Since the patient is asplenic, the second dose of the primary series of MenACWY should be given at least 8 weeks after the first dose. He will need a dose of MenACWY every 5 years for the rest of his life. The series of MenB (whether Trumenba or Bexsero) should be completed. The first booster dose of MenB will be due one year after completion of the primary series and subsequent booster doses are recommended every 2–3 years for the rest of his life. The same MenB vaccine should be used for all doses in the series, including booster doses. People who receive Trumenba brand MenB vaccine have an option to receive MenABCWY (Penbraya, Pfizer) when both MenACWY and MenB vaccines are due at the same visit, as long as doses of Penbraya are spread out by at least 6 months. The patient has already received the one dose of PCV15 recommended for adults, so no further doses are needed. He also has properly received his first dose of PPSV at least 8 weeks after the dose of PCV15. No additional doses of pneumococcal vaccination are recommended at this time. Based on the patient’s age, only one dose of Hib vaccine is recommended, so no further doses are needed. The patient should receive influenza vaccine annually.
Any of these vaccines can be given at the same appointment, except for PCV15 and PPSV23.
Last reviewed:
April 10, 2024
Eculizumab (Soliris) and related long-acting compounds, such as ravulizumab (Ultomiris), 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 2-dose primary series of MenACWY vaccine (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.
Penbraya (MenABCWY, Pfizer) contains MenB-Fhbp (Trumenba) and is given as two doses, 6 months apart, when vaccination against all 5 serogroups is needed. For people age 10 years or older at increased risk of meningococcal disease, like this patient, Penbraya may be used for MenACWY and MenB (Trumenba) doses (including booster doses) if both vaccines would be given on the same clinic day and at least 6 months have elapsed since most recent Penbraya dose.
Because patients treated with complement inhibitors can develop invasive meningococcal disease despite vaccination, clinicians using these products also may consider antimicrobial prophylaxis for the duration of complement inhibitor therapy.
Last reviewed:
March 24, 2024
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 (for example, eculizumab [Soliris] or ravulizumab [Ultomiris]). People with these high-risk medical conditions also need booster doses of MenACWY.
Last reviewed:
March 24, 2024
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 (examples include eculizumab [Soliris] and 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. MenQuadfi (MenACWY-TT) is approved for children age 2 years and older. Children at increased risk for meningococcal disease should receive booster doses as long as they remain at increased risk.
Last reviewed:
March 24, 2024
Yes. Menveo (MenACWY-CRM) or MenQuadfi (MenACWY-TT) may be given simultaneously with PCV or at any interval before or after receipt of PCV.
Last reviewed:
March 24, 2024
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:
March 24, 2024
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, unavailable since 2017) previously, she may not have an adequate booster response to a single dose of MenACWY.
Last reviewed:
March 24, 2024
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:
March 24, 2024
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:
March 24, 2024
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:
March 24, 2024
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 complement inhibitors such as eculizumab [Soliris] or ravulizumab [Ultomiris], and HIV infection) and do not include other forms of altered immunocompetence.
Last reviewed:
March 24, 2024
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:
March 24, 2024
