Age-related schedule of meningococcal vaccination for HCT recipients
| Age group . | Type . | Primary doses (N) . | Booster . | Comments . |
|---|---|---|---|---|
| ≥6-23 mo | MCV4 (Men-ACWY) | 2* | Three years later, then every 5 y while still at risk | Menveo preferred for <2 y old because Menactra may interfere with primary PCV13 series |
| 2-10 y | MCV4 (Men-ACWY) | 2† | If last dose was age <6, then boost 3 y later, then every 5 y while still at risk | Menveo or Menactra, but Menactra may interfere with the immunologic response to PCV13 and so should be separated by at least 4 wk |
| 11-12 y | MCV4 (Men-ACWY) | 2† | Age 16 y‡ | Based on principle that vaccine immunity lasts 3-5 y and highest risk group is age 16-21 y |
| Men-B | 2 or 3§ | No data | Routinely for high-risk groups (see FAQ 14) | |
| 13-15 y | MCV4 (Men-ACWY) | 2† | Age 16-18 y‡ | For example, primary doses at age 14.8 y, so might give booster at age 16.8 or 17.8 y |
| Men-B | 2 or 3§ | No data | Routinely for high-risk groups (see FAQ 14) | |
| ≥16 y | MCV4 (Men-ACWY)|| | 2† | Not generally | Exception: occupational exposure or functionally asplenic‡ |
| Men-B | 2 or 3§ | No data | Routinely for high-risk groups and may be offered to 16-23 y (see FAQ 14) |
| Age group . | Type . | Primary doses (N) . | Booster . | Comments . |
|---|---|---|---|---|
| ≥6-23 mo | MCV4 (Men-ACWY) | 2* | Three years later, then every 5 y while still at risk | Menveo preferred for <2 y old because Menactra may interfere with primary PCV13 series |
| 2-10 y | MCV4 (Men-ACWY) | 2† | If last dose was age <6, then boost 3 y later, then every 5 y while still at risk | Menveo or Menactra, but Menactra may interfere with the immunologic response to PCV13 and so should be separated by at least 4 wk |
| 11-12 y | MCV4 (Men-ACWY) | 2† | Age 16 y‡ | Based on principle that vaccine immunity lasts 3-5 y and highest risk group is age 16-21 y |
| Men-B | 2 or 3§ | No data | Routinely for high-risk groups (see FAQ 14) | |
| 13-15 y | MCV4 (Men-ACWY) | 2† | Age 16-18 y‡ | For example, primary doses at age 14.8 y, so might give booster at age 16.8 or 17.8 y |
| Men-B | 2 or 3§ | No data | Routinely for high-risk groups (see FAQ 14) | |
| ≥16 y | MCV4 (Men-ACWY)|| | 2† | Not generally | Exception: occupational exposure or functionally asplenic‡ |
| Men-B | 2 or 3§ | No data | Routinely for high-risk groups and may be offered to 16-23 y (see FAQ 14) |
MCV4 is licensed down to 2 mo, but the earliest we offer vaccination is ≥6 mo after HCT. For infants aged 7-23 mo, 2 doses of Menveo (MCV4, Novartis) are given with the second dose ≥12 wk after the first dose and after the first birthday.
A second dose (2 mo after first) is advised routinely after HCT for age 11-18 y (see Mahler et al18 ). We extend this practice to “high-risk” patients of any age with anatomical or functional asplenia (includes those with chronic GVHD).
Repeat every 5 y if functionally asplenic or occupationally at risk (military, microbiologist).
Men-B (Bexsero, Novartis) series is 2 doses (0 and ≥1 mo later), and Men-B (Trumenba, Pfizer) series is 3 doses (0, 2, and 6 mo).
MCV4 is also used for older adults despite the fact that the polysaccharide vaccine MPSV4 (Menomune, Sanofi Pasteur) is the only licensed vaccine for age ≥55; off-label use of MCV4 is advised, especially if previously received MCV4 and/or ≥2 doses of meningococcal vaccine are anticipated (as for functional asplenia or occupationally exposed).