Meningococcal Vaccination for Adolescents: Questions and Answers
Information for Healthcare Professionals
Meningococcal vaccination is recommended for all adolescents. Follow the recommended immunization schedule to ensure that your patients get the meningococcal vaccines that they need.
- All 11 to 12 year olds should be vaccinated with a single dose of quadrivalent (protects against serogroups A, C, W, and Y) meningococcal conjugate vaccine.
- Since protection wanes, a booster dose is recommended at age 16 years so adolescents continue to have protection during the ages when they are at highest risk of meningococcal disease.
- New meningococcal vaccines for serogroup B were licensed by the Food and Drug Administration (FDA) in 2014 and 2015.
- Adolescents and young adults (16 through 23 years of age) may also be vaccinated with a serogroup B meningococcal vaccine, preferably at 16 through 18 years of age.
Q: Why are meningococcal vaccines recommended for adolescents?
A: Anyone can get meningococcal disease, but adolescents and young adults 16 through 23 years of age (not just those in college) are at increased risk for meningococcal disease. Meningococcal bacteria can cause severe disease, including meningitis, bacteremia, and septicemia, resulting in permanent disabilities and even death.
Q: Is there one meningococcal vaccine that can help protect adolescents from all common serogroups of meningococcal disease?
A: No. Some meningococcal vaccines for adolescents are designed to protect against four serogroups (A, C, W, and Y), while others help protect against one serogroup (B). There are currently no meningococcal vaccines that can help protect against all common serogroups that cause most meningococcal disease.
Q: Can adolescents receive quadrivalent meningococcal vaccine and serogroup B meningococcal vaccine at the same time? What about with other vaccines recommended for adolescents?
A: Yes. Meningococcal and other vaccines may be administered during the same visit, but at a different anatomic site if feasible.
Q: Are meningococcal vaccines recommended for adolescents during outbreaks?
A: Yes. In the setting of a serogroup A, C, W, or Y meningococcal disease outbreak, vaccination with quadrivalent meningococcal vaccine is recommended for adolescents identified as being at increased risk because of the outbreak. In the setting of a serogroup B meningococcal disease outbreak, adolescents identified as being at increased risk because of the outbreak should be vaccinated with serogroup B meningococcal vaccine.
Quadrivalent Meningococcal Conjugate Vaccines
Q: Why is a booster dose of quadrivalent meningococcal vaccine recommended at 16 years of age?
A: Protection from meningococcal conjugate vaccination wanes in most adolescents within 5 years. Based on that information, a booster dose is needed, preferably at age 16, so adolescents continue to have protection during the years when they are at highest risk of meningococcal disease.
Q: How safe are quadrivalent meningococcal conjugate vaccines?
A: Quadrivalent meningococcal conjugate vaccines are very safe. Vaccine safety continues to be monitored. For information about side effects, see the Meningococcal ACWY Vaccine Information Statement.
Q: Should I vaccinate patients who are about to start college and got their first dose of quadrivalent meningococcal conjugate vaccine more than 5 years ago?
A: Yes. For the best protection, these patients should receive a booster dose of quadrivalent meningococcal conjugate vaccine. This vaccination is required to attend many colleges. CDC recommends that students receive the vaccine within 5 years prior to starting college.
Q: What is the minimum booster dose interval for quadrivalent meningococcal vaccine?
A: The minimum interval between doses is 8 weeks. A booster is not indicated if the initial dose is given at or after age 16 in healthy persons.
Q: Should I administer a booster dose of quadrivalent meningococcal conjugate vaccine to patients younger than 16 years who I might not see again?
A: As in many similar situations, clinicians should use their clinical judgment in a situation where you may not have another opportunity to provide the booster dose to patients. The minimum interval between doses is 8 weeks.
Q: What is the dosing schedule of quadrivalent meningococcal conjugate vaccine for adolescents who have HIV?
A: Adolescents 11 through 18 years of age with HIV should be routinely vaccinated with a 2-dose primary series administered 8 weeks apart. Those adolescents should also receive the routine booster dose at age 16 years if the primary series is received before their 16th birthday.
Q: Is meningococcal polysaccharide vaccine a valid vaccination for adolescents?
A: Only the quadrivalent meningococcal conjugate vaccine is recommended for adolescents. However, a first dose of meningococcal vaccine administered as polysaccharide vaccine can be counted as valid in the adolescent schedule. The booster dose of meningococcal vaccine should always be quadrivalent meningococcal conjugate vaccine. If polysaccharide vaccine is inadvertently administered as the booster dose, revaccination with conjugate vaccine is recommended 8 weeks later.
Serogroup B Meningococcal Vaccines
Q: Why aren’t all adolescents recommended to routinely receive serogroup B meningococcal vaccine?
A: The Advisory Committee on Immunization Practices (ACIP) recently recommended that clinicians may choose to administer serogroup B meningococcal vaccine to patients 16 through 23 years of age. This guideline is different from the recommendation for quadrivalent meningococcal conjugate vaccine, which specifically states that clinicians should administer that vaccine to adolescents at 11 or 12 and again at 16 years of age.
ACIP recommended to leave serogroup B meningococcal vaccination in adolescents up to individual clinical decision making for the following reasons:
- Important data for making policy recommendations are not yet available because these vaccines were recently licensed for use in the United States under an accelerated approval process. This includes data on
- Breadth of coverage of these vaccines against serogroup B strains circulating in the United States
- Vaccine effectiveness and duration of effectiveness
- Impact of these vaccines on carriage and herd immunity
- Safety of these vaccines post-licensure
- The current burden of disease is low, which means that the number of adolescents that need to be vaccinated to prevent a case and death is high.
Q: What data are currently available on serogroup B meningococcal vaccines?
A: Available data suggest that serogroup B meningococcal vaccines are an important step forward for controlling serogroup B meningococcal disease, but they will not prevent all cases. These vaccines provide protection against most but not all serogroup B strains circulating in the United States. Additional studies assessing breadth of strain coverage are ongoing, and ACIP will review results as they become available. Immunogenicity studies predict efficacy of serogroup B meningococcal vaccines in most individuals in the short term, but there are currently no data available on vaccine effectiveness or duration of effectiveness; the limited data available on antibody persistence suggest rapid waning of antibodies after vaccination. Additionally, the potential impact of serogroup B meningococcal vaccines on carriage and herd immunity is inconclusive, as is the potential impact selection pressure from vaccine introduction will have on circulating strains.
Q: Why is serogroup B meningococcal vaccine preferred to be administered at 16 through 18 years of age?
A: Based on the available antibody persistence data, ACIP concluded that there was a preference to administer the serogroup B meningococcal vaccine series in later adolescence, preferably at age 18 years, to maximize the likelihood that adolescents would have protection during the ages (16 through 23 years) when they are at highest risk of meningococcal disease. However, ACIP recognized that while young adults may still be under the care of a pediatrician at 16 years of age, it is less likely they will receive care from a pediatrician at age 18. Adolescents should be making a visit to their healthcare professional at age 16 years for the quadrivalent meningococcal conjugate booster; this visit at age 16 years provides the opportunity to initiate and complete the multi-dose serogroup B meningococcal vaccine series before entering the higher age-related risk period.
Q: Are serogroup B meningococcal vaccines safe?
A: Available data suggest that serogroup B meningococcal vaccines are safe. Side effects like pain at the injection site, fever, and headache are common, but resolve on their own within 3 to 7 days after vaccination. Serogroup B meningococcal vaccines are more reactogenic than other adolescent vaccines (i.e., HPV, quadrivalent meningococcal conjugate, and Tdap vaccine) and likely to produce common or expected short-term side effects (especially pain at the injection site). There have been no unusual patterns of serious reactions associated with these vaccines.
There is also a theoretical concern for autoimmune disorders following serogroup B meningococcal vaccination. Both serogroup B meningococcal vaccines contain components that include factor H binding protein. In 2 animal models, antibodies measured after Bexsero® vaccination have been noted to be cross reactive with human factor H. However, it is not known if auto-antibodies to factor H develop in humans after vaccination with either serogroup B meningococcal vaccine. It is also not known if auto-antibodies generated post-vaccination are of clinical significance. Safety data were available from 6 Bexsero® clinical trials and 7 Trumenba® clinical trials, which in total included approximately 3,100 and 4,500 vaccine recipients. For most of the participants who reported an autoimmune condition, the onset of symptoms consistent with the diagnosis existed prior to the first vaccination. Theoretically, onset of autoimmune disease related symptoms could be delayed well beyond vaccination. Post-licensure safety surveillance will be important to detect any potential safety signals.
Q: Are there any precautions to consider when administering serogroup B meningococcal vaccine?
A: Before administering serogroup B meningococcal vaccine, providers should consult the package insert (Bexsero® [11 pages] or Trumenba® [10 pages]) for precautions, warnings, and contraindications. For a summary of contraindications and precautions, see the Serogroup B Meningococcal Vaccine Information Statement.
Q: Do I need to administer all the recommended doses of serogroup B meningococcal vaccine?
A: Yes. Both serogroup B meningococcal vaccine products require more than one dose for maximum protection; two doses for Bexsero® (0, ≥1 month after first dose) and three doses for Trumenba® (0, 2 months after first dose, 6 months after first dose). The same vaccine product must be used for all doses.
Q: Is there a preference for which serogroup B meningococcal vaccine I use?
A: No, CDC has no preference as to which serogroup B meningococcal vaccine you use. The same vaccine product must be used for all doses. If different products were administered for any of the doses, proceed with the next scheduled dose of the selected product with a minimum of 1 month since the last dose of either product.
Q: Does insurance cover the cost for serogroup B meningococcal vaccination?
A: Most health plans must cover a set of preventive services, including vaccines recommended on the CDC immunization schedules, with no out-of-pocket costs when provided by an in-network healthcare provider. Health plans are required to cover new vaccine recommendations without cost-sharing in the next plan year that occurs one year after the effective date of the recommendation, which is the date of publication in CDC’s Morbidity and Mortality Weekly Report (MMWR).
On October 23, 2015, a new recommendation was published in the MMWR for serogroup B meningococcal vaccination of those 16 through 23 years of age. The recommendation to administer serogroup B meningococcal vaccine to persons 10 years or older identified as being at increased riskdue to a medical condition or a serogroup B meningococcal disease outbreak was published in theMMWR on June 12, 2015.
Patients should check with their insurance provider for details on whether there is any cost to them for this vaccine.
The Vaccines for Children, or VFC, program provides vaccines for children 18 and younger who are not insured, Medicaid-eligible, or American Indian or Alaska Native. Parents can find a VFC provider by contacting their local health department. VFC will cover the cost of serogroup B meningococcalvaccination for those
- 16 through 18 years of age
- 10 through 18 years of age identified as being at increased risk due to a medical condition or a serogroup B meningococcal disease outbreak
Q: Where should I refer patients who request serogroup B meningococcal vaccination if I do not stock the vaccine?
A: College health centers or pharmacies may have serogroup B meningococcal vaccine available. Patients can also locate vaccine providers who carry serogroup B meningococcal vaccine by using the HealthMap Vaccine Finder.
Q: If parents ask me about serogroup B meningococcal vaccination, where can I find more information to educate myself or share with them?
A: The below resources offer additional information for clinicians and parents about serogroup B meningococcal vaccination:
- ACIP Recommendations
- Package Inserts: Bexsero® [10 pages], Trumenba® [11 pages]
- For Parents of Teenagers: Questions and Answers about Meningococcal Vaccination
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