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Ask the Experts: Meningococcal ACWY: Vaccine Recommendations

Results (19)

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

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

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