meningococcal A C Y and W-135 diphtheria conjugate vaccine (Rx)

Meningococcal Vaccination

Indicated active immunization to prevent invasive meningococcal disease caused by Neisseria meningitidis serogroups A, C, Y, and W-135 in high risk adults

0.5 mL/dose IM

Immunization for High-Risk Conditions (ACIP Guidelines)

MenACWY is preferred for adults with any of the following indications who are aged ≤55 yr as well as for adults aged ≥56 years who a) were vaccinated previously with MenACWY and are recommended for revaccination, or b) for whom multiple doses are anticipated

Meningococcal polysaccharide vaccine (MPSV4 [Menomune]) is preferred for adults aged ≥56 years who have not received MenACWY previously and who require a single dose only (eg, travelers)

Asplenia or complement deficiencies

• Indicated in adults of all ages with functional asplenia or persistent complement component deficiencies
• Menactra or Menveo: Administer 2 doses at least 2 months apart to adults of all ages with functional asplenia or persistent complement component deficiencies
• Booster dose: Every 5 years

HIV Infection

• ACIP recommends routine immunization for persons aged ≥2 months with HIV infection

• Menactra or Menveo

  • Not previously vaccinated: Give 2-dose primary series
  • Previously vaccinated with 1 dose of conjugate vaccine: Give a booster dose at the earliest opportunity, provided at least 8 wk have elapsed since the previous dose, and then continue to receive boosters at the appropriate interval throughout life

Microbiologists

• Administer a single dose of meningococcal vaccine to microbiologists routinely exposed to isolates of Neisseria meningitidis
• Booster dose: Every 5 years

Military recruits

• Administer a single dose

First-year college students

• Administer a single dose for first-year college students (up through age 21 years) who are living in residence halls should be vaccinated if they have not received a dose on or after their 16th birthday

Community outbreak

• Administer a single dose for persons at risk during an outbreak attributable to a vaccine serogroup

Travel/reside in hyperendemic/epidemic countries

• Administer a single dose for adults who travel to or reside in countries in which meningococcal disease is hyperendemic or epidemic, including countries in the African meningitis belt or the Hajj
• International travelers should receive a booster dose of MenACWY if the last dose was administered >4 years previously
• Vaccination in the 3 years before the date of travel is required by the government of Saudi Arabia for all travelers to Mecca during the annual Hajj

Primary Immunization (Adolescent)

Routine primary vaccination of adolescents recommended at age 11 or 12 years unless high risk or outbreak requires earlier vaccination at younger age

11-12 years: 0.5 mL IM once; CDC recommends booster dose at age 16 yr

11-12 years (HIV infection): 2-dose primary series of 0.5 mL IM with at least 8 wk between doses (CDC guidelines)

Catch-up schedule (Adolescent)

• Administer vaccine at age 13 through 18 years if not previously vaccinated
• If first dose is administered at age 13 through 15 years, a booster dose should be given at age 16 through 18 years; minimum interval between doses is 8 weeks
• If first dose administered at age 16 or older, a booster dose is not needed

First-year college students

• First-year college students (up to age 21 yr) living in residence halls should receive at least 1 dose of MenACWY before college entry; the preferred timing of the most recent dose is on or after their 16th birthday
• If only 1 dose of vaccine was administered before the 16th birthday, a booster dose should be administered before enrollment

Immunization for High-Risk Conditions (ACIP Guidelines)

Asplenia

• Indicated for children with anatomic or functional asplenia (including sickle cell disease)
• Menveo for children aged <19 months: 4-dose infant series given at 2, 4, 6, and 12 through 15 months
• For children aged 19 through 23 months who have not completed a series of MenHibrix or Menveo, administer 2 primary doses of Menveo at least 3 months apart
• For children aged ≥24 months who have not received a complete series of MenHibrix or Menveo or Menactra, administer 2 primary doses of either Menactra or Menveo at least 2 months apart
• Booster dose: Every 5 years

HIV Infection

• ACIP recommends routine immunization for persons aged ≥2 months with HIV infection

• Menactra or Menveo

  • Not previously vaccinated: Give 2-dose primary series
  • Previously vaccinated with 1 dose of conjugate vaccine: Give a booster dose at the earliest opportunity, provided at least 8 wk have elapsed since the previous dose, and then continue to receive boosters at the appropriate interval throughout life

Complement Deficiency

• For children with persistent complement component deficiency
• For children younger than 19 months of age, administer a 4-dose infant series of Menveo at 2, 4, 6, and 12 through 15 months of age
• For children 7 through 23 months who have not initiated vaccination, 2 options exist depending on age and vaccine brand:
• -a. For children who initiate vaccination with Menveo at 7 months through 23 months of age, a 2-dose series should be administered with the 2nd dose after 12 months of age and at least 3 months after the first dos
• -b. For children who initiate vaccination with Menactra at 9 months through 23 months of age, a 2-dose series of Menactra should be administered at least 3 months apart
• For children ≥24 months who have not received a complete series of any meningococcal vaccine, administer 2 primary doses of either Menactra or Menveo at least 2 months apart
• Booster dose: Every 5 years

Travel/reside in hyperendemic/epidemic countries

• For children who travel to or reside in countries in which meningococcal disease is hyperendemic or epidemic, including countries in the African meningitis belt or the Hajj
• Administer an age-appropriate formulation and series of Menactra (minimum age 9 months) or Menveo (minimum age 2 months) for protection against serogroups A and W meningococcal disease
• Note: Prior receipt of MenHibrix is not sufficient for children traveling to the meningitis belt or the Hajj because it does not contain serogroups A or W
• International travelers should receive a booster dose of MenACWY if the last dose was administered >4 years previously
• Vaccination in the 3 years before the date of travel is required by the government of Saudi Arabia for all travelers to Mecca during the annual Hajj

Community outbreak

• For children at risk during a community outbreak attributable to a vaccine serogroup, administer or complete an age- and formulation-appropriate series of MenHibrix, Menactra, or Menveo

Dosing Considerations

Indicated for routine prophylaxis initiated during adolescence

CDC guidelines provide guidance for high risk infants/children (eg, sickle cell, asplenia, persistent complement deficiencies, traveling to endemic areas, outbreaks)

Schedule for initiating vaccine at a particular age (product specific)

• Menveo (age 2 months): FDA approved for 4-dose series given at 2, 4, 6, and 12 months of age
• Meveo (age 7-23 months): FDA approved for 2-dose series with 2nd dose being given in 2nd year of life at least 3 months after the first dose
• Menveo (age 2-10 years): Single dose; for children aged 2 yr through 5 yr at continued high risk of meningococcal disease, a 2nd dose may be administered 2 months after the 1st dose
• Menveo (adolescents and adults aged 11 through 55 years): FDA approved as a single dose
• Menactra: (age 9-23 months): FDA approved for 2-dose series given 3 months apart
• Menactra: (age 2-55 years): FDA approved as single dose with a booster dose (if at least 4 yr have elapsed) in high risk individuals aged 15 yr through 55 yr

Safety and efficacy of Menactra and Menveo not established in adults aged >55 yr (Menomune A/C/Y/W-135 recommended for 1 time doses in travelers)