How Long Can We Keep Menveo Out After Reconsitution

Meningococcal ACWY

Disease Issues		Administering Vaccines

Vaccine Recommendations		Vaccine Safety

For People with Risk Factors		Contraindications and Precautions

Booster Doses		Vaccine Storage and Handling

Illness Bug

Please tell us about meningococcal disease.

Meningococcal illness is a bacterial infection caused by Neisseria meningitidis. Meningococcal illness unremarkably presents clinically as meningitis (about 50% of cases), bacteremia (xxx% of cases), or bacteremic pneumonia (fifteen% of cases). North. meningitidis colonizes mucosal surfaces of the nasopharynx and is transmitted through directly contact with big-droplet respiratory tract secretions from patients or asymptomatic carriers. Meningococcal disease can be severe. The overall case-fatality ratio in the U.South. is 15%, and 10%–20% of survivors accept long-term sequelae such as neurologic disability, limb or digit loss, and hearing loss.

N. meningitidis is classified into 12 serogroups based on characteristics of the polysaccharide capsule. Nearly invasive disease (such as meningitis and sepsis) is caused past serogroups A, B, C, W, X and Y. The relative importance of serogroups depends on geographic location and other factors such as historic period. Serogroups B and C are the most frequent causes of disease in the U.S., accounting for 42% and 26% of cases with known serogroup, respectively, during 2022–2018. Serogroups W, Y, and nongroupable strains each acquired 9%–fourteen% of cases during that menstruum. Serogroup A is rare in the U.S. Historically, serogroup A was common in the meningitis belt of sub-Saharan Africa, but after the implementation of a meningococcal serogroup A conjugate vaccine entrada, serogroup A disease has been nearly eliminated in the meningitis belt.

Nasopharyngeal carriage rates are highest in adolescents and young adults who serve as reservoirs for transmission of N. meningitidis.

How mutual is meningococcal disease?

The incidence of meningococcal affliction has declined steadily in the U.Due south. since a meridian of reported disease in the late 1990s. Even before routine use of a meningococcal conjugate vaccine (MenACWY) in adolescents was recommended in 2005, the overall annual incidence of meningococcal illness had decreased 64%, from ane.i cases per 100,000 population in 1996 to 0.4 cases per 100,000 population in 2005. In 2022, the rate of meningococcal disease in the U.S. reached a historic depression of 0.1 cases per 100,000 population. Incidence of disease caused by serogroup B, a serogroup not included in the routinely recommended MenACWY vaccine, also has declined for reasons that are not known.

During 2022–2018, an estimated 360 cases of meningococcal disease occurred annually in the U.s.a., representing an boilerplate annual incidence of 0.xi cases per 100,000 population. Of those with known serogroup in 2022 (N=302), 39% were serogroup B and 51% were serogroups C, Y, or Due west-135. The incidence of disease is highest in infants under 1 year, children age 1 yr, and adolescents age 16–20 years.

What groups are at increased gamble for meningococcal disease?

In addition to take chances based on age, not-specific risk factors for serogroups A, C, W and Y include having a previous viral infection, living in a crowded household, having an underlying chronic disease, and existence exposed to cigarette smoke (either directly or second-hand).

The following groups are at increased risk for all meningococcal serogroups:

•		People with persistent (genetic) complement component deficiencies (a type of allowed system disorder)

•		People who employ complement inhibitors such as eculizumab (Soliris, Alexion Pharmaceuticals) and ravulizumab (Ultomiris, Alexion Pharmaceuticals) for handling of singular hemolytic uremic syndrome or paroxysmal nocturnal hemoglobinuria

•		People with anatomic or functional asplenia

•		Microbiologists routinely exposed to meningococcal isolates in a laboratory

•		People at increased chance during an outbreak of meningococcal disease

•		Armed services recruits

•		College students

Certain groups are at increased risk of serogroups A, C, W and Y, but not serogroup B:

•		People living with HIV

•		Men who take sex with men (MSM)

•		Travelers to countries where meningococcal affliction is owned or hyperendemic, such as the meningitis chugalug of sub-Saharan Africa

Vaccine Recommendations

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What meningococcal vaccines are available in the United States?

The vaccines for meningococcal serogroups A, C, Due west, and Y (MenACWY; Menactra, Sanofi Pasteur; Menveo, GlaxoSmithKline [GSK]; MenQuadfi, Sanofi Pasteur) contain meningococcal conjugate in which the surface polysaccharide is chemically bonded ("conjugated") to a protein to produce a robust immune response to the polysaccharide. Although each of the 3 MenACWY vaccine products uses a different protein conjugate, the products are considered interchangeable; the aforementioned vaccine product is recommended, but not required, for all doses.

A discontinued meningococcal polysaccharide vaccine (MPSV4, Menomune, Sanofi Pasteur) was available in the United States until all doses expired in September 2022. With rare exception, it was not interchangeable with MenACWY cohabit vaccines.

Since late 2022, vaccines accept go bachelor that offer protection from meningococcal serogroup B disease (MenB; Bexsero, GSK; Trumenba, Pfizer). These vaccines are composed of proteins found on the surface of the bacteria. These vaccine products are not interchangeable; the same vaccine product is required for all doses.

MenACWY vaccines provide no protection confronting serogroup B disease, and meningococcal serogroup B vaccines (MenB) provide no protection against serogroup A, C, W, or Y disease. For protection against all 5 serogroups of meningococcus, it is necessary to receive both MenACWY and MenB.

Trade Name	Type of Vaccine	Serogroups	Year Licensed	Approved Ages

Menactra	Conjugate	A, C, W, Y	2005	9 mos.–55 years*

Menveo	Cohabit	A, C, West, Y	2010	2 mos.–55 years*

MenQuadfi	Cohabit	A, C, W, Y	2020	2 years and older

Trumenba	Protein	B	2014	x–25 years*

Bexsero	Poly peptide	B	2015	10–25 years*

*May be given to adults at increased hazard older than the FDA-approved upper age limit (see ACIP recommendations, Tabular array eleven, folio 41, www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6909a1-H.pdf)

Where can I find the most current meningococcal vaccine recommendations?

The near current comprehensive recommendations from the Advisory Commission on Immunization Practices (ACIP) for meningococcal vaccines is available on the MMWR website at world wide web.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6909a1-H.pdf. This document replaces all previously published reports and policy notes.

Who is recommended to be vaccinated confronting meningococcal ACWY disease?

MenACWY is recommended for these groups:

Routine vaccination of all children and teens, age xi through 18 years: a unmarried dose at age eleven or 12 years with a booster dose at historic period xvi years

Routine vaccination of people historic period 2 months or older at increased risk for meningococcal disease (the master dosing schedule and booster dose interval varies past age and indication):

•		People with functional or anatomic asplenia

•		People who have persistent complement component deficiency (an immune system disorder) or who take a complement inhibitor (eculizumab [Soliris] or ravulizumab [Ultomiris])

•		People who have HIV infection

•		People who are at risk during an outbreak caused past a vaccine serogroup

•		People age 2 months and older who reside in or travel to certain countries in sub-Saharan Africa also equally to other countries for which meningococcal vaccine is recommended (e.grand., travel to Mecca, Kingdom of saudi arabia, for the almanac Hajj)

•		Microbiologists who work with meningococcus bacterial isolates in a laboratory

•		First-twelvemonth college students living in residence halls who are unvaccinated or undervaccinated; these students should receive a dose if they have not had a dose since turning xvi or if information technology has been more than 5 years since their previous dose

What is the schedule for MenACWY vaccine?

All adolescents should receive a dose of MenACWY at 11 or 12 years of age. A second (booster) dose is recommended at sixteen years of age. Adolescents who receive their first dose at historic period thirteen through 15 years should receive a booster dose at age 16 years. The minimum interval betwixt MenACWY doses is viii weeks. Adolescents who receive a first dose later their 16th altogether do not demand a booster dose unless they get at increased risk for meningococcal disease. Colleges may not consider a second dose given even a few days earlier age sixteen years as valid, and then proceed that in mind when scheduling patients. People 19 through 21 years of age are non recommended routinely to receive MenACWY. However, MenACWY may be administered to people age 19 through 21 years as catch-upward vaccination for those who have not received a dose after their 16th altogether.

If a kid without whatever high adventure conditions received a dose of MenACWY (Menactra, MenQuadfi or Menveo) vaccine at age 10 years does the child need to be revaccinated at age 11–12 years?

No. ACIP considers a dose of MenACWY given to a 10-yr-erstwhile kid to be valid for the showtime dose in the boyish series. Doses given before age 10 years should not be counted. The child should receive the 2nd (booster) dose at age 16 years equally usual.

Should college students exist vaccinated against meningococcal ACWY disease?

Kickoff-year college students living in residence halls should be vaccinated against meningococcal ACWY disease. Before enrollment, administrate a dose of MenACWY vaccine to those previously unvaccinated, to those who have not had a dose of MenACWY since turning 16, and to those whose most contempo MenACWY dose (given afterwards turning 16) was not given within the past 5 years. Some schools, colleges, and universities have policies requiring vaccination against meningococcal illness as a condition of enrollment.

Several salubrious adult college students from outside the U.S. (ages 24 years and older) presented to our dispensary. They volition be living in a residence hall. None have a tape of having received MenACWY. Should the receive a dose of MenACWY at present?

Aye. I dose of MenACWY vaccine is recommended for all first twelvemonth college students who are or will be living in a residence hall if they are previously unvaccinated, have not received a dose of MenACWY since turning 16, or if their virtually recent dose (given after turning sixteen) was not given within the past five years.

We run immunization clinics at the local jail, which has a living organization comparable to a college residential hall. In this setting, would you lot recommend vaccinating incarcerated individuals as is recommended for people living in a college dormitory?

ACIP does not identify incarceration as an indication for meningococcal vaccination. Providers are always free to employ their clinical judgment in situations non addressed by ACIP.

Are there recommendations for meningococcal ACWY vaccination for people who reside in homeless shelters or halfway houses? In improver, can you comment on general vaccination recommendations for people who reside in homeless shelters or halfway houses?

Residence in a homeless shelter or halfway firm is considered a high-risk indication simply for hepatitis A vaccination because of the increased risk of hepatitis A exposure and serious affliction among people experiencing homelessness or living in temporary housing. In all other respects, recommendations for vaccinating adult residents would be the same equally those for all adults on the ACIP adult immunization schedule. Residents with medical weather condition identified on Table 2 of the schedule should be vaccinated according to that table.

Any residents 18 or younger should exist vaccinated according to the catch-up recommendations on the ACIP child/teen immunization schedule. People age 19 through 21 years are not recommended routinely to receive MenACWY. MenACWY may be administered through age 21 years as a catch-up vaccination for those who have non received a dose subsequently their 16th birthday.

Our patient is starting college with no documented doses of meningococcal ACWY vaccine and has had titers drawn. The lab test was positive for A, C, Westward, and Y. Lab reference values show >ii.1 as "suggestive of protection." Can nosotros have this titer in lieu of documented MenACWY vaccine doses?

No. In that location are no adequate serologic titers that tin can be used equally testify of protection against meningococcal A, C, W, and Y disease. In addition, the immunologic studies used for licensing purposes (serum bactericidal assay, SBA) are likely dissimilar from the serologic titers obtained at a doctor's office (IgG antibiotic, for example). It is not clear what sort of testing is shown in the results you sent. Yet, even if SBA results are available, they cannot be used to assess whether there is a level of protection at the individual level.

Can you provide a comprehensive overview of the MenACWY recommendations, including those for vaccinating younger children and older adults who have risk factors?

IAC has prepared a document that provides a summary of the ACIP recommendations for use of MenACWY for people of all ages. The certificate is available at www.immunize.org/catg.d/p2018.pdf.

Menveo (MenACWY-CRM) is approved by the FDA for utilize in children every bit immature as ii months of age. What is the ACIP recommendation for apply of this vaccine?

Menveo is approved for people age 2 months through 55 years. For children start the vaccination series at age ii months the schedule is 4 doses at age 2, 4, six, and 12 to15 months. Fewer doses are recommended for children beginning the vaccination serial at age 7 months or older. Come across the IAC document at www.immunize.org/catg.d/p2018.pdf for details.

ACIP recommends the use of Menveo in loftier-chance children 2 through 23 months of age: children with persistent complement deficiency, including those taking a complement inhibitor such as eculizumab (Soliris) or ravulizumab (Ultomiris), functional or anatomic asplenia, HIV infection, who travel to or reside in regions where meningitis is epidemic or hyperendemic, or who are at risk during a customs outbreak attributable to a vaccine serogroup. Menactra (MenACWY-D) tin can be given to children ix months and older at increased run a risk of meningococcal disease. MenQuadfi (MenACWY-TT) may be used for children at increased hazard who are age 2 years and older. These recommendations are summarized in Table three of the recommendations published by ACIP in MMWR in 2022: www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6909a1-H.pdf.

I have a 3-calendar month-old patient whose family unit will be doing mission piece of work in sub-Saharan Africa. They are leaving every bit soon equally the child is six months old. We gave her the kickoff dose of Menveo brand MenACWY vaccine today. I know the usual Menveo schedule for an infant is 2, four, 6, and 12 months. If we maintain usual spacing, she will just become one more dose before she leaves. Can nosotros compress the schedule so she can get two more doses prior to travel?

The meningococcal ACIP recommendations don't clearly state a minimum interval for MenACWY in this situation. Withal, the minimum interval for a pediatric MenACWY schedule would presumably exist 4 weeks like for other pediatric vaccines on a two-4-half-dozen schedule. Y'all should try to give a third dose earlier travel begins.

If a healthy kid received MenACWY or meningococcal polysaccharide (MPSV4) vaccination prior to international travel at historic period nine years, will ii additional doses of MenACWY exist needed?

Yep. Doses of any quadrivalent meningococcal vaccine given before 10 years of age should not be counted as office of the boyish MenACWY series. If a child received a dose of either MPSV4 or MenACWY before age ten years, they should receive a dose of MenACWY at xi or 12 years and a booster dose at age xvi.

If someone received MenACWY vaccine at age 10 years and a dose of MenACWY earlier the 16th altogether, will they all the same need a booster dose at age 16?

Yep, they should receive a booster dose at historic period xvi. A booster dose of MenACWY is recommended at age xvi years even if 2 (or more) doses of MenACWY vaccine were received before historic period 16 years. Outset-year college students living in a residence hall who have not received a dose of MenACWY on or after age 16 years, should as well be vaccinated.

ACIP recommends that adolescents who receive the kickoff dose of MenACWY at age 13 through 15 years receive a 1-time booster dose at historic period xvi through eighteen years. Given how difficult it is to get teens into a medical office, is information technology okay to give the doses close together if the opportunity arises or should we try to space it out as far every bit possible (historic period eighteen)?

If the first dose is given at age thirteen through fifteen years, y'all tin requite the booster dose as early as age xvi years, with a minimum interval of viii weeks from the previous dose. So even if the patient was vaccinated at age 15 years 11 months, you lot could wait at to the lowest degree viii weeks and so give the booster at age 16 years 1 calendar month (or later on).

The ACIP recommendations suggest using MenACWY in certain adults older than age 55 years. Please provide details of this recommendation. Two of the MenACWY vaccines (Menactra and Menveo) are approved for adults through age 55 years. MenQuadfi was approved in 2022 for ages 2 years and older. If MenACWY is indicated for a person older than age 55 and you practice not have MenQuadfi, use the MenACWY production available.

I administer a lot of travel vaccine doses. What options do I have to give MenACWY to travelers age 56 years and older?

Every bit of 2022, at that place are three options for MenACWY vaccination. In 2022, MenQuadfi (Sanofi Pasteur) was approved for apply in all people ages 2 years and older. If MenQuadfi is not bachelor and vaccination is needed, you may administer Menactra or Menveo.

Are the 3 MenACWY vaccines interchangeable?

Menactra (MenACWY-D) is not approved for children younger than nine months so merely Menveo (MenACWY-CRM) should be used for children age 2 through 8 months. MenQuadfi (MenACWY-TT) is non canonical for children younger than historic period 2 years. From age ii years and upward the vaccines are interchangeable.

For People with Take a chance Factors

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Which people age 2 years and older are recommended to receive a 2-dose master series of MenACWY?

For people who are historic period two years or older, a 2-dose series of MenACWY, spaced 8–12 weeks apart, is recommended if they take functional or anatomic asplenia, HIV infection, persistent complement component deficiency (an immune disorder including C3, C5–C9, properdin, gene H, and factor D deficiency), or if they take a complement inhibitor (eculizumab [Soliris] or ravulizumab [Ultomiris]). People with these high-hazard medical conditions also need booster doses of MenACWY (come across Booster Doses section beneath).

Which children should exist vaccinated before the routine recommended age (xi–12 years)?

ACIP recommends meningococcal vaccination simply for high-chance children younger than 11 years. ACIP defines high-risk children age ii months and older as (1) those with persistent complement component deficiency (an immune organization disorder) or who take a complement inhibitor (including eculizumab [Soliris] or ravulizumab [Ultomiris]), (2) those with functional or anatomic asplenia, (3) those with HIV infection, (4) those traveling to or residing in an area of the world where meningococcal affliction is hyperendemic or epidemic or (5) those identified by public health officials as existence at take a chance during a customs outbreak attributable to a vaccine serogroup. Menveo (MenACWY-CRM) is approved for children age 2 months and older. Menactra (MenACWY-D) is approved for children age 9 months and older. MenQuadfi (MenACWY-TT) is approved for children age ii years and older.

For children with functional or anatomic asplenia, Menactra should not exist administered until at to the lowest degree 4 weeks later on the pneumococcal conjugate vaccine (PCV13, Prevnar13, Pfizer) vaccination series is completed. Children at increased risk for meningococcal disease should receive booster doses as long as they remain at increased risk (see Booster Doses section beneath).

Why filibuster meningococcal vaccination with Menactra (MenACWY-D) for infants with HIV or functional or anatomic asplenia until the pneumococcal cohabit vaccine series is completed?

In addition to being at increased risk for meningococcal disease, children with HIV infection or functional or anatomic asplenia are at loftier risk for invasive disease caused past Streptococcus pneumoniae, which is more than mutual than meningococcal affliction. Data evidence that the Menactra may interfere with the immunologic response to PCV13 if these two vaccines are given too close together. So ACIP recommends that Menactra non be administered to children with these conditions before age two years to avoid interference with the response to PCV13. If Menactra is used in people of any age with these conditions, do not administer it until at least four weeks after completion of the PCV13 series. Menveo (MenACWY-CRM) and MenQuadfi (MenACWY-TT) do non bear upon the immune response to pneumococcal vaccine and can be given at whatsoever time earlier or after PCV13, although MenQuadfi is not licensed for use in children younger than age two years.

Tin we vaccinate a ii-year-old boy with sickle cell disease against meningococcal disease if he has not completed a serial of PCV13?

Peradventure. If you are going to give him Menactra (MenACWY-D), you lot need to wait at to the lowest degree 4 weeks subsequently he completes the PCV13 series before giving him the Menactra. There is no similar space consideration if Menveo (MenACWY-CRM) or MenQuadfi (MenACWY-TT) is used; these brands may exist given simultaneously with PCV13 or at any interval earlier or after receipt of PCV13.

Adults who are asplenic need PCV13 and MenACWY. Does the recommendation to separate PCV13 and Menactra (MenACWY-D) employ to adults likewise equally children?

Yeah. If Menactra (MenACWY-D) is beingness used, you should space it 4 weeks after PCV13. With both asplenic children and asplenic adults, if less than iv weeks separate Menactra and PCV13 (in either order), the dose of PCV13 should be repeated four weeks after whichever vaccine was administered 2d.

Menveo (MenACWY-CRM) and MenQuadfi (MenACWY-TT) can be administered at any time before, simultaneous with, or after PCV13.

Do whatever of the bacterial vaccines that are recommended for people with functional or anatomic asplenia need to exist given earlier splenectomy? Do the doses count if they are given during the two weeks prior to surgery?

PCV13, Haemophilus influenzae type b vaccine, MenACWY, and meningococcal B vaccine should exist given 14 days before splenectomy, if possible. Doses given during the fourteen days earlier surgery can be counted every bit valid. If the doses cannot exist given prior to the splenectomy, they should exist given as soon equally the patient's condition has stabilized later surgery. Pneumococcal polysaccharide vaccine should exist administered eight weeks subsequently the dose of PCV13 for people two years of age and older.

I accept a pediatric patient who has functional asplenia. I gave her a dose of Menactra (MenACWY-D) when she was 3 years sometime. Exercise I need to give her a booster at some fourth dimension?

Because she has functional asplenia, she is due for the second dose of the primary series (assuming 8 weeks have passed since the first primary series dose). Considering she has a loftier-risk medical status she volition need periodic booster doses. If she is younger than age 7 years when she receives the 2nd dose of her primary serial, she should receive her beginning booster dose 3 years after completing the primary series. She should then receive a booster dose every five years thereafter. If she is age 7 years or older when she receives the second chief dose she should receive her first booster dose 5 years after the completing the primary series and every v years thereafter.

Nosotros have a 68-year-old who has been asplenic since 2009. She had one dose of meningococcal polysaccharide vaccine (MPSV4) in 2009, but no subsequent dose. She is now due for a booster. Should she receive ii doses of MenACWY, two months apart, to take hold of up, or merely one dose?

This situation is not addressed in the ACIP guidelines for meningococcal conjugate vaccine. Information technology is the CDC meningococcal bailiwick matter adept's opinion that this patient should receive 2 doses of MenACWY separated by at to the lowest degree 8 weeks, followed by a booster dose of MenACWY every v years thereafter. The concern is that having had only MPSV4 (Menomune, Sanofi Pasteur, discontinued in 2022) previously, she may not have an adequate booster response to a single dose of MenACWY.

I accept a patient with paroxysmal nocturnal hemoglobinuria who is existence treated with Soliris (eculizumab). Should he receive meningococcal vaccine?

Eculizumab (Soliris) and the related long-acting compound, ravulizumab (Ultomiris) bind to C5 and inhibit the terminal complement pathway. People with persistent complement component deficiency due to an immune system disorder or use of a complement inhibitor are at increased adventure for meningococcal illness even if fully vaccinated. This patient should be given a series of MenACWY vaccine, MenACWY (ii doses separated by at least viii weeks) and a 2- or 3-dose series (depending on brand) of MenB vaccine. The patient should receive regular booster doses of MenACWY and MenB as long as he remains at hazard: a booster dose of MenACWY every v years and a booster dose of MenB 1 year subsequently completion of the master serial, followed by a booster dose of MenB every 2–3 years thereafter.

Because patients treated with complement inhibitors tin can develop invasive meningococcal disease despite vaccination, clinicians using Soliris or Ultomiris also may consider antimicrobial prophylaxis for the duration of complement inhibitor therapy.

We have a 10-twelvemonth-old getting renal dialysis. The nephrologist will exist starting her on ravulizumab (Ultomiris), which interferes with C5 complement. If we administer MenACWY and pneumococcal polysaccharide vaccine (PPSV23) at present, and and then give her PCV13 in 8 weeks, volition the PCV13 interfere with the efficacy of the PPSV23 or the MenACWY?

Recommendations to separate MenACWY and PCV13 only apply to one of the 3 MenACWY vaccines, Menactra (MenACWY-D), and also only employ to individuals with functional or anatomic asplenia or HIV infection. So the best schedule is to requite MenACWY (whatsoever make) simultaneously with PCV13, and then PPSV23 in 8 weeks. ACIP recommends giving PCV13 before PPSV23 in lodge to maximize the immune response from PCV13. PPSV23 may blunt the immune response to PCV13 if PCV13 is given after PPSV23, although in children there is a smaller effect than in adults. A 10 year-old with persistent complement component deficiency also should receive a 2- or 3-dose serial (depending on brand) of meningococcal B vaccine.

Equally long as the kid remains at high risk of meningococcal disease due to complement inhibitor use, booster doses of both MenACWY and MenB are recommended. A MenACWY booster dose should be given every 5 years and a MenB booster dose should be given one year subsequently the completion of the primary serial, followed past a booster dose every 2–3 years thereafter.

Are people who are HIV-positive at increased adventure for meningococcal disease?

Yeah. Studies from the U.s., S Africa, and the Uk have shown that people with HIV infection have a risk of invasive meningococcal disease that is 11–24 times higher than the general population. In the Usa, this excess risk is specifically for serogroups C, W, and Y. ACIP recommends that all HIV-infected people 2 months of age and older should receive an historic period-appropriate MenACWY serial. Children younger than age ii years should be vaccinated using a multidose schedule based upon historic period (see the IAC document "Meningococcal Vaccine Recommendations by Historic period and Risk Factor for Serogroups A, C, Due west, or Y Protection" bachelor at www.immunize.org/catg.d/p2018.pdf for details).

People age two years and older with HIV infection who take non been previously vaccinated should receive a ii-dose primary series of MenACWY (doses separated by at to the lowest degree 8 weeks). People with HIV infection who accept previously received one dose of MenACWY should receive a second dose at the earliest opportunity (at least 8 weeks after the previous dose) and and so receive booster doses at the appropriate intervals (see Booster Doses below). ACIP does not recommend routine meningococcal serogroup B vaccination of people with HIV infection.

I have an otherwise healthy 26-year-one-time patient with HIV infection who received 1 dose of MenACWY 3 years ago. Should he receive ane or two doses now? Volition he need booster doses later?

It is not necessary to restart the MenACWY series. Requite the person one dose of MenACWY vaccine now. This dose represents a delayed second dose in the primary series (a 2-dose chief series recommended for people with HIV infection). The patient will subsequently need booster doses every 5 years.

I have a 24-calendar month-quondam patient with HIV infection and I want to use Menactra (MenACWY-D) because this is the merely vaccine we accept available in our clinic. However, this child received DTaP vaccine yesterday at another clinic. Can I administer MenACWY-D?

If Menactra (MenACWY-D) is to be administered to a child at increased risk for meningococcal disease, including children who take HIV infection, Menactra should exist given either earlier, at the aforementioned visit, or at to the lowest degree 6 months subsequently DTaP. This is because information advise a reduced response to the Menactra if given inside a month after DTaP. Menactra may be used earlier than half dozen months afterward DTaP if it is the but available option and vaccination is necessary due to travel to an expanse with epidemic or hyperendemic meningococcal affliction. Menveo (MenACWY-CRM) and MenQuadfi (MenACWY-TT) vaccines may be given at any fourth dimension before or after DTaP.

I take a 24-month-old patient with a complement component deficiency who received a dose of DTaP at 23 months of historic period so received a dose of Menactra (MenACWY-D) two weeks later. Practise I demand to echo the dose of Menactra?

No. Fifty-fifty though ACIP recommends that Menactra (MenACWY-D) should be given either before, at the same visit, or at least 6 months afterward DTaP, there is no show to support repeating the dose of Menactra. A kid with a complement component deficiency should still receive a second dose of MenACWY vaccine at least 8 weeks after the outset dose. In this example, if the 2nd dose also will be Menactra, it should look until the child is 29 months old (6 months after the dose of DTaP).

Does the recommendation for separation of DTaP and Menactra (MenACWY-D) also apply to children with functional or anatomic asplenia?

Yeah. The recommendation almost spacing of DTaP and Menactra (MenACWY-D) applies to all children younger than 7 years with a loftier-take chances condition for meningococcal illness, including travelers. Menactra may be used earlier than half-dozen months later DTaP if information technology is the only available option and vaccination is necessary due to travel to an expanse with epidemic or hyperendemic meningococcal affliction. Menveo (MenACWY-CRM) and MenQuadfi (MenACWY-TT) may exist given at any time before or later DTaP.

A 32-year-onetime patient with ulcerative colitis is taking loftier-dose immunosuppressive medications (half dozen-mercaptopurine). Should he receive meningococcal vaccine?

There is no specific indication for meningococcal vaccine in this patient. He is older than 21 years, and the risk�based recommendations are restricted to specific forms of altered immunocompetence (persistent complement component deficiency, functional or anatomic asplenia, use of eculizumab [Soliris] or ravulizumab [Ultomiris]) and HIV infection) and exercise not include other forms of contradistinct immunocompetence.

Should I recommend MenACWY vaccine for a nonsmoker living in a crowded household of smokers?

Although 2nd-hand smoke and other environmental conditions have been identified as risk factors for meningococcal disease, ACIP does non include them as indications for MenACWY vaccination. Providers may e'er utilize their clinical judgment in situations non addressed by ACIP.

Booster Doses

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Should all adolescents receive a routine booster dose of MenACWY?

ACIP recommends adolescents age 11 or 12 years be routinely vaccinated with MenACWY and receive a booster dose at age 16 years. Adolescents who receive the first dose at age 13 through fifteen years should receive a ane-fourth dimension booster dose, preferably at age 16 through 18 years, simply earlier the peak in incidence of meningococcal disease among adolescents occurs. Teens who receive their starting time dose of MenACWY at or later on age 16 years practice not demand a booster dose, every bit long equally they accept no additional risk factors.

Why does ACIP recommend a routine booster dose of MenACWY for adolescents at age sixteen years?

In 2005, ACIP recommended routine MenACWY vaccination for all adolescents at historic period xi or 12 years to protect them from meningococcal disease as older teens. The superlative age for meningococcal disease is 16 through 21 years. Subsequent studies indicated that the protection provided past MenACWY wanes within five years post-obit vaccination. For this reason, in 2010, ACIP recommended a MenACWY booster dose to provide continuing protection during the age of increased meningococcal incidence.

Which previously vaccinated college students demand a dose of MenACWY?

A booster dose should be given to first-year college students, regardless of age, who are or will be living in a residence hall if the previous dose was given before the age of sixteen years or if their about contempo dose (given after the 16th birthday) was not given within the by 5 years.

If someone received MPSV4 or MenACWY at historic period 9 years, will two additional doses of MenACWY be needed?

Yes. Doses of quadrivalent meningococcal vaccine (either MPSV4 or MenACWY) given before 10 years of age should not be counted as role of the serial. If a kid received a dose of either MPSV4 (Menomune, a meningococcal polysaccharide vaccine no longer available in the United states) or MenACWY before historic period x years, they should receive a dose of MenACWY at 11 or 12 years and a booster dose at age 16 years. A dose of MenACWY administered at age 10 may count equally the first boyish dose commonly given at 11 or 12.

Which people with run a risk factors should receive booster doses across the routinely recommended adolescent doses of MenACWY?

ACIP recommends routine booster doses of MenACWY for people 2 months quondam or older at ongoing high gamble for meningococcal infection (see www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6909a1-H.pdf, Tabular array iii). This group includes people (1) with persistent complement component deficiency (an immune system disorder) or who have a complement inhibitor (eculizumab [Soliris] or ravulizumab [Ultomiris]), (2) with anatomic or functional asplenia, (3) with HIV infection, (4) who have higher adventure of exposure (including microbiologists who handle Neisseria meningitidis isolates and travelers to or residents of areas with epidemic or hyperendemic meningococcal disease [such as the meningitis belt of sub-Saharan Africa]).

Children at continued high risk who received the last dose of the chief series of MenACWY earlier historic period 7 years should receive the next dose iii years after the most recent dose, and so every 5 years as long as adventure remains. People at continued high risk who received the last dose of the principal series at age 7 years or older should receive the side by side dose v years later on the most recent dose then every five years as long as adventure remains. Two of the iii MenACWY brands are licensed through age 55 years; however, if MenQuadfi (MenACWY-TT, licensed for use at age 2 years and older) is unavailable for an adult age 56 years or older, you may employ the available MenACWY production.

Should people with continued high risk of meningococcal disease receive additional doses of meningococcal vaccine beyond the 3- or 5-year booster?

Yeah, people should receive additional booster doses (every 5 years) if they go on to be at highest take chances for meningococcal infection.

If a kid with a high-risk status receives MenACWY at age ix years (and a second main dose 8 weeks later on), should they receive a booster dose at historic period 14 years (v years afterward the main series), or should they receive a dose at age sixteen years as recommended in the routine schedule?

The MenACWY booster dose should exist given at 14 years (5 years after the principal series) and every 5 years thereafter. The every five-year booster dose schedule for people with loftier-risk conditions takes precedence over the routine adolescent schedule.

What practice you do if an adult patient is in a high-adventure situation for meningococcal disease (for example travel to sub-Saharan Africa) and doesn't know whether they received MenACWY or MPSV4 in the by. Should we vaccinate them?

If the person cannot provide written documentation of the previous vaccination y'all should assume they are unvaccinated and vaccinate appropriately.

Administering Vaccine

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By what road should meningococcal vaccines be administered?

All meningococcal cohabit vaccines should exist administered by the intramuscular route. Meningococcal serogroup B vaccine is given by the intramuscular route.

We mistakenly gave a patient the diluent for Menveo (MenACWY-CRM) without adding information technology to the powdered vaccine. Since vaccine antigen is present in the diluent every bit well as in the powder, what should we exercise now?

The liquid vaccine component (the diluent) of Menveo contains the C, W-135, and Y serogroups, and the lyophilized vaccine component (the freeze-dried powder) contains serogroup A. Because the patient received simply the diluent, he or she is non protected confronting invasive meningococcal disease caused by Due north. meningitidis serogroup A.

Invasive disease with N. meningitidis serogroup A is very rare in the United States, but is more common in some other countries. If the recipient (of the C-Y-135 "diluent" only) is certain not to travel outside the United States then the dose does non need to be repeated. However, if the recipient plans to travel outside the Us the dose should exist repeated with either correctly reconstituted Menveo, or with a dose of another make of MenACWY. There is no minimum interval between the incorrect dose and the repeat dose.

Tin can MenACWY and MenB vaccines be given at the same visit?

Yes. MenACWY and MenB vaccines can exist given at the same visit or at any fourth dimension before or afterwards the other.

Vaccine Safety

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What adverse events are expected after receiving MenACWY?

In all 3 brands of MenACWY, the almost mutual adverse outcome were injection site pain, swelling or redness. Other reported symptoms included malaise and headache.

Is MenACWY included in the National Vaccine Injury Compensation Plan?

Yes. The National Vaccine Injury Compensation Program includes payment for injuries adamant to have occurred post-obit vaccination with a vaccine routinely recommended for children in the United States. The recipient can be of whatsoever age, only the vaccine must be routinely recommended for children and teens through historic period xviii years. MenACWY is routinely recommended for children so it is included in the program. More information about the program and the covered vaccines is at world wide web.hrsa.gov/vaccine-compensation/covered-vaccines/index.html.

Contraindications and Precautions

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What are the contraindications and precautions for MenACWY?

As with all vaccines, a severe allergic reaction (for case, anaphylaxis) to a vaccine component or to a prior dose is a contraindication to further doses of that vaccine. A moderate or severe acute illness is a precaution; vaccination should be deferred until the person's status has improved. Because MenACWY is an inactivated vaccine, information technology tin can be administered to people who are immunosuppressed every bit a result of disease or medications; however, response to the vaccine might be less than optimal.

Tin can a pregnant woman receive MenACWY vaccine?

Yes. No prophylactic concerns associated with vaccination have been identified in mothers vaccinated during pregnancy or their infants.

I understand that a prior history of Guillain-Barré syndrome (GBS) is no longer a precaution for giving meningococcal conjugate vaccine. Please tell me more about this.

A history of GBS had previously been a precaution for Menactra (MenACWY-D). Findings from ii studies that examined more than 2 meg doses of Menactra given since 2005 showed no evidence of an increased take chances of GBS. Consequently, ACIP recommended in 2010 to remove the precaution for use of Menactra in people with a history of GBS. This precaution did not apply to other meningococcal vaccines.

Vaccine Storage and Handling

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What is the storage requirement for MenACWY?

Store any brand of MenACWY at fridge temperature, between 2° and 8°C (between 36° and 46°F). The vaccine must not exist frozen. Vaccine that has been frozen or exposed to freezing temperature should not be used. Practise not use after the expiration date.

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