Vaccines: Neisseria meningitidis (Meningococcal) Infections

Specific vaccination recommendations vary among countries or even within a given country. Local or country-specific guidelines should be consulted.

1. Vaccines: All meningococcal vaccines contain inactivated viruses. Some meningococcal vaccines are oligosaccharide or polysaccharide conjugate vaccines, in which the antigens are attached to a carrier protein, increasing their immunogenicity. A monovalent recombinant meningococcal group B (MenB) vaccine is also available. Vaccines available for use in North America fall into 1 of 3 categories:

1) Monovalent conjugate meningococcal vaccines (Men-C-C).

2) Quadrivalent conjugate meningococcal vaccines (Men-C-ACYW), containing the antigens of groups A, C, Y, and W.

3) Monovalent recombinant MenB vaccines (MenB-fHBP or 4CMenB).

2. Indications: Conjugated and recombinant meningococcal vaccines are recommended for the prevention of invasive meningococcal disease caused by meningococci in susceptible individuals, particularly in:

1) Patients with anatomic or functional asplenia (optimally vaccination should be performed ≥2 weeks prior to elective splenectomy), sickle cell disease, and combined T- and B-cell immunodeficiencies.

2) Patients with impaired humoral immune responses, including primary deficiencies of complement components, properdin, factor D; acquired complement deficiency, such as in patients receiving eculizumab; or patients living with HIV infection.

3) Laboratory personnel handling microbiologic samples.

4) Patients living in congregant settings, such as dormitories, boarding houses, or military barracks.

5) Children and adolescents living in epidemic regions.

6) Travelers to endemic areas, with specific considerations for those traveling to sub-Saharan Africa or to Saudi Arabia for the purposes of Umrah or Hajj or for seasonal work (see Immunization Prior to Travel to Endemic Areas).

There is limited pregnancy safety data. Immunocompromised patients may receive the vaccine safely.

3. Contraindications are the same as general contraindications for all inactivated vaccines.

4. Immunization schedule: The primary vaccination series consists of 1 IM dose of Men-C-C given at 12 to 23 months of age followed by a dose of Men-C-C or Men-C-ACYW at the age of 12 to 24 years. In some Canadian provinces or territories, infants may receive Men-C-C vaccine from 2 months of age as per the local childhood immunization series. MenB-fHBP or 4CMenB vaccines may be added to the primary series in regions with high serogroup B endemicity. In cases where serotype B vaccination is required, if 4CMenB is used, 2 doses should be given ≥4 weeks apart; if MenB-fHBP is used, 2 doses should be given ≥6 months apart. In patients with functional or anatomic asplenia or complement deficiency, consider adding a booster dose after 5 years. Travel-specific recommendations: see Immunization Prior to Travel to Endemic Areas.

5. Postexposure immunization: Close contacts of patients with invasive meningococcal disease should, in addition to chemoprophylaxis, be considered for immunization with repeat vaccination regardless of the close contacts’ immune status if they are household contacts, share sleeping arrangements with the patient, or have direct contact with oropharyngeal secretions of the patient. In particular, immunization should be considered when the index case is identified as being a vaccine-preventable serogroup.

6. Adverse events: Approximately 50% of individuals develop a local and transient injection-site reaction with Men-C-C vaccine. In infants up to 3 years old, the coadministration of 4CMenB with other vaccinations in the primary childhood series leads to an increased rate of fever, and acetaminophen (INN paracetamol) is often given prophylactically. Serious adverse events with meningococcal vaccines are rare.