Meningococcal B Vaccine Recommendations

Routine Vaccination for Healthy Adolescents

The Centers for Disease Control and Prevention recommends that the first dose of meningococcal B vaccine should be administered between ages 16-23 years, with the preferred age being 16-18 years, based on shared clinical decision-making between the provider and patient/family 1, 2
MenB vaccination is not routinely recommended for all adolescents, but rather requires a shared clinical decision-making discussion 2, 3
The preferred age window for MenB vaccination is 16-18 years, though vaccination can occur anytime between 16-23 years 1, 4, 5

For persons aged ≥10 years at increased risk for meningococcal disease, vaccination should begin at age 10 years or older when the risk factor is identified 6, 4, 5
High-risk groups include persons with persistent complement deficiencies 4, 5, persons using complement inhibitors (e.g., eculizumab) 4, 7, persons with anatomical or functional asplenia (including sickle cell disease) 4, 7, microbiologists routinely exposed to Neisseria meningitidis 7, and persons at risk during serogroup B meningococcal disease outbreaks 6, 8
For high-risk individuals, a 3-dose schedule is recommended 6, 4, 8

When discussing MenB vaccination with healthy adolescents aged 16-23 years, consider the serious disease consequences, low disease incidence, increased college risk, short duration of protection, and lack of herd immunity 2, 3
The American Academy of Pediatrics and the Centers for Disease Control and Prevention recommend considering these factors in shared clinical decision-making discussions 2, 3

The two MenB vaccines are not interchangeable, and the same product must be used for all doses in the series 1, 2, 3, 8
MenB vaccines are only licensed for ages 10-25 years in the United States, and there are no recommendations for use in children under age 10 1, 4, 5

The Centers for Disease Control and Prevention recommends that MenB vaccination should be deferred until after pregnancy unless the woman is at increased risk, in which case the benefit may outweigh potential risks after consultation 9, 7
For individuals aged ≥26 years, MenB vaccination is not routinely recommended, but may be considered for those at increased risk (off-label use) 1, 9, 8

The Centers for Disease Control and Prevention recommends that the same MenB vaccine product be used for all doses in a series, including booster doses, as the two MenB vaccines—MenB-FHbp (Trumenba) and MenB-4C (Bexsero)—are not interchangeable 10, 11, 12, 13, 14, 15

MenB-4C (Bexsero) contains four components, including outer membrane vesicles and three recombinant proteins, providing distinct mechanisms of protection 10

If the original MenB vaccine product is known, complete the series with the same product 10, 11, 12, 14
If the original product is unknown, make every effort to identify it through immunization registries, previous providers, or pharmacy records, and consider restarting the series with a documented product if the patient is at high risk 14

For high-risk patients, the recommended dosing schedule for MenB-FHbp (Trumenba) is 3 doses at 0, 1-2, and 6 months 12
For healthy adolescents, the recommended dosing schedule for MenB-FHbp (Trumenba) is 2 doses at 0 and 6 months 12

For persons at continued increased risk requiring boosters, the same product used for the primary series must be used for booster doses, with boosters recommended 1 year after primary series completion, then every 2-3 years for those who remain at increased risk 11, 12, 14

The U.S. Food and Drug Administration has licensed Bexsero only for individuals 10–25 years old; use outside this age range is considered off‑label. 16
The Centers for Disease Control and Prevention (CDC) does not issue recommendations for Bexsero use in infants or children younger than 10 years in the United States, even though the vaccine is licensed for younger ages in other countries. 17

Persistent complement component deficiencies (e.g., properdin, factor D, C3, C5‑C9) are a Category A (routine) indication for the 3‑dose schedule. 16
Anatomical or functional asplenia, including sickle‑cell disease, is a Category A indication for the 3‑dose schedule. [18][19]
Microbiologists with routine occupational exposure to Neisseria meningitidis are a Category A indication for the 3‑dose schedule. [18][19]
Individuals at risk during serogroup B meningococcal disease outbreaks are a Category A indication for the 3‑dose schedule. [16][17]

For persons with ongoing increased risk, a single booster dose should be given 1 year after completion of the primary series, with subsequent boosters every 2–3 years. (Evidence strength not explicitly stated.)
During outbreak situations, the booster interval may be shortened to ≥6 months based on public‑health assessment. 17

Bexsero and Trumenba are not interchangeable; the same MenB product must be used for all doses in a series. If the original product is unknown, providers should attempt to verify it through immunization registries before restarting the series. [16][18]19

MenACWY vaccines (protecting serogroups A, C, W, Y) are licensed for infant use starting at 2 months of age and follow distinct dosing schedules; they should not be confused with Bexsero, which targets serogroup B. 17

Pregnant or lactating women should defer Bexsero unless they have a heightened risk for serogroup B disease; in high‑risk situations, vaccination may be considered after provider consultation. 16
Adults aged ≥26 years are not routinely recommended to receive Bexsero; off‑label use may be considered for high‑risk individuals (e.g., complement deficiency, asplenia, occupational exposure, outbreak settings). [18][19]
Immunocompromised patients (including those with HIV infection, complement deficiencies, or asplenia) may have reduced immune responses to Bexsero, but the 3‑dose schedule remains recommended for those at high risk. [18][19]
Adults with HIV infection are not routinely recommended to receive MenB vaccines because invasive meningococcal disease in this group is predominantly caused by serogroups C, W, and Y rather than B. [18][19]