Ask the Experts: Meningococcal B: Vaccine Recommendations

Results (14)

The vaccines for meningococcal serogroups A, C, W, and Y (MenACWY; 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. The MenACWY vaccine products are considered interchangeable; the same vaccine product is recommended, but not required, for all doses.

Two meningococcal vaccines were used in the recent past but are no longer available. Menactra (Sanofi) is a discontinued MenACWY conjugate vaccine. The last doses of Menactra expired in 2023. Menactra was considered interchangeable with Menveo or MenQuadfi. An older meningococcal polysaccharide vaccine (MPSV4, Menomune, Sanofi) was available in the United States until the last doses expired in 2017: it was never routinely recommended for children or teens.

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. Bexsero and Trumenba are not interchangeable; the same vaccine product is required for all doses.

A pentavalent MenACWY and MenB vaccine, abbreviated MenABCWY (Penbraya, Pfizer) contains a conjugated MenACWY vaccine mixed with the MenB vaccine contained in Trumenba (Pfizer).

MenACWY vaccines provide no protection against serogroup B disease, and MenB vaccines 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, either as separate vaccines or as the combination MenABCWY vaccine, Penbraya.

Trade Name Type of Vaccine Serogroups Year Licensed Approved Ages
Penbraya Conjugate A, B, C, W, Y 2023 10–25 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: March 24, 2024

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.

The use of MenABCWY (Penbraya) is discussed in the notes of the current CDC Recommended Immunization Schedules available at: www.cdc.gov/vaccines/schedules/hcp/index.html.

Last reviewed: March 24, 2024

MenB is routinely recommended for these groups:

  • People age 10 years and older who have functional or anatomic asplenia (including sickle cell disease)
  • People age 10 years and older who have persistent complement component deficiency (an immune system disorder) or who take a complement inhibitor (examples include eculizumab [Soliris, Alexion Pharmaceuticals] and ravulizumab [Ultomiris, Alexion Pharmaceuticals])
  • People age 10 years and older who are exposed during an outbreak caused by serogroup B
  • Microbiologists who work with meningococcal isolates in a laboratory

For adolescents and young adults not otherwise at increased risk for meningococcal B disease, ACIP recommends that a MenB series may be administered to people 16 through 23 years of age (preferred age 16 through 18 years) on the basis of shared clinical decision-making. The shared clinical decision-making recommendation allows the clinician and patient to decide together based upon the risks and benefits of vaccination for the individual patient.

Last reviewed: March 24, 2024

The terminology change from “Category B” to “shared clinical decision-making” was done to describe more clearly the intent of the recommendation that the patient should be informed of the option to be vaccinated against meningococcal serogroup B disease and that the decision to vaccinate against MenB should be made by the provider and patient together. ACA requires coverage of vaccines as indicated on the recommended immunization schedule, including vaccines with shared clinical decision-making recommendations. The Vaccines for Children (VFC) program also covers vaccines recommended for shared clinical decision-making.

Last reviewed: March 24, 2024

To assist with the shared clinical decision-making around the option to vaccinate against meningococcal serogroup B disease and the timing of vaccination, CDC has provided some specific considerations about the disease and the vaccine that the patient and provider may weigh:

  • Serious nature of invasive meningococcal serogroup B infection, with a high risk of death and permanent complications
  • Low level of serogroup B disease in the United States, with an average of 34 cases each year among people age 16 through 23 years between 2015 and 2018, declining to 4 cases in 2021.
  • Increased risk among college students, especially those who are freshmen, attending a 4-year university, living in on-campus housing, or participating in sorority and fraternity life
  • Protection of MenB vaccine against most strains of meningococcal serogroup B bacteria
  • Estimated relatively short duration of MenB vaccine protection, with antibody levels waning within 1–2 years of completing the primary series; however, if a booster is indicated (e.g., during an outbreak) antibody titers rise in one to two weeks after booster dose administration
  • Evidence to date suggests no impact of MenB vaccine on meningococcal B carriage (may protect an individual from invasive disease but is unlikely to impact transmission of the bacteria to others)
Last reviewed: March 24, 2024

MenB vaccines were approved based on the serologic response to the vaccine. No data are available on vaccine effectiveness against clinical disease or duration of protection against clinical disease. Short term protection refers to the known duration of the antibody response. Available data indicate that protective antibody levels wane in most recipients within 1–2 years of completion of the primary series. Antibody levels rise sharply within 1-2 weeks of a booster dose.

Last reviewed: March 24, 2024

Several small outbreaks of meningococcal serogroup B disease have occurred on college campuses since 2013. However, the disease incidence in college students remains very low (0.03 cases per 100,000 college students age 18 to 24 years in 2020). ACIP does not routinely recommend MenB vaccine for college students. However, the recommendation for shared clinical decision-making applies to all college students age 16 through 23 years who may choose to receive MenB vaccine to reduce their risk of meningococcal serogroup B disease. In addition, some colleges and universities require MenB vaccination for incoming students.

If a college student completes the MenB vaccine series at least 6 months to 1 year before being identified as at risk during an outbreak, a single booster dose of the same brand can boost levels of protective antibodies within 1-2 weeks. The ability to be protected quickly during an outbreak by a single booster dose may be an important consideration for college students, families, and administrators when deciding about getting the MenB vaccine primary series.

Last reviewed: March 24, 2024

The MenB schedule depends upon the product used. Bexsero (MenB-4C, GSK) is a 2-dose series with doses given at least 1 month apart. Trumenba (MenB-Fhbp, Pfizer) is routinely given as a 2-dose series with doses administered at least 6 months apart. A 3-dose Trumenba schedule is recommended for people who need rapid protection against MenB due to an increased risk of MenB disease and for those who are immunocompromised and may not respond optimally to the 2-dose series. For the 3-dose schedule, dose 2 is given 1-2 months after dose 1 and dose 3 at least 6 months after dose 1.

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 adolescents and adults not at increased risk, if Penbraya is used for dose 1 MenB, Trumenba should be administered for dose 2 MenB. For people age 10 years or older at increased risk of meningococcal disease, Penbraya may be used for additional MenACWY and MenB 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.

Last reviewed: March 24, 2024

Healthy adolescents who are not at increased risk for meningococcal B disease should receive 2 doses of Trumenba (MenB-FHbp) administered at 0 and 6 months. If the second dose is given at an interval of less than 6 months, a third dose should be given at least 4 months after the 2nd dose.

For people age 10 years and older at increased risk for meningococcal B disease, 3 doses of Trumenba should be administered at 0, 1–2, and 6 months. The 3-dose series should be used for all people with functional or anatomic asplenia, people with persistent complement component deficiency (an immune system disorder) or those who take a complement inhibitor (examples include eculizumab [Soliris] and ravulizumab [Ultomiris]), microbiologists who work with meningococcal isolates in a laboratory, and people exposed during serogroup B outbreaks.

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 adolescents or adults not at increased risk, if Penbraya is used for dose 1 MenB, Trumenba should be administered for dose 2 MenB. For people age 10 years or older at increased risk of meningococcal disease, Penbraya may be used for additional MenACWY and MenB 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.

Last reviewed: March 24, 2024

No. The 3-dose series (at 0, 1–2 and 6 months) is intended to rapidly induce immunity to serogroup B meningococcal bacteria. If a microbiologist or other person at increased risk has received 2 doses of Trumenba separated by 6 months their vaccine series can be considered to be complete.

Last reviewed: March 24, 2024

The only way to meet the school entry deadline for a complete series by September would be to restart a primary series with Bexsero (MenB-4C), which requires two doses spaced at least 4 weeks apart. You must wait a minimum of 4 weeks after the Trumenba dose to initiate the Bexsero series.

Last reviewed: March 24, 2024

The patient can complete the series with either vaccine. If Bexsero (MenB-4C) is chosen, the second and final dose should be administered at least 1 month after yesterday’s dose. If Trumenba (MenB-FHbp) is chosen and the patient is healthy (i.e., does not have a high-risk condition for meningococcal B disease such as asplenia), the second and final dose of Trumenba should be administered at least 4 months after yesterday’s Bexsero dose (6 months after the first Trumenba dose). If the person is at increased risk for meningococcal B disease and Trumenba is being used, a second Trumenba dose should be administered 1 month after yesterday’s Bexsero dose and a third dose should be administered 4 months after the second Trumenba dose.

Last reviewed: March 24, 2024

Immunize.org has prepared a document that provides a summary of the ACIP recommendations for use of MenB. The document is available at www.immunize.org/catg.d/p2035.pdf.

Last reviewed: March 24, 2024

No. The ACIP meningococcal serogroup B vaccine recommendations state that the same vaccine (either Bexsero by GSK or Trumenba by Pfizer) must be used for all doses in the MenB series, including booster doses. If the brand of a previous dose is unavailable or cannot be determined, restart the primary series with the available brand. The pentavalent MenABCWY product Penbraya (Pfizer) contains MenB-Fhbp (Trumenba) as its MenB component; therefore, Penbraya should only be used in series with Trumenba.

Last reviewed: March 24, 2024

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