Technically Speaking: ACIP Updates Recommendations on the Use of MenACWY and MenB Vaccines

The Advisory Committee on Immunization Practice’s (ACIP’s) updated guidance for meningococcal serogroups A, C, W, and Y vaccine (MenACWY) and meningococcal serogroup B vaccine (MenB) was recently published in the MMWR Recommendations and Reports. This publication, Meningococcal Vaccination: Recommendations of the Advisory Committee on Immunization Practices, United States, 2020, replaces and consolidates all previously published ACIP meningococcal vaccine recommendations. The descriptive terminology “shared clinical decision-making” has been added for the two-dose MenB vaccination series in people between 16–23 years of age. The guidance also contains new recommendations for off-label administration of booster doses of MenB for persons at increased risk for serogroup B meningococcal disease, including microbiologists and people age ≥ 10 years with persistent complement deficiencies, complement inhibitor use, or anatomic or functional asplenia. Booster doses are recommended one year following completion of a MenB primary series followed by MenB booster doses every 2–3 years thereafter. A one-time booster dose also is recommended for persons at increased risk during an outbreak.

A summary (from Box 1, found on page 3 of the publication) of the ACIP recommendations for MenACWY and MenB vaccines is reprinted below.

ACIP recommends MenACWY vaccination for the following groups:

• Routine vaccination for adolescents age 11 or 12 years, with a booster dose at age 16 years
• Routine vaccination of persons age ≥ 2 months at increased risk for meningococcal disease (dosing schedule varies by age and indication, and interval for booster dose varies by age at time of previous vaccination)
  • Persons with certain medical conditions, including anatomic or functional asplenia, complement component deficiencies (e.g., C3, C5–C9, properdin, factor H, or factor D), complement inhibitor (e.g., eculizumab [Soliris] or ravulizumab [Ultomiris]) use, or human immunodeficiency virus infection
  • Microbiologists with routine exposure to Neisseria meningitidis isolates
  • Persons at increased risk during an outbreak (e.g., in community or organizational settings, and among men who have sex with men [MSM])
  • Persons who travel to or live in countries in which meningococcal disease is hyperendemic or epidemic
  • Unvaccinated or under-vaccinated first-year college students living in residence halls
  • Military recruits
• Booster doses for previously vaccinated persons who become or remain at increased risk

ACIP recommends MenB vaccination for the following groups:

• Routine vaccination of persons age ≥ 10 years at increased risk for meningococcal disease (dosing schedule varies by vaccine brand; boosters should be administered at 1 year after primary series completion, then every 2–3 years thereafter):
  • Persons with certain medical conditions, such as anatomic or functional asplenia, complement component deficiencies, or complement inhibitor use
  • Microbiologists with routine exposure to Neisseria meningitidis isolates
  • Persons at increased risk during an outbreak (e.g., in community or organizational settings, and among MSM)
• Vaccination of adolescents and young adults age 16–23 years with a two-dose MenB series on the basis of shared clinical decision-making. The preferred age for MenB vaccination is 16–18 years. Booster doses are not recommended unless the person becomes at increased risk for meningococcal disease
• Booster doses for previously vaccinated persons who become or remain at increased risk

Additional resources

From CDC

• Meningococcal Vaccination: Recommendations of the Advisory Committee on Immunization Practices
• Meningococcal Vaccination: Information for Healthcare Professionals gateway page

From IAC

• Ask the Experts: Meningococcal ACWY webpage
• Ask the Experts: Meningococcal B webpage
• Handouts: Meningococcal ACWY gateway page
• Handouts: Meningococcal B gateway page
• Meningococcal ACWY VIS gateway page
• Meningococcal B VIS gateway page