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ACIP Updates Recommendations on the Use of MenACWY and MenB Vaccines

October 2020

Technically Speaking
A Monthly Column by Deborah Wexler, MD
Deborah Wexler MD
IAC Executive Director Dr. Deborah Wexler writes Technically Speaking, a column featured in each issue of Vaccine Update for Healthcare Professionals, the monthly e-newsletter from the Vaccine Education Center (VEC) at the Children’s Hospital of Philadelphia. Technically Speaking columns cover practical topics in immunization delivery such as vaccine administration techniques, storage and handling, contraindications and precautions, and scheduling.
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TECHNICALLY SPEAKING
ACIP Updates Recommendations on the Use of MenACWY and MenB Vaccines
Published October 2020
The Advisory Committee on Immunization Practice’s (ACIP’s) updated guidance for meningococcal serogroups A, C, W, and Y vaccine (MenACWY) and meningococcal serogroup B vaccine (MenB) was recently published in the MMWR Recommendations and Reports. This publication, Meningococcal Vaccination: Recommendations of the Advisory Committee on Immunization Practices, United States, 2020, replaces and consolidates all previously published ACIP meningococcal vaccine recommendations. The descriptive terminology “shared clinical decision-making” has been added for the 2-dose MenB vaccination series in persons age 16–23 years. The guidance also contains new recommendations for off-label administration of booster doses of MenB for persons at increased risk for serogroup B meningococcal disease, including microbiologists and people age >10 years with persistent complement deficiencies, complement inhibitor use, or anatomic or functional asplenia. Booster doses are recommended one year following completion of a MenB primary series followed by MenB booster doses every 2–3 years thereafter. A one-time booster dose also is recommended for persons at increased risk during an outbreak.

A summary (from Box 1, found on page 3 of the publication) of the ACIP recommendations for MenACWY and MenB vaccines is reprinted below.

ACIP recommends MenACWY vaccination for the following groups:

  • Routine vaccination for adolescents age 11 or 12 years, with a booster dose at age 16 years.
  • Routine vaccination of persons age >2 months at increased risk for meningococcal disease (dosing schedule varies by age and indication, and interval for booster dose varies by age at time of previous vaccination):
    • Persons with certain medical conditions including anatomic or functional asplenia, complement component deficiencies (e.g., C3, C5–C9, properdin, factor H, or factor D), complement inhibitor (e.g., eculizumab [Soliris] or ravulizumab [Ultomiris]) use, or human immunodeficiency virus infection.
    • Microbiologists with routine exposure to Neisseria meningitidis isolates.
    • Persons at increased risk during an outbreak (e.g., in community or organizational settings, and among men who have sex with men [MSM]).
    • Persons who travel to or live in countries in which meningococcal disease is hyperendemic or epidemic.
    • Unvaccinated or undervaccinated first-year college students living in residence halls.
    • Military recruits.
  • Booster doses for previously vaccinated persons who become or remain at increased risk.

ACIP recommends MenB vaccination for the following groups:

  • Routine vaccination of persons age >10 years at increased risk for meningococcal disease (dosing schedule varies by vaccine brand; boosters should be administered at 1 year after primary series completion, then every 2–3 years thereafter):
    • Persons with certain medical conditions, such as anatomic or functional asplenia, complement component deficiencies, or complement inhibitor use.
    • Microbiologists with routine exposure to Neisseria meningitidis isolates.
    • Persons at increased risk during an outbreak (e.g., in community or organizational settings, and among MSM).
  • Vaccination of adolescents and young adults age 16–23 years with a 2-dose MenB series on the basis of shared clinical decision-making. The preferred age for MenB vaccination is 16–18 years. Booster doses are not recommended unless the person becomes at increased risk for meningococcal disease.
  • Booster doses for previously vaccinated persons who become or remain at increased risk.

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