDC recommends meningococcal vaccination for people identified as being at increased risk during outbreaks.

CDC supports state and local health departments in investigating outbreaks and implementing outbreak control measures. In the setting of a serogroup A, C, W, or Y meningococcal disease outbreak, CDC recommends vaccination with a meningococcal conjugate vaccine for people identified as being at increased risk because of the outbreak. In the setting of a serogroup B meningococcal disease outbreak, CDC recommends vaccination with a serogroup B meningococcal vaccine for people identified as being at increased risk because of the outbreak.

 Top of Page

Meningococcal Conjugate Vaccines

A booster dose of a meningococcal conjugate vaccine helps protect adolescents during the ages they are at highest risk.

Protection from meningococcal conjugate vaccination wanes in most adolescents within 5 years. Based on that information, adolescents need a booster dose, preferably at age 16, so they continue to have protection during the years when they are at highest risk of meningococcal disease.

Meningococcal conjugate vaccines are safe.

Meningococcal conjugate vaccines are safe. Vaccine safety continues to be monitored. For information about side effects, see the Meningococcal ACWY Vaccine Information Statement.

Many colleges require proof of meningococcal conjugate vaccination within 5 years before starting school.

CDC recommends that students receive a meningococcal conjugate vaccine within 5 years prior to starting college. This vaccination is required to attend many colleges.

The minimum booster dose interval is 8 weeks for meningococcal conjugate vaccines.

The minimum interval between doses is 8 weeks. However, a booster is not indicated for adolescents if the initial dose is given at or after age 16 in healthy persons.

Use clinical judgement when deciding whether or not to administer a booster dose of a meningococcal conjugate vaccine to patients younger than 16 years who you might not see again.

As in many similar situations, clinicians should use their clinical judgment in a situation where you may not have another opportunity to provide the booster dose to patients. The minimum interval between doses is 8 weeks.

People with certain medical conditions need a 2-dose primary series of meningococcal conjugate vaccine and routine booster doses.

Vaccinate people with the following medical conditions with a 2-dose primary series of meningococcal conjugate vaccine administered 8 weeks apart:

• Complement component deficiency (e.g., C5-C9, properdin, factor H, factor D, or are taking Soliris®)
• Functional or anatomic asplenia (including sickle cell anemia)
• HIV

Also administer routine booster doses every 5 years throughout life to people with these medical conditions to help maintain protection against meningococcal disease.

 Top of Page

Serogroup B Meningococcal Vaccines

CDC does not routinely recommend a serogroup B meningococcal vaccine for all adolescents.

Clinicians may choose to administer serogroup B meningococcal vaccine to patients 16 through 23 years of age, preferably at 16 through 18 years old. This is different from CDC’s recommendation for meningococcal conjugate vaccine, which specifically states that clinicians should administer that vaccine to adolescents at 11 or 12 and again at 16 years of age.

Data suggest serogroup B meningococcal vaccines provide protection, but antibodies wane rapidly after vaccination.

Available data suggest that serogroup B meningococcal vaccines are an important step forward for controlling serogroup B meningococcal disease, but they will not prevent all cases. These vaccines provide protection against most but not all serogroup B strains circulating in the United States. Additional studies assessing breadth of strain coverage are ongoing, and CDC will review results as they become available. Immunogenicity studies predict efficacy of serogroup B meningococcal vaccines in most individuals in the short term, but there are currently no data available on vaccine effectiveness or duration of effectiveness; the limited data available on antibody persistence suggest rapid waning of antibodies after vaccination. Additionally, initial data suggest the serogroup B meningococcal vaccines do not impact carriage and therefore will not lead to herd immunity. The impact selection pressure from serogroup B meningococcal vaccine introduction will have on circulating strains remains unknown.

Administer serogroup B meningococcal vaccines at 16 through 18 years of age to maximize protection when adolescents are at highest risk.

CDC recommends clinicians who choose to administer the serogroup B meningococcal vaccine series give it in later adolescence, preferably between 16 to 18 years old. This timing maximizes the likelihood that vaccinated adolescents will have protection during the ages (16 through 23 years) when they are at highest risk of meningococcal disease. Adolescents should be making a visit to their healthcare professional at age 16 years for the meningococcal conjugate booster; this visit at age 16 years provides the opportunity to initiate and complete the multi-dose serogroup B meningococcal vaccine series before entering the higher age-related risk period.

Serogroup B meningococcal vaccines are safe.

Available data suggest that serogroup B meningococcal vaccines are safe. Side effects like pain at the injection site, fever, and headache are common, but resolve on their own within 3 to 7 days after vaccination. Serogroup B meningococcal vaccines are more reactogenic than other adolescent vaccines (i.e., HPV, meningococcal conjugate, and Tdap vaccine) and likely to produce common or expected short-term side effects (especially pain at the injection site). There have been no unusual patterns of serious reactions associated with these vaccines.

There is also a theoretical concern for autoimmune disorders following serogroup B meningococcal vaccination. Both serogroup B meningococcal vaccines contain components that include factor H binding protein. In 2 animal models, antibodies measured after Bexsero® vaccination have been noted to be cross reactive with human factor H. However, it is not known if auto-antibodies to factor H develop in humans after vaccination with either serogroup B meningococcal vaccine. It is also not known if auto-antibodies generated post-vaccination are of clinical significance. Safety data were available from 6 Bexsero® clinical trials and 7 Trumenba® clinical trials, which in total included approximately 3,100 and 4,500 vaccine recipients. For most of the participants who reported an autoimmune condition, the onset of symptoms consistent with the diagnosis existed prior to the first vaccination. Theoretically, onset of autoimmune disease related symptoms could be delayed well beyond vaccination. Post-licensure safety surveillance will be important to detect any potential safety signals.

Before administering a serogroup B meningococcal vaccine, providers should consult the package insert (Bexsero® [11 pages] or Trumenba® [10 pages]) for precautions, warnings, and contraindications. For a summary of contraindications and precautions, see the Serogroup B Meningococcal Vaccine Information Statement.

Serogroup B meningococcal vaccines require multiple doses.

Both serogroup B meningococcal vaccine products require more than one dose for maximum protection. The same vaccine product must be used for all doses.

• Bexsero:^® Administer two doses (0, ≥1 month after first dose).
• Trumenba:^® Administer two or three doses
  • Administer two doses (0, 6 months after first dose) to healthy adolescents who are not at increased risk for serogroup B meningococcal disease.
  • Administer three doses (0, 1 to 2 months after first dose, 6 months after first dose) to adolescents who are at increased risk for meningococcal disease (including during outbreaks of serogroup B meningococcal disease).

It does not matter which serogroup B meningococcal vaccine you use.

CDC has no preference as to which serogroup B meningococcal vaccine you use. The same vaccine product must be used for all doses. If different products were administered for any of the doses, proceed with the next scheduled dose of the selected product with a minimum of 1 month since the last dose of either product.

Most health insurance plans cover the cost for serogroup B meningococcal vaccination.

Most health plans must cover a set of preventive services, including vaccines recommended on the CDC immunization schedules, with no out-of-pocket costs when provided by an in-network healthcare provider. Health plans are required to cover new vaccine recommendations without cost-sharing in the next plan year that occurs one year after the effective date of the recommendation, which is the date of publication in CDC’s Morbidity and Mortality Weekly Report (MMWR).

CDC published the following two recommendations about serogroup B meningococcal vaccination in 2015:

• All people 10 years or older identified as being at increased risk of meningococcal disease should get vaccinated — publication date June 12, 2015
• All teens may get vaccinated, preferably at 16 through 18 years old — publication date October 23, 2015

Patients should check with their insurance provider for details on whether there is any cost to them for this vaccine.

The Vaccines for Children, or VFC, program provides vaccines for children 18 and younger who are not insured, Medicaid-eligible, or American Indian or Alaska Native. Parents can find a VFC provider by contacting their local health department. VFC will cover the cost of serogroup B meningococcal vaccination for those

• 16 through 18 years of age
• 10 through 18 years of age identified as being at increased risk due to a medical condition or a serogroup B meningococcal disease outbreak

There are multiple places you can refer patients to for serogroup B meningococcal vaccination if you do not stock the vaccine.

College health centers or pharmacies may have serogroup B meningococcal vaccines available. Patients can also locate vaccine providers who carry serogroup B meningococcal vaccine by using the HealthMap Vaccine Finder.

Get more information, for yourself and your patients, about serogroup B meningococcal vaccination.

The below resources offer additional information for clinicians and parents about serogroup B meningococcal vaccination:

• ACIP Recommendations
  • Use of Serogroup B Meningococcal Vaccines in Adolescents and Young Adults
  • Use of Serogroup B Meningococcal Vaccines in Persons Aged ≥10 Years at Increased Risk
• Package Inserts: Bexsero® [10 pages], Trumenba® [11 pages]
• For Parents of Teenagers: Information about Meningococcal Vaccination

 Top of Page