Meningococcal vaccination: risk groups and schedules

Meningococcal disease is caused by the bacterium Neisseria meningitidis and manifests as meningitis and meningococcemia. The disease progresses rapidly, with a mortality rate of 8-15% without treatment, and among survivors, severe consequences are possible, including neurological deficits and amputations. Vaccination remains a key measure of individual and collective protection, particularly in age groups at highest risk and in close contact groups. [1]

In recent years, new vaccine platforms and indications have emerged. In addition to conjugate vaccines against serogroups A, C, W, and Y, protein vaccines against serogroup B are available, as well as a pentavalent vaccine covering A, B, C, W, and Y for situations where both categories are indicated on the same day. These solutions allow for flexible closure of immune "windows" in adolescents, students, travelers, and other at-risk individuals. [2]

The global strategy "Defeat Meningitis by 2030" sets goals for eliminating bacterial meningitis epidemics, reducing morbidity and mortality, and improving the quality of life of survivors. Immunoprophylaxis is central to this roadmap and is supported by updated World Health Organization position papers. [3]

In Europe, after a decline during the coronavirus pandemic, invasive meningococcal disease rates are returning to pre-COVID levels. The highest incidence rates are observed in children under 1 year of age, adolescents, and young adults. These data are important for understanding the need for age-specific and risk-based vaccination schedules. [4]

What does the vaccine protect against and what does it not protect against?

There are three types of meningococcal vaccines: conjugate vaccines against A, C, W, and Y; protein vaccines against B; and combined vaccines that simultaneously cover A, B, C, W, and Y. Conjugate vaccines reduce carriage rates and promote herd immunity, which reduces the transmission of the pathogen within communities. Protein vaccines against B reduce the risk of disease, although their effect on carriage is weaker. [5]

Vaccination protects against invasive forms of the disease, but does not replace antibiotic prophylaxis for contacts during outbreaks. In case of close contact with an infected person, the decision on chemoprophylaxis and an additional booster dose is made by an epidemiologist according to local protocols. [6]

Immunity after the primary series and boosters declines over time, so adolescents and other high-risk individuals require repeat doses at intervals depending on their age and the type of vaccine. This "immunity boost" is especially important during periods of highest risk, such as when entering college or dorm life. [7]

Vaccines do not cure the disease once it has begun. Symptoms such as fever, headache, rash, and stiff neck require immediate medical attention, regardless of vaccination status. [8]

Disease codes for medical documentation

Table 1. Frequently used codes

Classifier	Chapter	Code	Name
ICD 10	Class I	A39	Meningococcal infection
ICD 11	1C1G	1C1G	Neisseria meningitidis infection
ICD 11	1C1G.0	1C1G.0	Meningococcal meningitis
ICD 11	1C1G.1	1C1G.1	Meningococcemia
ICD 11	1C1G.Y	1C1G.Y	Other specified disease caused by Neisseria meningitidis

Mastering the codes helps accurately record diagnoses and vaccination indications, including for reporting and surveillance purposes. The listed positions reflect clinically significant forms of invasive disease. [9]

The codes are important for planning post-exposure prophylaxis and for the correct administration of boosters in high-risk groups. They are also used in insurance reporting systems and when coordinating travel plans for those traveling to high-risk regions. [10]

Standardized coding facilitates data comparability when analyzing trends in disease incidence and the effectiveness of vaccination programs across countries and regions. [11]

It is recommended to check local code correspondence tables when switching between versions of classifiers, since countries implement updates at different times. [12]

Epidemiological situation

According to the European Centre for Disease Prevention and Control, in 2022, the cumulative notification rate in the European Union and the European Economic Area was approximately 0.3 cases per 100,000 population, with peaks in infants and in adolescents and young adults. Serogroup B remained dominant in individuals under 65 years of age. [13]

Serogroups W and Y are relatively important in the elderly, while carriage and transmission within groups play a significant role in adolescents. This justifies vaccination programs targeted at adolescents, which reduce carriage and ensure group protection. [14]

The World Health Organization's global strategic goal is to reduce cases and deaths from vaccine-preventable meningitis by 2030. To achieve this goal, countries are adjusting their boosting schedules and strategies to local epidemiological realities. [15]

Some publications indicate a return to pre-COVID levels in a number of European countries by 2023, which underlines the importance of timely coverage of adolescents and young people with vaccinations and boosters. [16]

Types of vaccines, composition and age indications

Table 2. Main vaccine products and indications

Category	Examples	Protected serogroups	Age of application
Conjugated MenACWY	Menveo, Nimenrix, MenQuadfi	A, C, W, Y	Usually from 12 months and older according to country indications
Protein MenB	Bexsero, Trumenba	B	Usually from 2 months for Bexsero and from 10 years for Trumenba in Europe, according to the instructions
Pentavalent MenABCWY	Penbraya	A, B, C, W, Y	From 10 to 25 years old, when MenACWY and MenB are shown on the same day

Conjugate vaccines against A, C, W, and Y induce T-dependent immunity and are capable of reducing carrier rates, leading to herd protection. This is an important difference from older polysaccharide formulas. [17]

Protein vaccines against B contain recombinant antigens and show high efficacy against most circulating strains of serogroup B. Country registration dossiers and protocols specify age limits and schedules. [18]

The pentavalent vaccine is approved by the US advisory committee for use in individuals 10 years of age and older, when both categories are indicated at a single visit. This reduces the number of injections and may improve adherence without compromising immunogenicity. [19]

In the European Union, indications for individual products are also being expanded, such as MenQuadfi and updates to Bexsero. Local licensing, availability, and the official vaccine schedule are taken into account when selecting a specific vaccine. [20]

Who is eligible for vaccination?

All adolescents are recommended to receive vaccination against A, C, W, and Y, followed by a booster dose, as protection declines over time and the risk increases in late adolescence. This strategy is consistent with epidemiological peaks and close contact scenarios. [21]

Individuals at risk receive extended regimens. These include individuals with anatomical or functional asplenia, those with persistent complement deficiencies, those receiving complement inhibitors, and laboratory workers working with meningococci. Primary series and regular boosters are indicated for them. [22]

Students living in dormitories, new recruits, travelers to high-risk regions, and participants in mass events are considered candidates for vaccination and boosting, especially in the short term before departure. [23]

For the simultaneous need for MenACWY and MenB on the same day, pentavalent MenABCWY can be used, with subsequent adherence to the manufacturer's invariance principle for the B component. [24]

Vaccination schedules by age and situation

Table 3. Basic patterns and intervals

Situation	What to enter	Scheme and intervals
Adolescents without risk factors	MenACWY	One dose at 11-12 years, booster at 16 years
Young people 16-23 at their own discretion and by decision of a doctor	MenB	2 doses with an interval of 6 months; for urgent protection, 0, 1-2, 6 months are possible
Concurrent need for MenACWY and MenB	MenABCWY	1 dose on the day of the visit; subsequent dose B after 6 months according to the brand of the B component
Constant risk in children and adults	MenACWY and MenB	Extended series with boosters every 2-5 years depending on age and vaccine type

Current guidelines clarify the intervals and need for boosters if risk remains: for individuals younger than 7 years, a MenACWY booster 3 years after the series, then every 5 years; for those 7 years and older, every 5 years. For MenB, in individuals at risk, a booster after 1 year and then every 2–3 years. [25]

Bexsero now has an updated regimen: for healthy adolescents, two doses are given six months apart, reducing the number of visits and maintaining immunogenicity. For accelerated protection, the three-dose regimen remains. [26]

MenABCWY is used when both categories are indicated on the same day. Subsequently, the principle of manufacturer consistency for component B must be maintained. This is due to the lack of interchangeability of protein platforms B. [27]

Different brand names of MenACWY are available in a number of countries. Products in this category are considered interchangeable, whereas protein MenB products are not.[28]

Special situations: outbreaks, contacts, chronic risk

In outbreaks and close contacts, the decision on chemoprophylaxis and unscheduled dosing is made by an epidemiologist. Rifampicin, ciprofloxacin, or ceftriaxone are most commonly used, according to updated guidelines, taking into account restrictions and age limits. [29]

People on complement inhibitors, with asplenia, or with persistent complement deficiency have an increased risk even with vaccination, so full series and regular boosters at shorter intervals are mandatory for them. [30]

If simultaneous coverage of A, C, W, Y, and B is needed in people at risk, MenABCWY may be acceptable, especially if both pathways need to be covered quickly. Subsequent doses of B should be from the same manufacturer. [31]

Travellers and participants in mass events should take into account local requirements and timing of certificate checks, as some countries move checks to airlines at the boarding stage. [32]

Efficacy, carriage and collective protection

In the United Kingdom, vaccination of adolescents with conjugate MenACWY reduced the carriage of W and Y strains in the community and allowed for rapid outbreak control, even with moderate coverage. This demonstrates a powerful indirect protective effect. [33]

Historical experience with MenC has shown a sharp decline in morbidity and mortality in target age groups and a reduction in carrier rates, confirming the mechanism of herd immunity. This experience has formed the basis for current adolescent strategies. [34]

Modern protein vaccines against B reduce the risk of invasive disease at various ages. The effectiveness of programs and their impact on circulation depend on antigenic matching with local strains and population coverage. [35]

The pentavalent approach allows for both categories to be addressed simultaneously while maintaining immunogenicity and safety profile, which may improve adherence and cost-effectiveness in selected scenarios.[36]

Safety and tolerability

Table 4. Frequent local and systemic reactions

Category	Frequent manifestations	Usually when they pass
Locals	Pain at the injection site, redness, induration	Within 1-3 days
Systemic	Fatigue, headache, low-grade fever	Within 1-3 days
In small children	Irritability, drowsiness, fever	Within 1-3 days

In clinical trials of the pentavalent vaccine, the rate of non-serious reactions was comparable to or lower than with separate administration of MenACWY and MenB. The most common reactions were pain at the injection site, fatigue, and headache. Serious reactions were rare and were not considered vaccine-related by the investigators. [37]

For Bexsero and Trumenba, the European Medicines Agency's summary reviews indicate expected local and systemic reactions, mostly mild to moderate in severity. The safety profile is favorable when used as directed. [38]

When administered simultaneously, higher temperatures may occur in infants. It is recommended to inform parents in advance and provide simple instructions on temperature monitoring and fluid intake. [39]

The presence of a mild acute respiratory infection without high fever is usually not a contraindication, but the decision is made individually according to the general principles of immunization. [40]

Contraindications and precautions

Table 5. Contraindications and precautions

Situation	Action
Severe immediate allergic reaction to any component	Do not administer this drug
Acute severe illness with high fever	Postpone until recovery
Immunodeficiency, complement inhibitors	Vaccinate according to extended schedules and boosters, taking into account the residual risk
Pregnancy and lactation	Use according to risk indications, based on official recommendations

Anaphylaxis to a component or a previous dose remains an absolute contraindication. The decision to change brands or postpone vaccination is made by a physician. [41]

In immunodeficiencies and complement inhibitor therapy, even after vaccination, there remains an increased risk of invasive infection. For this reason, intensive regimens and regular boosters are necessary. [42]

Pregnancy does not preclude vaccination in high-risk settings, but it is preferable to administer it before pregnancy or after childbirth, if the epidemiological situation permits. The decision is made by a physician based on current national guidelines. [43]

If unusual reactions occur after vaccination, a doctor should be contacted and a report should be made to the pharmacovigilance system in accordance with national regulations. [44]

Compatibility with other vaccines and interchangeability

Table 6. Simultaneous administration

Combination	Principle
MenACWY with other planned	Acceptable in different anatomical areas
MenB with other planned	It is acceptable to take into account local recommendations for infants and adolescents
MenABCWY	Use when both categories are required in one visit

Concurrent administration of different vaccines at different sites is permitted. The exception is compliance with the rules for a specific age and product. Interchangeability is relevant for MenACWY, but not for protein-based MenB. [45]

When using MenABCWY, subsequent doses of component B should be from the same manufacturer, as the B platforms are not interchangeable. This is an important detail when planning a course. [46]

In infants, co-administration of Bexsero with other childhood vaccines increases the risk of fever, requiring parents to be informed of the potential reaction and monitoring measures.[47]

In adolescents, co-administration with other age-appropriate vaccinations helps close the "window of risk" before starting college and living in dorms.[48]

Travel, Hajj and Umrah

Table 7. MenACWY requirements for Hajj and Umrah

Requirement	Detail
Mandatory	A valid MenACWY certificate is required.
Deadlines	The vaccine must be administered at least 10 days prior to arrival.
Validity period	Conjugated MenACWY is generally valid for 5 years according to country requirements
Examination	Certificates are often checked by airlines upon boarding.

The Kingdom of Saudi Arabia requires a valid MenACWY vaccination certificate for pilgrims and seasonal workers in Hajj areas. The vaccine must be administered at least 10 days prior to arrival. In practice, screening often occurs upon boarding. [49]

Several countries and public health agencies are publishing synchronized recommendations for pilgrims, specifying the dates, acceptable types of vaccines, and certificate validity periods. The most current documentation for the season should be followed. [50]

When planning a trip with a short time horizon before departure, accelerated regimens and the pentavalent vaccine may be used if both categories are indicated. The decision is made taking into account age, availability, and local regulations. [51]

Some sources also point to differences in the validity periods of certificates for conjugate and polysaccharide vaccines. In practice, conjugate formulas are used as a guide. [52]

Storage and handling

Table 8. Basic storage rules

Parameter	Recommendation
Temperature	Typically between 2 and 8 degrees Celsius, do not freeze
Light	Store in original packaging, protect from light.
Best before date	According to the instructions of the specific product
Preparation	Before administration, check the appearance of the suspension and expiration date.

Product instructions contain detailed storage instructions, tolerances, and disposal procedures. Failure to comply with temperature requirements may reduce immunogenicity. [53]

For new batches and expanded indications, regulators publish updates that may include changes to storage and dilution. Healthcare professionals should consult the latest versions of the documents. [54]

When handling mass campaign logistics, it is important to adhere to cold chain and quality control protocols to minimize waste and ensure efficiency. [55]

Before vaccination, a visual assessment of the solution is carried out, its completeness and compliance with the patient's age and indications are checked. [56]

Frequently asked questions

Should teenagers be vaccinated if they already received a dose at age 11 or 12?
Yes, a booster is required at age 16, as protection declines and the risk increases in late adolescence. [57]

What if both MenACWY and MenB are needed in one visit?
There are two options: administer both separately at different sites, or administer MenABCWY followed by the instructions for component B. [58]

Is it possible to change vaccine brands within a batch?
This is possible for MenACWY. For MenB, this is not possible; all doses and boosters must be the same brand. [59]

Why are adolescent programs beneficial to society?
Adolescents are more likely to be carriers. Reducing carrier rates with conjugate vaccines leads to herd protection and rapid outbreak control. [60]

Conclusion

Modern meningococcal immunization consists of several complementary strategies targeting serogroups A, C, W, Y, and B, with an emphasis on adolescents, high-risk groups, and travelers. The advent of a pentavalent regimen simplifies coverage of both categories in a single visit and may improve adherence. The result is a reduction in individual risk of severe disease and the development of herd protection. [61]

The success of programs depends on coverage, adherence to intervals, and timely boosters. In practice, it is recommended to follow current national calendars and use official guidelines for outbreaks, travel, and special groups. [62]