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
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
