Ask the Experts: Meningococcal ACWY

Results (57)

Meningococcal disease is a bacterial infection caused by Neisseria meningitidis. Meningococcal disease usually presents clinically as meningitis (about 50% of cases), bacteremia (30% of cases), or bacteremic pneumonia (15% of cases). N. meningitidis colonizes mucosal surfaces of the nasopharynx and is transmitted through direct contact with large-droplet respiratory tract secretions from patients or asymptomatic carriers. Meningococcal disease can be severe. The overall case-fatality ratio in the U.S. is 15%, and 10%–20% of survivors have long-term sequelae such as neurologic disability, limb or digit loss, and hearing loss.

N. meningitidis is classified into 12 serogroups based on characteristics of the polysaccharide capsule. Most invasive disease (such as meningitis and sepsis) is caused by serogroups A, B, C, W, X and Y. The relative importance of serogroups depends on geographic location and other factors such as age. Between 2011 and 2020 in the United States, serogroup B caused about 60% of cases among children younger than 5 years old, and serogroups C, W, or Y caused about two out of three cases in people age 11 years or older. Serogroup A is rare in the U.S. Historically, serogroup A was common in the meningitis belt of sub-Saharan Africa, but after the implementation of a meningococcal serogroup A conjugate vaccine campaign, serogroup A disease has been nearly eliminated in the meningitis belt.

Nasopharyngeal carriage rates are highest in adolescents and young adults who serve as reservoirs for transmission of N. meningitidis.

Last reviewed: July 15, 2023

The incidence of meningococcal disease has declined steadily in the U.S. since a peak of reported disease in the late 1990s. Even before routine use of a meningococcal conjugate vaccine against serogroups A, C, W, and Y (MenACWY) was recommended for adolescents in 2005, the overall annual incidence of meningococcal disease had decreased 64%, from 1.1 cases per 100,000 population in 1996 to 0.4 cases per 100,000 population in 2005. In 2020, the rate of meningococcal disease in the United States reached a historic low of 0.07 cases per 100,000 population.

In 2020, of U.S. cases with known serogroup, 55 cases were serogroup B (incidence rate of 0.02 cases per 100,000 population) and 119 cases were serogroups C, Y, or W. The incidence of disease is extremely low in all age groups, but is highest in infants under 1 year (0.43 cases per 100,000), children age 1 through 4 years (0.12 cases per 100,000), and adolescents age 16–23 (0.09 cases per 100,000 years).

Last reviewed: July 15, 2023

In addition to risk based on age, non-specific risk factors for serogroups A, C, W and Y include having a previous viral infection, living in a crowded household, having an underlying chronic illness, and being exposed to cigarette smoke (either directly or second-hand).

The following groups are at increased risk for all meningococcal serogroups:

  • People with persistent (genetic) complement component deficiencies (a type of immune system disorder)
  • People who use complement inhibitors such as eculizumab (Soliris, Alexion Pharmaceuticals) and ravulizumab (Ultomiris, Alexion Pharmaceuticals) for treatment of atypical hemolytic uremic syndrome or paroxysmal nocturnal hemoglobinuria
  • People with anatomic or functional asplenia
  • Microbiologists routinely exposed to meningococcal isolates in a laboratory
  • People at increased risk during an outbreak of meningococcal disease
  • Military recruits
  • College students

Certain groups are at increased risk of serogroups A, C, W and Y, but not serogroup B:

  • People living with HIV
  • Men who have sex with men (MSM)
  • Travelers to countries where meningococcal disease is endemic or hyperendemic, such as the meningitis belt of sub-Saharan Africa
Last reviewed: July 15, 2023

The vaccines for meningococcal serogroups A, C, W, and Y (MenACWY; Menactra or MenQuadfi by Sanofi; Menveo by GSK) contain meningococcal conjugate in which the surface polysaccharide is chemically bonded (“conjugated”) to a protein to produce a robust immune response to the polysaccharide. Although each of the 3 MenACWY vaccine products uses a different protein conjugate, the products are considered interchangeable; the same vaccine product is recommended, but not required, for all doses.

A discontinued meningococcal polysaccharide vaccine (MPSV4, Menomune, Sanofi) was available in the United States until all doses expired in September 2017. With rare exception, it was not interchangeable with MenACWY conjugate vaccines.

Since late 2014, vaccines have become available that offer protection from meningococcal serogroup B disease (MenB; Bexsero by GSK; Trumenba by Pfizer). These vaccines are composed of proteins found on the surface of the bacteria. These vaccine products are not interchangeable; the same vaccine product is required for all doses.

MenACWY vaccines provide no protection against serogroup B disease, and meningococcal serogroup B vaccines (MenB) provide no protection against serogroup A, C, W, or Y disease. For protection against all 5 serogroups of meningococcus, it is necessary to receive both MenACWY and MenB.

Trade Name Type of Vaccine Serogroups Year Licensed Approved Ages
Menactra Conjugate A, C, W, Y 2005 9 mos.–55 years*
Menveo (two vial)
Menveo (one vial)
Conjugate
Conjugate
A, C, W, Y
A, C, W, Y
2010
2022
2 mos.–55 years*
10–55 years
MenQuadfi Conjugate A, C, W, Y 2020 2 years and older
Trumenba Protein B 2014 10–25 years*
Bexsero Protein B 2015 10–25 years*

*May be given to adults at increased risk older than the FDA-approved upper age limit (see ACIP recommendations, Table 11, page 41, www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6909a1-H.pdf)

Last reviewed: July 15, 2023

The most current comprehensive recommendations from the Advisory Committee on Immunization Practices (ACIP) for meningococcal vaccines is available on the MMWR website at www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6909a1-H.pdf. This document replaces all previously published reports and policy notes.

Last reviewed: July 15, 2023

MenACWY is recommended for these groups:

Routine vaccination of all children and teens, age 11 through 18 years: a single dose at age 11 or 12 years with a booster dose at age 16 years

Routine vaccination of people age 2 months or older at increased risk for meningococcal disease (the primary dosing schedule and booster dose interval varies by age and indication):

  • People with functional or anatomic asplenia
  • People who have persistent complement component deficiency (an immune system disorder) or who take a complement inhibitor (eculizumab [Soliris] or ravulizumab [Ultomiris])
  • People who have HIV infection
  • People who are at risk during an outbreak caused by a vaccine serogroup
  • People age 2 months and older who reside in or travel to certain countries in sub-Saharan Africa as well as to other countries for which meningococcal vaccine is recommended (e.g., travel to Mecca, Saudi Arabia, for the annual Hajj)
  • Microbiologists who work with meningococcus bacterial isolates in a laboratory
  • First-year college students living in residence halls who are unvaccinated or undervaccinated; these students should receive a dose if they have not had a dose since turning 16 or if it has been more than 5 years since their previous dose
Last reviewed: July 15, 2023

All adolescents should receive a dose of MenACWY at 11 or 12 years of age. A second (booster) dose is recommended at 16 years of age. Adolescents who receive their first dose at age 13 through 15 years should receive a booster dose at age 16 years. The minimum interval between MenACWY doses is 8 weeks. Adolescents who receive a first dose after their 16th birthday do not need a booster dose unless they become at increased risk for meningococcal disease. Colleges may not consider a second dose given even a few days before age 16 years as valid, so keep that in mind when scheduling patients. People 19 through 21 years of age are not recommended routinely to receive MenACWY. However, MenACWY may be administered to people age 19 through 21 years as catch-up vaccination for those who have not received a dose after their 16th birthday.

Last reviewed: July 15, 2023

No. ACIP considers a dose of MenACWY given to a 10-year-old child to be valid for the first dose in the adolescent series. Doses given before age 10 years should not be counted. The child should receive the second (booster) dose at age 16 years as usual.

Last reviewed: July 15, 2023

First-year college students living in residence halls should be vaccinated against meningococcal ACWY disease. Before enrollment, administer a dose of MenACWY vaccine to those previously unvaccinated, to those who have not had a dose of MenACWY since turning 16, and to those whose most recent MenACWY dose (given after turning 16) was not given within the past 5 years. Some schools, colleges, and universities have policies requiring vaccination against meningococcal disease as a condition of enrollment.

Last reviewed: July 15, 2023

Yes. One dose of MenACWY vaccine is recommended for all first year college students who are or will be living in a residence hall if they are previously unvaccinated, have not received a dose of MenACWY since turning 16, or if their most recent dose (given after turning 16) was not given within the past 5 years.

Last reviewed: July 15, 2023

ACIP does not identify incarceration as an indication for meningococcal vaccination. Providers are always free to use their clinical judgment in situations not addressed by ACIP.

Last reviewed: July 15, 2023

Residence in a homeless shelter or halfway house is considered a high-risk indication only for hepatitis A vaccination because of the increased risk of hepatitis A exposure and serious illness among people experiencing homelessness or living in temporary housing. In all other respects, recommendations for vaccinating adult residents would be the same as those for all adults on the ACIP adult immunization schedule. Residents with medical conditions identified on Table 2 of the schedule should be vaccinated according to that table.

Any residents 18 or younger should be vaccinated according to the catch-up recommendations on the ACIP child/teen immunization schedule. People age 19 through 21 years are not recommended routinely to receive MenACWY. MenACWY may be administered through age 21 years as a catch-up vaccination for those who have not received a dose after their 16th birthday.

Last reviewed: July 15, 2023

No. There are no acceptable serologic titers that can be used as evidence of protection against meningococcal A, C, W, and Y disease. In addition, the immunologic studies used for licensing purposes (serum bactericidal assay, SBA) are likely different from the serologic titers obtained at a doctor’s office (IgG antibody, for example). It is not clear what sort of testing is shown in the results you sent. However, even if SBA results are available, they cannot be used to assess whether there is a level of protection at the individual level.

Last reviewed: July 15, 2023

Immunize.org has prepared a document that provides a summary of the ACIP recommendations for use of MenACWY for people of all ages. The document is available at www.immunize.org/catg.d/p2018.pdf.

Last reviewed: July 15, 2023

Menveo, in the two-vial presentation that requires reconstitution, is approved for people age 2 months through 55 years. The one-vial formulation that does not require reconstitution was licensed in 2022 for ages 10 through 55 years and should not be used for children younger than age 10. For children beginning the vaccination series at age 2 months the schedule is 4 doses at age 2, 4, 6, and 12 to 15 months. Fewer doses are recommended for children beginning the vaccination series at age 7 months or older. See the Immunize.org document at www.immunize.org/catg.d/p2018.pdf for details.

ACIP recommends the use of Menveo in high-risk children 2 through 23 months of age: children with persistent complement deficiency, including those taking a complement inhibitor such as eculizumab (Soliris) or ravulizumab (Ultomiris), functional or anatomic asplenia, HIV infection, who travel to or reside in regions where meningitis is epidemic or hyperendemic, or who are at risk during a community outbreak attributable to a vaccine serogroup. Menactra (MenACWY-D) can be given to children 9 months and older at increased risk of meningococcal disease. MenQuadfi (MenACWY-TT) may be used for children at increased risk who are age 2 years and older. These recommendations are summarized in Table 3 of the recommendations published by ACIP in MMWR in 2020: www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6909a1-H.pdf.

Last reviewed: July 15, 2023

The meningococcal ACIP recommendations don’t clearly state a minimum interval for MenACWY in this situation. However, the minimum interval for a pediatric MenACWY schedule would presumably be 4 weeks like for other pediatric vaccines on a 2-4-6 schedule. You should try to give a third dose before travel begins.

Last reviewed: July 15, 2023

Yes. Doses of any quadrivalent meningococcal vaccine given before 10 years of age should not be counted as part of the adolescent MenACWY series. If a child received a dose of either MPSV4 or MenACWY before age 10 years, they should receive a dose of MenACWY at 11 or 12 years and a booster dose at age 16.

Last reviewed: July 15, 2023

Yes, they should receive a booster dose at age 16. A booster dose of MenACWY is recommended at age 16 years even if 2 (or more) doses of MenACWY vaccine were received before age 16 years. First-year college students living in a residence hall who have not received a dose of MenACWY on or after age 16 years, should also be vaccinated.

Last reviewed: July 15, 2023

If the first dose is given at age 13 through 15 years, you can give the booster dose as early as age 16 years, with a minimum interval of 8 weeks from the previous dose. So even if the patient was vaccinated at age 15 years 11 months, you could wait at least 8 weeks and then give the booster at age 16 years 1 month (or later).

Last reviewed: July 15, 2023

Two of the MenACWY vaccines (Menactra and Menveo) are approved for adults through age 55 years. MenQuadfi was approved in 2020 for ages 2 years and older. If MenACWY is indicated for a person older than age 55 and you do not have MenQuadfi, use the MenACWY product available.

Last reviewed: July 15, 2023

The “two-vial” formulation of Menveo (MenACWY-CRM, GSK) requires reconstitution of a lyophilized powder with a diluent: it is FDA-licensed for administration to individuals age 2 months through 55 years. The “one-vial” liquid formulation of Menveo licensed in 2022 is essentially the same vaccine, but does not require reconstitution before administration; however, this formulation is currently licensed only for administration to people age 10 through 55 years.

If the “one-vial” formulation is inadvertently administered to a child younger than age 10 years, this incident should be reported to the Vaccine Adverse Event Reporting System (VAERS, https://vaers.hhs.gov) as a vaccine administration error; however, the dose may be counted as valid and should not be repeated. If your facility stocks both one-vial and two-vial Menveo formulations, review practices and protocols and ensure clear labeling of vaccines in storage units to minimize the risk of administering the one-vial formulation to a child younger than age 10 years.

Note that administration of a dose of either Menveo formulation or Menactra (MenACWY-D, Sanofi) to a patient who is older than the FDA-licensed upper age limit of 55 years should not be reported to VAERS and is not considered an error. This is because ACIP recommendations state that Menveo or Menactra may be administered to adults age 56 or older when MenACWY vaccination is indicated and MenQuadfi (MenACWY-TT, Sanofi, licensed with no upper age limit) is not available.

Last reviewed: August 23, 2023

Eculizumab (Soliris) and the related long-acting compound, ravulizumab (Ultomiris) bind to C5 and inhibit the terminal complement pathway. People with persistent complement component deficiency due to an immune system disorder or use of a complement inhibitor are at increased risk for meningococcal disease even if fully vaccinated. This patient should be given a series of MenACWY vaccine, MenACWY (2 doses separated by at least 8 weeks) and a 2- or 3-dose series (depending on brand) of MenB vaccine. The patient should receive regular booster doses of MenACWY and MenB as long as he remains at risk: a booster dose of MenACWY every 5 years and a booster dose of MenB one year after completion of the primary series, followed by a booster dose of MenB every 2–3 years thereafter.

Because patients treated with complement inhibitors can develop invasive meningococcal disease despite vaccination, clinicians using Soliris or Ultomiris also may consider antimicrobial prophylaxis for the duration of complement inhibitor therapy.

Last reviewed: July 15, 2023

As of 2020, there are three options for MenACWY vaccination. In 2020, MenQuadfi (Sanofi) was approved for use in all people ages 2 years and older. If MenQuadfi is not available and vaccination is needed, you may administer Menactra or Menveo.

Last reviewed: July 15, 2023

Menactra (MenACWY-D) is not approved for children younger than 9 months so only the Menveo two-vial formulation requiring reconstitution (MenACWY-CRM) should be used for children age 2 through 8 months. MenQuadfi (MenACWY-TT) is not approved for children younger than age 2 years. The one-vial formulation of Menveo that does not require reconstitution is approved for children and adults age 10 through 55 years. When more than one brand is age-appropriate, the vaccines are interchangeable.

Last reviewed: July 15, 2023

For people who are age 2 years or older, a 2-dose series of MenACWY, spaced 8–12 weeks apart, is recommended if they have functional or anatomic asplenia, HIV infection, persistent complement component deficiency (an immune disorder including C3, C5–C9, properdin, factor H, and factor D deficiency), or if they take a complement inhibitor (eculizumab [Soliris] or ravulizumab [Ultomiris]). People with these high-risk medical conditions also need booster doses of MenACWY.

Last reviewed: July 15, 2023

ACIP recommends meningococcal vaccination only for high-risk children younger than 11 years. ACIP defines high-risk children age 2 months and older as (1) those with persistent complement component deficiency (an immune system disorder) or who take a complement inhibitor (including eculizumab [Soliris] or ravulizumab [Ultomiris]), (2) those with functional or anatomic asplenia, (3) those with HIV infection, (4) those traveling to or residing in an area of the world where meningococcal disease is hyperendemic or epidemic or (5) those identified by public health officials as being at risk during a community outbreak attributable to a vaccine serogroup. Menveo (MenACWY-CRM), in its two-vial formulation requiring reconstitution, is approved for children age 2 months and older; the one-vial formulation that does not require reconstitution may be administered to children age 10 years or older. Menactra (MenACWY-D) is approved for children age 9 months and older. MenQuadfi (MenACWY-TT) is approved for children age 2 years and older.

For children with functional or anatomic asplenia, Menactra should not be administered until at least 4 weeks after the pneumococcal conjugate vaccine vaccination series is completed. Children at increased risk for meningococcal disease should receive booster doses as long as they remain at increased risk.

Last reviewed: July 15, 2023

In addition to being at increased risk for meningococcal disease, children with HIV infection or functional or anatomic asplenia are at high risk for invasive disease caused by Streptococcus pneumoniae, which is more common than meningococcal disease. Data show that the Menactra may interfere with the immunologic response to PCV if these two vaccines are given too close together. So ACIP recommends that Menactra not be administered to children with these conditions before age 2 years to avoid interference with the response to PCV. If Menactra is used in people of any age with these conditions, do not administer it until at least 4 weeks after completion of the PCV series. Menveo (MenACWY-CRM) and MenQuadfi (MenACWY-TT) do not affect the immune response to PCV and can be given at any time before or after PCV, although MenQuadfi is not licensed for use in children younger than age 2 years.

Last reviewed: July 15, 2023

Possibly. If you are going to give him Menactra (MenACWY-D), you need to wait at least 4 weeks after he completes the PCV series before giving him the Menactra. There is no similar space consideration if Menveo (MenACWY-CRM) or MenQuadfi (MenACWY-TT) is used; these brands may be given simultaneously with PCV or at any interval before or after receipt of PCV.

Last reviewed: July 15, 2023

Yes. If Menactra (MenACWY-D) is being used, you should space it 4 weeks after PCV. With both asplenic children and asplenic adults, if less than four weeks separate Menactra and PCV (in either order), the dose of PCV should be repeated four weeks after whichever vaccine was administered second.

Menveo (MenACWY-CRM) and MenQuadfi (MenACWY-TT) can be administered at any time before, simultaneous with, or after PCV.

Last reviewed: July 15, 2023

Pneumococcal conjugate vaccine (PCV), Haemophilus influenzae type b vaccine, MenACWY, and meningococcal B vaccine should be given at least 14 days before a scheduled splenectomy, if possible. This is done so the patient is protected from these diseases before the spleen is removed; however, doses given during the 14 days before surgery also can be counted as valid. If the doses cannot be given prior to the splenectomy, they should be given as soon as the patient’s condition has stabilized after surgery. If PCV20 is given, pneumococcal polysaccharide vaccine (PPSV23) is not needed; if PCV15 is given, administer a dose of PPSV23 at least 8 weeks after the dose of PCV15 if the patient is age 2 years or older.

Last reviewed: July 15, 2023

Because she has functional asplenia, she is due for the second dose of the primary series (assuming 8 weeks have passed since the first primary series dose). Because she has a high-risk medical condition she will need periodic booster doses. If she is younger than age 7 years when she receives the second dose of her primary series, she should receive her first booster dose 3 years after completing the primary series. She should then receive a booster dose every five years thereafter. If she is age 7 years or older when she receives the second primary dose she should receive her first booster dose 5 years after the completing the primary series and every five years thereafter.

Last reviewed: July 15, 2023

This situation is not addressed in the ACIP guidelines for meningococcal conjugate vaccine. It is the CDC meningococcal subject matter expert’s opinion that this patient should receive 2 doses of MenACWY separated by at least 8 weeks, followed by a booster dose of MenACWY every 5 years thereafter. The concern is that having had only MPSV4 (Menomune, Sanofi, discontinued in 2017) previously, she may not have an adequate booster response to a single dose of MenACWY.

Last reviewed: July 15, 2023

Recommendations to separate MenACWY and PCV only apply to one of the three MenACWY vaccines, MenACWY-D (Menactra), and also only apply to individuals with functional or anatomic asplenia or HIV infection. So, you do may administer the recommended vaccines at the same time. A 10-year-old with persistent complement component deficiency also should receive a 2- or 3-dose series (depending on brand) of MenB vaccine.

As long as the child remains at high risk of meningococcal disease due to complement inhibitor use, booster doses of both MenACWY and MenB are recommended. A MenACWY booster dose should be given every 5 years and a MenB booster dose should be given one year after the completion of the primary series, followed by a booster dose every 2–3 years thereafter.

Because patients treated with complement inhibitors can develop invasive meningococcal disease despite vaccination, clinicians using Soliris or Ultomiris also may consider antimicrobial prophylaxis for the duration of complement inhibitor therapy.

Last reviewed: July 15, 2023

Yes. Studies from the United States, South Africa, and the United Kingdom have shown that people with HIV infection have a risk of invasive meningococcal disease that is 11–24 times higher than the general population. In the United States, this excess risk is specifically for serogroups C, W, and Y. ACIP recommends routine MenACWY vaccination of all HIV-infected people 2 months of age and older. Children younger than age 2 years should be vaccinated using a multidose schedule based upon age (see the Immunize.org document “Meningococcal ACWY Vaccine Recommendations by Age and Risk Factor,” available at www.immunize.org/catg.d/p2018.pdf for details).

People age 2 years and older with HIV infection who have not been previously vaccinated should receive a 2-dose primary series of MenACWY (doses separated by at least 8 weeks). People with HIV infection who have previously received one dose of MenACWY should receive a second dose at the earliest opportunity (at least 8 weeks after the previous dose) and then receive booster doses at the appropriate intervals (see Booster Doses below). ACIP does not recommend routine meningococcal serogroup B vaccination of people with HIV infection.

Last reviewed: July 15, 2023

It is not necessary to restart the MenACWY series. Give the person one dose of MenACWY vaccine now. This dose represents a delayed second dose in the primary series (a 2-dose primary series recommended for people with HIV infection). The patient will subsequently need booster doses every 5 years.

Last reviewed: July 15, 2023

If Menactra (MenACWY-D) is to be administered to a child at increased risk for meningococcal disease, including children who have HIV infection, Menactra should be given either before, at the same visit, or at least 6 months after DTaP. This is because data suggest a reduced response to the Menactra if given within a month after DTaP. Menactra may be used earlier than 6 months after DTaP if it is the only available option and vaccination is necessary due to travel to an area with epidemic or hyperendemic meningococcal disease. Menveo (MenACWY-CRM) and MenQuadfi (MenACWY-TT) vaccines may be given at any time before or after DTaP.

Last reviewed: July 15, 2023

No. Even though ACIP recommends that Menactra (MenACWY-D) should be given either before, at the same visit, or at least 6 months after DTaP, there is no evidence to support repeating the dose of Menactra. A child with a complement component deficiency should still receive a second dose of MenACWY vaccine at least 8 weeks after the first dose. In this case, if the 2nd dose also will be Menactra, it should wait until the child is 29 months old (6 months after the dose of DTaP).

Last reviewed: July 15, 2023

Yes. The recommendation about spacing of DTaP and Menactra (MenACWY-D) applies to all children younger than 7 years with a high-risk condition for meningococcal disease, including travelers. Menactra may be used earlier than 6 months after DTaP if it is the only available option and vaccination is necessary due to travel to an area with epidemic or hyperendemic meningococcal disease. Menveo (MenACWY-CRM) and MenQuadfi (MenACWY-TT) may be given at any time before or after DTaP.

Last reviewed: July 15, 2023

There is no specific indication for meningococcal vaccine in this patient. He is older than 21 years, and the risk–based recommendations are restricted to specific forms of altered immunocompetence (persistent complement component deficiency, functional or anatomic asplenia, use of eculizumab [Soliris] or ravulizumab [Ultomiris]) and HIV infection) and do not include other forms of altered immunocompetence.

Last reviewed: July 15, 2023

Although second-hand smoke and other environmental conditions have been identified as risk factors for meningococcal disease, ACIP does not include them as indications for MenACWY vaccination. Providers may always use their clinical judgment in situations not addressed by ACIP.

Last reviewed: July 15, 2023

ACIP recommends adolescents age 11 or 12 years be routinely vaccinated with MenACWY and receive a booster dose at age 16 years. Adolescents who receive the first dose at age 13 through 15 years should receive a one-time booster dose, preferably at age 16 through 18 years, just before the peak in incidence of meningococcal disease among adolescents occurs. Teens who receive their first dose of MenACWY at or after age 16 years do not need a booster dose, as long as they have no additional risk factors.

Last reviewed: July 15, 2023

In 2005, ACIP recommended routine MenACWY vaccination for all adolescents at age 11 or 12 years to protect them from meningococcal disease as older teens. The peak age for meningococcal disease is 16 through 21 years. Subsequent studies indicated that the protection provided by MenACWY wanes within 5 years following vaccination. For this reason, in 2010, ACIP recommended a MenACWY booster dose to provide continuing protection during the age of increased meningococcal incidence.

Last reviewed: July 15, 2023

A booster dose should be given to first-year college students, regardless of age, who are or will be living in a residence hall if the previous dose was given before the age of 16 years or if their most recent dose (given after the 16th birthday) was not given within the past 5 years.

Last reviewed: July 15, 2023

Yes. Doses of any quadrivalent meningococcal vaccine (MenACWY) given before 10 years of age should not be counted as part of the series. If a child received a dose of either MPSV4 (Menomune, a meningococcal polysaccharide vaccine no longer available in the United States) or MenACWY before age 10 years, they should receive a dose of MenACWY at 11 or 12 years and a booster dose at age 16 years. A dose of MenACWY administered at age 10 may count as the first adolescent dose normally given at 11 or 12.

Last reviewed: July 15, 2023

ACIP recommends routine booster doses of MenACWY for people two months old or older at ongoing high risk for meningococcal infection (see www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6909a1-H.pdf, Table 3). This group includes people (1) with persistent complement component deficiency (an immune system disorder) or who take a complement inhibitor (eculizumab [Soliris] or ravulizumab [Ultomiris]), (2) with anatomic or functional asplenia, (3) with HIV infection, (4) who have higher risk of exposure (including microbiologists who handle Neisseria meningitidis isolates and travelers to or residents of areas with epidemic or hyperendemic meningococcal disease [such as the meningitis belt of sub-Saharan Africa]).

Children at continued high risk who received the last dose of the primary series of MenACWY before age 7 years should receive the next dose 3 years after the most recent dose, then every 5 years as long as risk remains. People at continued high risk who received the last dose of the primary series at age 7 years or older should receive the next dose 5 years after the most recent dose then every 5 years as long as risk remains. Two of the 3 MenACWY brands are licensed through age 55 years; however, if MenQuadfi (MenACWY-TT, licensed for use at age 2 years and older) is unavailable for an adult age 56 years or older, you may use the available MenACWY product.

Last reviewed: July 15, 2023

Yes, people should receive additional booster doses (every 5 years) if they continue to be at highest risk for meningococcal infection.

Last reviewed: July 15, 2023

The MenACWY booster dose should be given at 14 years (5 years after the primary series) and every 5 years thereafter. The every 5-year booster dose schedule for people with high-risk conditions takes precedence over the routine adolescent schedule.

Last reviewed: July 15, 2023

If the person cannot provide written documentation of the previous vaccination you should assume they are unvaccinated and vaccinate accordingly.

Last reviewed: July 15, 2023

All meningococcal conjugate vaccines (MenACWY, MenB) should be administered by the intramuscular route.

Last reviewed: July 15, 2023

The liquid vaccine component (the diluent) of Menveo contains the C, W-135, and Y serogroups, and the lyophilized vaccine component (the freeze-dried powder) contains serogroup A. Because the patient received only the diluent, he or she is not protected against invasive meningococcal disease caused by N. meningitidis serogroup A.

Invasive disease with N. meningitidis serogroup A is very rare in the United States, but is more common in some other countries. If the recipient (of the C-Y-135 “diluent” only) is certain not to travel outside the United States then the dose does not need to be repeated. However, if the recipient plans to travel outside the United States the dose should be repeated with correctly reconstituted Menveo, the one-vial formulation of Menveo that does not require reconstitution, or with a dose of another brand of MenACWY. There is no minimum interval between the incorrect dose and the repeat dose.

Last reviewed: July 15, 2023

Yes. MenACWY and MenB vaccines can be given at the same visit or at any time before or after the other.

Last reviewed: July 15, 2023

In all three brands of MenACWY, the most common adverse events were injection site pain, swelling or redness. Other reported symptoms included malaise and headache.

Last reviewed: July 15, 2023

Yes. The National Vaccine Injury Compensation Program includes payment for injuries determined to have occurred following vaccination with a vaccine routinely recommended for children in the United States. The recipient can be of any age, but the vaccine must be routinely recommended for children and teens through age 18 years. MenACWY is routinely recommended for children so it is included in the program. More information about the program and the covered vaccines is at www.hrsa.gov/vaccine-compensation/covered-vaccines/index.html.

Last reviewed: July 15, 2023

As with all vaccines, a severe allergic reaction (for example, anaphylaxis) to a vaccine component or to a prior dose is a contraindication to further doses of that vaccine. A moderate or severe acute illness is a precaution; vaccination should be deferred until the person’s condition has improved. Because MenACWY is an inactivated vaccine, it can be administered to people who are immunosuppressed as a result of disease or medications; however, response to the vaccine might be less than optimal.

Last reviewed: July 15, 2023

Yes. No safety concerns associated with vaccination have been identified in mothers vaccinated during pregnancy or their infants.

Last reviewed: July 15, 2023

A history of GBS had previously been a precaution for Menactra (MenACWY-D). Findings from two studies that examined more than 2 million doses of Menactra given since 2005 showed no evidence of an increased risk of GBS. Consequently, ACIP recommended in 2010 to remove the precaution for use of Menactra in people with a history of GBS. This precaution did not apply to other meningococcal vaccines.

Last reviewed: July 15, 2023

Store any brand of MenACWY at refrigerator temperature, between 2° and 8°C (between 36° and 46°F). The vaccine must not be frozen. Vaccine that has been frozen or exposed to freezing temperature should not be used. Do not use after the expiration date.

Last reviewed: July 15, 2023

This page was updated on .