ACIP Updates Recommendations for Meningococcal Vaccination

October 7, 2020, 2:37 pm Michael Devitt -- A new report on the use of meningococcal vaccines from the Advisory Committee on Immunization Practices is designed to guide family physicians and other clinicians and ensure they have the latest information on the topic.

The report, published Sept. 25 in the CDC Morbidity and Mortality Weekly Report, compiles and summarizes the ACIP’s previously published recommendations and reports on the use of meningococcal vaccines in the United States, including both quadrivalent meningococcal and serogroup B meningococcal vaccines. In addition, it clarifies some existing recommendations and offers new recommendations regarding the administration of booster doses of serogroup B vaccine for patients who are at increased risk for serogroup B meningococcal disease.

“Meningococcal disease can result in high morbidity and mortality,” Nina Ahmad, M.D., the Academy’s liaison to the ACIP Meningococcal Vaccines Work Group, told AAFP News. “It develops quickly and can have devastating effects on even healthy individuals. In the United States, even with antimicrobial therapy, the overall case-fatality ratio is 15%. Of those that survive, 10% to 20% have long-term effects (i.e., neurologic disability, limb or digit loss, or hearing loss). When indicated, vaccinating can spare individuals from these devastating consequences.”

Background

While rates of meningococcal disease in the United States have declined since the 1990s, the CDC estimates that about 330 cases occurred in the United States in 2018, the most recent year for which data were available.

In the United States, most cases of meningococcal disease are caused by serogroups B, C and Y. Of the two types of meningococcal vaccines licensed in the United States, the quadrivalent meningococcal conjugate vaccine provides protection against serogroups A, C, W and Y; the serogroup B vaccine provides protection against serogroup B.

Story Highlights

Three MenACWY vaccines are licensed for use in the United States: Menactra (for persons age 9 months to 55 years), Menveo (for those age 2 months to 55 years) and MenQuadfi (for those age 2 years and older). Two MenB vaccines are licensed for use: Trumenba and Bexsero (both for individuals ages 10 to 25 years).

ACIP Recommendations

The report divides the recommendations into several categories based on age and risk factors, and includes tables and vaccination schedules for different populations. These recommendations will be included in the updated 2021 immunization schedules, and the AAFP will review changes to the schedules once they are available.

Infants and children. The ACIP does not routinely recommend administration of a MenACWY vaccine for infants or children aged 2 months to 10 years unless they are at increased risk for meningococcal disease. In addition, while the ACIP has no recommendations for routine use of MenB vaccines in this population, it does recommend use of the MenB vaccine in individuals 10 years and older who are at increased risk for serogroup B meningococcal disease.

Adolescents and young adults. The ACIP recommends routine administration of a MenACWY vaccine for all people ages 11-18. The recommended schedule consists of a single dose of MenACWY administered at 11 or 12 years followed by a booster dose at age 16.

The recommendations contain additional guidance for children who receive their first dose of MenACWY at or before age 10, children at increased risk for meningococcal disease, and adolescents and young adults who receive their first dose of MenACWY at age 13 or older.

While MenB vaccination is not routinely recommended for all adolescents, the ACIP recommends a MenB vaccine series for people ages 16-23 based on shared clinical decision-making with the patient (or parent/guardian) to provide short-term protection against serogroup B meningococcal disease.

The preferred age for MenB vaccination is 16-18 years. For adolescents who are not otherwise at increased risk for meningococcal disease (e.g., due to complement deficiency or asplenia), a two-dose series of MenB vaccine should be administered as follows: two doses of MenB-FHbp administered at 0 and 6 months or two doses of MenB-4C administered at 0 and 1 month or later.

While either MenB vaccine can be used when indicated, the same vaccine product must be used for all doses. MenB vaccines can be administered simultaneously with other vaccines indicated for individuals in this age group.

Adults 24 and older. Administration of MenACWY and MenB vaccines is not routinely recommended for adults 24 and older unless they are at increased risk.

Persons at increased risk for meningococcal disease. The ACIP recommends administration of a MenACWY vaccine at age 2 months or older for individuals who

have complement component deficiency;
are receiving a complement inhibitor;
have functional or anatomic asplenia, including sickle cell disease;
have HIV infection;
are at increased risk because of a meningococcal disease outbreak caused by serogroups, A, C, W or Y; or
are traveling to or living in countries where meningococcal disease is hyperendemic or epidemic.

Age-appropriate MenACWY vaccination is recommended for first-year college students living in residence halls, military recruits and microbiologists who are routinely exposed to Neisseria meningitidis.

MenACWY booster doses are recommended for previously vaccinated individuals who become or remain at increased risk.

The ACIP also recommends MenB vaccination for individuals 10 years and older who

have complement component deficiency, or functional or anatomic asplenia;
are receiving a complement inhibitor;
or are at increased risk because of a meningococcal disease outbreak caused by serogroup B.

FP Vaccine Expert Perspective

Ahmad, a former AAFP Vaccine Science Fellow and epidemic intelligence service officer with the CDC, stressed the importance of vaccinations – especially in light of the ongoing COVID-19 pandemic.

“As family physicians, we have a direct downstream effect on healthcare systems,” Ahmad said. “Should another COVID-19 wave arise, health care systems will likely be strained again. Doing what we can now to help patients receive necessary preventive care, including vaccines, will likely have a significant impact.”

Ahmad suggested that being receptive and proactive is the best step FPs can take to ensure that patients get the vaccinations they need.

“I find listening to the patient and hearing their individual concerns is helpful,” Ahmad said. “Then discussions can be focused on that individual’s concerns and their risks versus benefits.

“COVID-19 has certainly caused a disruption to many aspects of life, including preventive care. Reaching out to patients about steps you are taking to prevent exposure, the importance of vaccinating and what vaccines they might be due for are all helpful.”

The Academy offers a wealth of resources, including the AAFP’s Immunizations & Vaccines page, immunization schedules and the Shots Immunizations app, a collaborative effort between the AAFP and the Society of Teachers of Family Medicine.

Ahmad also suggested CDC resources, including the agency’s Vaccines & Immunizations page and the online edition of its Epidemiology and Prevention of Vaccine-Preventable Diseases.

Next Steps

The Academy is one of several medical organizations that work with the ACIP to develop immunization schedules. These recommendations will be included in the 2021 immunization schedules, which are expected to be published in February and will be posted on AAFP.org after review by the Academy.