| Meningococcal ACWY |
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| Disease Issues |
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Please tell us about meningococcal disease. |
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| Meningococcal
disease is a bacterial infection caused by
Neisseria meningitidis. Meningococcal disease
usually presents clinically as meningitis
(about 50% of cases), bacteremia (30% of
cases), or bacteremic pneumonia (15% of
cases). N. meningitidis colonizes mucosal
surfaces of the nasopharynx and is transmitted
through direct contact with large-droplet
respiratory tract secretions from patients or
asymptomatic carriers. Meningococcal disease
can be severe. The overall case-fatality ratio
in the U.S. is 15%, and 10%–20% of survivors
have long-term sequelae such as neurologic
disability, limb or digit loss, and hearing
loss. |
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| N. meningitidis
is classified into 12 serogroups based on
characteristics of the polysaccharide capsule.
Most invasive disease (such as meningitis and
sepsis) is caused by serogroups A, B, C, W, X
and Y. The relative importance of serogroups
depends on geographic location and other
factors such as age. Serogroups B and C are the most frequent causes of disease in the
U.S., accounting for 42% and 26% of cases with
known serogroup, respectively, during
2015–2018. Serogroups W, Y, and nongroupable
strains each caused 9%–14% of cases during
that period. Serogroup A is rare in the U.S.
Historically, serogroup A was common in the
meningitis belt of sub-Saharan Africa, but
after the implementation of a meningococcal
serogroup A conjugate vaccine campaign, serogroup A disease has been nearly eliminated
in the meningitis belt. |
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| Nasopharyngeal
carriage rates are highest in adolescents and
young adults who serve as reservoirs for transmission of N. meningitidis. |
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How common is meningococcal disease? |
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| The incidence of
meningococcal disease has declined steadily in
the U.S. since a peak of reported disease in
the late 1990s. Even before routine use of a
meningococcal conjugate vaccine (MenACWY) in
adolescents was recommended in 2005, the
overall annual incidence of meningococcal
disease had decreased 64%, from 1.1 cases per
100,000 population in 1996 to 0.4 cases per
100,000 population in 2005. In 2018, the rate
of meningococcal disease in the U.S. reached a
historic low of 0.1 cases per 100,000
population. Incidence of disease caused by
serogroup B, a serogroup not included in the
routinely recommended MenACWY vaccine, also
has declined for reasons that are not known. |
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| During 2015–2018,
an estimated 360 cases of meningococcal disease
occurred annually in the United States, representing an average annual incidence of
0.11 cases per 100,000 population. Of those
with known serogroup in 2018 (N=302), 39% were
serogroup B and 51% were serogroups C, Y, or
W-135. The incidence of disease is highest in
infants under 1 year, children age 1 year, and
adolescents age 16–20 years. |
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What groups are at increased risk for
meningococcal disease? |
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| In addition to
risk based on age, non-specific risk factors
for serogroups A, C, W and Y include having a
previous viral infection, living in a crowded
household, having an underlying chronic
illness, and being exposed to cigarette smoke
(either directly or second-hand). |
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| The following
groups are at increased risk for all
meningococcal serogroups: |
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People with persistent (genetic)
complement component deficiencies (a type
of immune system disorder) |
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People who use complement inhibitors such
as eculizumab (Soliris, Alexion
Pharmaceuticals) and ravulizumab (Ultomiris,
Alexion Pharmaceuticals) for treatment of
atypical hemolytic uremic syndrome or
paroxysmal nocturnal hemoglobinuria |
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People with anatomic or functional
asplenia |
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Microbiologists routinely exposed to
meningococcal isolates in a laboratory |
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People at increased risk during an
outbreak of meningococcal disease |
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Military recruits |
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College students |
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| Certain groups
are at increased risk of serogroups A, C, W
and Y, but not serogroup B: |
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People living with HIV |
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Men who have sex with men (MSM) |
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Travelers to countries where meningococcal
disease is endemic or hyperendemic, such
as the meningitis belt of sub-Saharan
Africa |
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What meningococcal vaccines are available in
the United States? |
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| The vaccines for
meningococcal serogroups A, C, W, and Y
(MenACWY; Menactra, Sanofi Pasteur; Menveo, GlaxoSmithKline [GSK]; MenQuadfi, Sanofi
Pasteur) 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. |
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| A discontinued
meningococcal polysaccharide vaccine (MPSV4,
Menomune, Sanofi Pasteur) was available in the United States until all doses expired in
September 2017. With rare exception, it was
not interchangeable with MenACWY conjugate
vaccines. |
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| Since late 2014,
vaccines have become available that offer
protection from meningococcal serogroup B
disease (MenB; Bexsero, GSK; Trumenba,
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. |
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| 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. |
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Trade Name |
Type of Vaccine |
Serogroups |
Year Licensed |
Approved Ages |
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| Menactra |
Conjugate |
A, C, W, Y |
2005 |
9 mos.–55
years* |
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| Menveo |
Conjugate |
A, C, W, Y |
2010 |
2 mos.–55
years* |
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| MenQuadfi |
Conjugate |
A, C, W, Y |
2020 |
2 years and
older |
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| Trumenba |
Protein |
B |
2014 |
10–25
years* |
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| Bexsero |
Protein |
B |
2015 |
10–25
years* |
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| *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) |
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Where can I find the most current
meningococcal vaccine recommendations? |
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| 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. |
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Who is recommended to be vaccinated against
meningococcal ACWY disease? |
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| MenACWY is
recommended for these groups: |
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| 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 |
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| 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): |
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People with functional or anatomic
asplenia |
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People who have persistent complement
component deficiency (an immune system
disorder) or who take a complement
inhibitor (eculizumab
[Soliris] or ravulizumab [Ultomiris]) |
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People who have HIV infection |
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People who are at risk during an outbreak
caused by a vaccine serogroup |
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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) |
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Microbiologists who work with
meningococcus bacterial isolates in a
laboratory |
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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 |
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What is the schedule for MenACWY vaccine? |
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| 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. |
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If a child without any high risk conditions
received a dose of MenACWY (Menactra,
MenQuadfi or Menveo) vaccine at age 10 years
does the child need
to be revaccinated at age 11–12 years? |
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| 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. |
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Should college students be vaccinated against
meningococcal ACWY disease? |
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| 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. |
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Several healthy adult college students from
outside the U.S. (ages 24 years and older)
presented to our clinic. They will be living
in a residence hall. None
have a record of having received MenACWY.
Should the receive a dose of MenACWY now? |
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| 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. |
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We run immunization clinics at the local jail,
which has a living arrangement comparable to a
college residential hall. In this setting,
would you recommend
vaccinating incarcerated individuals as is recommended for people living in a college
dormitory? |
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| 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. |
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| Are there
recommendations for meningococcal ACWY
vaccination for people who reside in homeless shelters or halfway houses? In addition, can
you
comment on general vaccination recommendations
for people who reside in homeless shelters or
halfway houses? |
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| 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. |
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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. |
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Our patient is starting college with no
documented doses of meningococcal ACWY vaccine
and has had titers drawn. The lab test was
positive for A, C, W,
and Y. Lab reference values show >2.1 as
"suggestive of protection." Can we accept this
titer in lieu of documented MenACWY vaccine
doses? |
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| 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. |
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Can you provide a comprehensive overview of
the MenACWY recommendations, including those
for vaccinating younger children and older
adults who
have risk factors? |
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| IAC 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. |
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Menveo (MenACWY-CRM) is approved by the FDA
for use in children as young as 2 months of
age. What is the ACIP recommendation for use
of this
vaccine? |
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| Menveo is
approved for people age 2 months through 55
years. For children beginning the vaccination
series at age 2 months the schedule is 4 doses
at
age 2, 4, 6, and 12 to15 months. Fewer doses
are recommended for children beginning the
vaccination series at age 7 months or older.
See the IAC
document at
www.immunize.org/catg.d/p2018.pdf
for details. |
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| 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. |
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| I have a
3-month-old patient whose family will be doing
mission work in sub-Saharan Africa. They are leaving as soon as the child is 6 months old.
We
gave her the first dose of Menveo brand
MenACWY vaccine today. I know the usual Menveo
schedule for an infant is 2, 4, 6, and 12
months. If we
maintain usual spacing, she will only get 1
more dose before she leaves. Can we compress
the schedule so she can get 2 more doses prior
to travel? |
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| 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. |
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If a healthy child received MenACWY or
meningococcal polysaccharide (MPSV4)
vaccination prior to international travel at
age 9 years, will two additional
doses of MenACWY be needed? |
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| 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. |
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If someone received MenACWY vaccine at age 10
years and a dose of MenACWY before the 16th
birthday, will they still need a booster dose
at age 16? |
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| 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. |
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ACIP recommends that adolescents who receive
the first dose of MenACWY at age 13 through 15
years receive a one-time booster dose at age
16
through 18 years. Given how hard it is to get
teens into a medical office, is it okay to
give the doses close together if the
opportunity arises or should we
try to space it out as far as possible (age
18)? |
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| 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). |
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| The ACIP
recommendations advise using MenACWY in
certain adults older than age 55 years. Please
provide details of this recommendation.
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. |
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I administer a lot of travel vaccine doses.
What options do I have to give MenACWY to
travelers age 56 years and older? |
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| As of 2020, there
are three options for MenACWY vaccination. In
2020, MenQuadfi (Sanofi Pasteur) 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. |
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Are the three MenACWY vaccines
interchangeable? |
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| Menactra
(MenACWY-D) is not approved for children
younger than 9 months so only Menveo
(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. From age 2 years and up the vaccines
are
interchangeable. |
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| Which people
age 2 years and older are recommended to
receive a 2-dose primary series of MenACWY? |
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| 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 (see Booster
Doses section below). |
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| Which children
should be vaccinated before the routine
recommended age (11–12 years)? |
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| 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) is approved
for children age 2 months and 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. |
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| For children with
functional or anatomic asplenia, Menactra
should not be administered until at least 4
weeks after the pneumococcal conjugate vaccine
(PCV13, Prevnar13, Pfizer) vaccination series
is completed. Children at increased risk for
meningococcal disease should receive booster
doses as long
as they remain at increased risk (see Booster
Doses section below). |
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| Why delay
meningococcal vaccination with Menactra
(MenACWY-D) for infants with HIV or functional
or anatomic asplenia until the pneumococcal
conjugate vaccine series is completed? |
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| 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 PCV13 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 PCV13.
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 PCV13 series. Menveo
(MenACWY-CRM) and MenQuadfi (MenACWY-TT) do
not affect
the immune response to pneumococcal vaccine
and can be given at any time before or after
PCV13, although MenQuadfi is not licensed for
use in
children younger than age 2 years. |
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| Can we
vaccinate a 2-year-old boy with sickle cell
disease against meningococcal disease if he
has not completed a series of PCV13? |
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| Possibly. If you
are going to give him Menactra (MenACWY-D),
you need to wait at least 4 weeks after he completes the PCV13 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 PCV13 or at any interval
before or after receipt of PCV13. |
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| Adults who are
asplenic need PCV13 and MenACWY. Does the
recommendation to separate PCV13 and Menactra
(MenACWY-D) apply to adults as well
as children? |
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| Yes. If Menactra
(MenACWY-D) is being used, you should space it
4 weeks after PCV13. With both asplenic children and asplenic adults, if less than
four
weeks separate Menactra and PCV13 (in either
order), the dose of PCV13 should be repeated
four weeks after whichever vaccine was
administered
second. |
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| Menveo
(MenACWY-CRM) and MenQuadfi (MenACWY-TT) can
be administered at any time before, simultaneous with, or after PCV13. |
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| Do any of the
bacterial vaccines that are recommended for
people with functional or anatomic asplenia need to be given before splenectomy? Do the
doses count if they are given during the 2
weeks prior to surgery? |
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| PCV13,
Haemophilus influenzae type b vaccine,
MenACWY, and meningococcal B vaccine should be
given 14 days before splenectomy, if possible.
Doses given during the 14 days before surgery
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. Pneumococcal polysaccharide
vaccine should be administered 8 weeks after
the dose of
PCV13 for people 2 years of age and older. |
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| I have a
pediatric patient who has functional asplenia.
I gave her a dose of Menactra (MenACWY-D) when she was 3 years old. Do I need to give her a
booster at some time? |
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| 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. |
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| We have a
68-year-old who has been asplenic since 2009.
She had one dose of meningococcal polysaccharide vaccine (MPSV4) in 2009, but no
subsequent dose. She is now due for a booster.
Should she receive 2 doses of MenACWY, 2
months apart, to catch up, or just one dose? |
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| 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 Pasteur, discontinued in 2017)
previously, she may not have an adequate booster
response to a single dose of MenACWY. |
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| I have a
patient with paroxysmal nocturnal
hemoglobinuria who is being treated with
Soliris (eculizumab). Should he receive
meningococcal vaccine? |
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| 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. |
|
| We have a
10-year-old getting renal dialysis. The
nephrologist will be starting her on
ravulizumab (Ultomiris), which interferes with
C5 complement. If we
administer MenACWY and pneumococcal polysaccharide vaccine (PPSV23) now, and then
give her PCV13 in 8 weeks, will the PCV13
interfere with the
efficacy of the PPSV23 or the MenACWY? |
|
| Recommendations
to separate MenACWY and PCV13 only apply to
one of the three MenACWY vaccines, Menactra
(MenACWY-D), and also only apply
to individuals with functional or anatomic
asplenia or HIV infection. So the best
schedule is to give MenACWY (any brand)
simultaneously with PCV13,
and then PPSV23 in eight weeks. ACIP
recommends giving PCV13 before PPSV23 in order
to maximize the immune response from PCV13. PPSV23
may blunt the immune response to PCV13 if
PCV13 is given after PPSV23, although in
children there is a smaller effect than in
adults. A 10 year-old with
persistent complement component deficiency
also should receive a 2- or 3-dose series
(depending on brand) of meningococcal B
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. |
|
| Are people who
are HIV-positive at increased risk for
meningococcal disease? |
|
| 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 that all HIV-infected
people 2 months of age and older should
receive an age-appropriate MenACWY series.
Children younger
than age 2 years should be vaccinated using a
multidose schedule based upon age (see the IAC document "Meningococcal Vaccine
Recommendations
by Age and Risk Factor for Serogroups A, C, W,
or Y Protection" 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. |
|
| I have an
otherwise healthy 26-year-old patient with HIV
infection who received one dose of MenACWY three years ago. Should he receive one or two
doses now? Will he need booster doses later? |
|
| 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. |
|
| I have a
24-month-old patient with HIV infection and I
want to use Menactra (MenACWY-D) because this is the only vaccine we have available in our
clinic. However, this child received DTaP
vaccine yesterday at another clinic. Can I
administer MenACWY-D? |
|
| 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. |
|
| I have a
24-month-old patient with a complement
component deficiency who received a dose of
DTaP at 23 months of age and then received a
dose of
Menactra (MenACWY-D) two weeks later. Do I
need to repeat the dose of Menactra? |
|
| 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). |
|
| Does the
recommendation for separation of DTaP and
Menactra (MenACWY-D) also apply to children with functional or anatomic asplenia? |
|
| 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. |
|
| A 32-year-old
patient with ulcerative colitis is taking
high-dose immunosuppressive medications
(6-mercaptopurine). Should he receive
meningococcal
vaccine? |
|
| 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. |
|
| Should I
recommend MenACWY vaccine for a nonsmoker
living in a crowded household of smokers? |
|
| 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. |
|
|
|
|
|
| Should all
adolescents receive a routine booster dose of
MenACWY? |
|
| ACIP recommends
adolescents age 11 or 12 years be routinely
vaccinated with MenACWY and receive a booster dose at age 16 years. Adolescents who
receive the first dose at age 13 through 15
years should receive a one-time booster dose,
preferably at age 16 through 18 years, just
before the peak in
incidence of meningococcal disease among
adolescents occurs. Teens who receive their
first dose of MenACWY at or after age 16 years
do not need a
booster dose, as long as they have no
additional risk factors. |
|
| Why does ACIP
recommend a routine booster dose of MenACWY
for adolescents at age 16 years? |
|
| In 2005, ACIP
recommended routine MenACWY vaccination for
all adolescents at age 11 or 12 years to
protect them from meningococcal disease as
older teens. The peak age for meningococcal
disease is 16 through 21 years. Subsequent
studies indicated that the protection provided
by MenACWY
wanes within 5 years following vaccination.
For this reason, in 2010, ACIP recommended a
MenACWY booster dose to provide continuing protection
during the age of increased meningococcal
incidence. |
|
| Which
previously vaccinated college students need a
dose of MenACWY? |
|
| A booster dose
should be given to first-year college
students, regardless of age, who are or will
be living in a residence hall if the previous
dose was given
before the age of 16 years or if their most
recent dose (given after the 16th birthday)
was not given within the past 5 years. |
|
| If someone
received MPSV4 or MenACWY at age 9 years, will
two additional doses of MenACWY be needed? |
|
| Yes. Doses of
quadrivalent meningococcal vaccine (either
MPSV4 or MenACWY) given before 10 years of age should not be counted as part of the
series. If a child received a dose of either
MPSV4 (Menomune, a meningococcal
polysaccharide vaccine no longer available in
the United States) 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 years. A dose of MenACWY
administered at age 10 may count as the first
adolescent dose normally given at 11 or 12. |
|
| Which people
with risk factors should receive booster doses
beyond the routinely recommended adolescent
doses of MenACWY? |
|
| ACIP recommends
routine booster doses of MenACWY for people
two months old or older at ongoing high risk
for meningococcal infection (see
www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6909a1-H.pdf,
Table 3). This group includes people (1) with
persistent complement component deficiency (an
immune system disorder) or who take a complement inhibitor (eculizumab [Soliris] or
ravulizumab [Ultomiris]), (2) with anatomic or
functional asplenia, (3)
with HIV infection, (4) who have higher risk
of exposure (including microbiologists who
handle Neisseria meningitidis isolates and
travelers to or residents
of areas with epidemic or hyperendemic
meningococcal disease [such as the meningitis
belt of sub-Saharan Africa]). |
|
| Children at
continued high risk who received the last dose
of the primary series of MenACWY before age 7
years should receive the next dose 3 years
after the most recent dose, then every 5 years
as long as risk remains. People at continued
high risk who received the last dose of the
primary series at
age 7 years or older should receive the next
dose 5 years after the most recent dose then
every 5 years as long as risk remains. Two of
the 3 MenACWY
brands are licensed through age 55 years;
however, if MenQuadfi (MenACWY-TT, licensed
for use at age 2 years and older) is
unavailable for an adult
age 56 years or older, you may use the
available MenACWY product. |
|
| Should people
with continued high risk of meningococcal
disease receive additional doses of meningococcal vaccine beyond the 3- or 5-year
booster? |
|
| Yes, people
should receive additional booster doses (every
5 years) if they continue to be at highest
risk for meningococcal infection. |
|
| If a child
with a high-risk condition receives MenACWY at
age 9 years (and a second primary dose 8 weeks
later), should they receive a booster dose at
age 14 years (5 years after the primary
series), or should they receive a dose at age
16 years as recommended in the routine
schedule? |
|
| The MenACWY
booster dose should be given at 14 years (5
years after the primary series) and every 5
years thereafter. The every 5-year booster
dose
schedule for people with high-risk conditions
takes precedence over the routine adolescent
schedule. |
|
| What do you do
if an adult patient is in a high-risk
situation for meningococcal disease (for
example travel to sub-Saharan Africa) and
doesn't know
whether they received MenACWY or MPSV4 in the
past. Should we vaccinate them? |
|
| If the person
cannot provide written documentation of the
previous vaccination you should assume they
are unvaccinated and vaccinate accordingly. |
|
|
|
|
|
| By what route
should meningococcal vaccines be administered? |
|
| All meningococcal
conjugate vaccines should be administered by
the intramuscular route. Meningococcal serogroup B vaccine is given by the
intramuscular route. |
|
| We mistakenly
gave a patient the diluent for Menveo
(MenACWY-CRM) without adding it to the
powdered vaccine. Since vaccine antigen is
present in the
diluent as well as in the powder, what should
we do now? |
|
| The liquid
vaccine component (the diluent) of Menveo
contains the C, W-135, and Y serogroups, and
the lyophilized vaccine component (the
freeze-dried
powder) contains serogroup A. Because the
patient received only the diluent, he or she
is not protected against invasive
meningococcal disease caused
by N. meningitidis serogroup A. |
|
| Invasive disease
with N. meningitidis serogroup A is very rare
in the United States, but is more common in
some other countries. If the recipient (of the
C-Y-135 "diluent" only) is certain not to
travel outside the United States then the dose
does not need to be repeated. However, if the
recipient plans to travel
outside the United States the dose should be
repeated with either correctly reconstituted
Menveo, or with a dose of another brand of
MenACWY. There is
no minimum interval between the incorrect dose
and the repeat dose. |
|
| Can MenACWY
and MenB vaccines be given at the same visit? |
|
| Yes. MenACWY and
MenB vaccines can be given at the same visit
or at any time before or after the other. |
|
|
|
|
|
| What adverse
events are expected after receiving MenACWY? |
|
| In all three
brands of MenACWY, the most common adverse
event were injection site pain, swelling or
redness. Other reported symptoms included
malaise
and headache. |
|
| Is MenACWY
included in the National Vaccine Injury
Compensation Program? |
|
| Yes. The National
Vaccine Injury Compensation Program includes
payment for injuries determined to have occurred following vaccination with a vaccine
routinely recommended for children in the
United States. The recipient can be of any
age, but the vaccine must be routinely
recommended for children
and teens through age 18 years. MenACWY is
routinely recommended for children so it is
included in the program. More information about the program
and the covered vaccines is at
www.hrsa.gov/vaccine-compensation/covered-vaccines/index.html. |
|
|
|
|
|
| What are the
contraindications and precautions for MenACWY? |
|
| As with all
vaccines, a severe allergic reaction (for
example, anaphylaxis) to a vaccine component
or to a prior dose is a contraindication to
further doses
of that vaccine. A moderate or severe acute
illness is a precaution; vaccination should be
deferred until the person's condition has
improved. Because
MenACWY is an inactivated vaccine, it can be
administered to people who are
immunosuppressed as a result of disease or
medications; however,
response to the vaccine might be less than
optimal. |
|
| Can a pregnant
woman receive MenACWY vaccine? |
|
| Yes. No safety
concerns associated with vaccination have been
identified in mothers vaccinated during
pregnancy or their infants. |
|
| I understand
that a prior history of Guillain-Barré
syndrome (GBS) is no longer a precaution for
giving meningococcal conjugate vaccine. Please
tell me
more about this. |
|
| A history of GBS
had previously been a precaution for Menactra
(MenACWY-D). Findings from two studies that examined more than 2 million doses of
Menactra given since 2005 showed no evidence
of an increased risk of GBS. Consequently,
ACIP recommended in 2010 to remove the
precaution for use
of Menactra in people with a history of GBS.
This precaution did not apply to other
meningococcal vaccines. |
|
|
|
|
|
| What is the
storage requirement for MenACWY? |
|
| Store any brand
of MenACWY at refrigerator temperature,
between 2° and 8°C (between 36° and 46°F). The vaccine must not be frozen. Vaccine that
has been frozen or exposed to freezing
temperature should not be used. Do not use
after the expiration date. |
|
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ACIP Recommendations
Vaccine Information Statements 
