Meningococcal Vaccination: Information for Health Care Providers

There are 3 types of meningococcal vaccines available in the United States. These vaccines vary by the number of serogroups they can protect against.

• Two conjugate vaccines can protect against 4 serogroups: A, C, W, and Y.
• Two recombinant protein vaccines can protect against serogroup B.
• Two combination conjugate and recombinant protein vaccines can protect against 5 serogroups: A, B, C, W, and Y.

MenQuadfi

MenQuadfi is formulated in 0.5-mL doses. Each dose contains 10 micrograms (µg) each of meningococcal A, C, W, and Y polysaccharides conjugated to approximately 55 µg of tetanus toxoid protein carrier. It does not contain a preservative or an adjuvant. The manufacturer supplies it as a liquid in a single-dose vial.

Menveo

Menveo is available as a one- or two-vial presentation.

Menveo two-vial presentation consists of 2 components:

• 10 µg of lyophilized meningococcal serogroup A (MenA) capsular polysaccharide conjugated to CRM197
• 5 μg each of capsular polysaccharide of serogroup C, W, and Y (MenCWY) conjugated to CRM197 in 0.5 mL of phosphate buffered saline

Vaccine providers reconstitute the lyophilized MenA component with the MenCWY liquid component before injection. It does not contain a preservative or an adjuvant. It is licensed for use in individuals ages 2 months through 55 years.

Menveo one-vial presentation:

• Contains the same active ingredients as the two-vial presentation
• Does not have any adjuvants or preservatives
• Does not require reconstitution before use
• Is licensed for use in individuals ages 10 years through 55 years

Bexsero

Each 0.5-mL dose of Bexsero contains:

• 50 µg each of recombinant proteins Neisserial adhesin A (NadA), Neisserial Heparin Binding Antigen (NHBA), and factor H binding protein (fHbp)
• 25 µg of Outer Membrane Vesicles (OMV)
• 1.5 milligrams (mg) aluminum hydroxide (0.519 mg of Al³⁺)
• 3.125 mg sodium chloride
• 0.776 mg histidine
• 10 mg sucrose at pH 6.4 – 6.7
• Less than 0.01 µg kanamycin (by calculation)

Trumenba

Each 0.5-mL dose of Trumenba contains:

• 60 µg each of 2 lipidated fHbp variants (total of 120 µg of protein)
• 0.018 mg of polysorbate 80
• 0.25 mg of Al³⁺
• 10 millimolar (mM) histidine buffered saline at pH 6.0

Penbraya

Each 0.5-mL dose of Penbraya contains 2 sterile components:

• A lyophilized MenACWY component
• A liquid MenB component (Trumenba)

Vaccine providers reconstitute the lyophilized MenACWY component with the MenB component before injection.

Each dose contains 5 µg each (20 µg total) of meningococcal A, C, W, and Y polysaccharides conjugated to 44 µg of tetanus toxoid, and 60 µg each (120 µg total) of 2 recombinant lipidated fHBP variants from meningococcal serogroup B. Each dose also contains:

• 0.78 mg of L-histidine
• 0.097 mg of trometamol
• 28 mg of sucrose
• 0.25 mg of aluminum phosphate
• 4.65 mg of sodium chloride
• 0.018 mg of polysorbate 80 at pH 6.0
  

Penmenvy

Each 0.5-mL dose of Penmenvy contains 2 sterile components:

• A lyophilized MenACWY component
• A liquid MenB component

Vaccine providers reconstitute the lyophilized MenACWY component with the MenB component before injection.

After reconstitution, each dose contains 10 mcg MenA oligosaccharide; 5 mcg of each of MenC, MenW, and MenY oligosaccharides; 25.4 to 65.8 mcg CRM197 protein; 50 mcg each of recombinant proteins NadA, NHBA, and fHbp; and 25 mcg of OMV. Each dose also contains:

• 1.5 mg aluminum hydroxide (0.5 mg of Al3+)
• 3.125 mg sodium chloride
• 0.776 mg histidine
• 22.5 mg sucrose
• ≤0.7 mg potassium phosphate salts
• less than 0.01 mcg kanamycin (by calculation)
• not more than 0.30 mcg residual formaldehyde (estimated)

Incidence of meningococcal disease has declined in the United States since the 1990s and remains low today. However, U.S. cases of meningococcal disease have increased sharply since 2021 and now exceed pre-pandemic levels. In 2024, 503confirmed and probable cases were reported based on preliminary data. This is the largest number of U.S. meningococcal disease cases reported since 2013.

CDC first recommended adolescents get a MenACWY vaccine in 2005. Since then, the incidence of meningococcal disease in adolescents caused by serogroups C, Y, and W decreased by over 90% (note: serogroup A meningococcal disease continues to be very rare in the United States).

As part of the licensure process, both MenACWY and MenB vaccines demonstrated that they produce an immune response. This immune response suggests the vaccines are protective (summarized from package inserts below), but effectiveness data are limited.

Available data suggest that protection from MenACWY vaccines decreases in many adolescents within 5 years. Getting the 16-year-old MenACWY booster dose is critical to maintaining protection when adolescents are most at risk for meningococcal disease. Available data on MenB vaccines suggest that protective antibodies also decrease quickly (within 1 to 2 years) after vaccination. MenB booster doses are important for those who remain at increased risk of serogroup B meningococcal disease.

Consult the following package inserts for proper storage and handing details, shelf life, and reconstitution instructions:

• Bexsero
• Menveo
• MenQuadfi
• Penbraya
• Penmenvy
• Trumenba

• Store meningococcal vaccines (lyophilized and liquid components) in original packaging refrigerated between 2°C and 8°C (36°F and 46°F).
• Protect from light
• Do not freeze vaccine (lyophilized and liquid components) or expose to freezing temperatures. If the vaccine has been exposed to inappropriate conditions/temperatures or handled improperly:
  • Mark "Do NOT Use"
  • Isolate from other vaccines in a separate container
  • Store the vaccine at the appropriate temperature
  • Document details of the temperature excursion. Consult the vaccine manufacturer and/or your state or local immunization program for further guidance

• Store meningococcal vaccines in the original packaging.
  • For meningococcal vaccines that require reconstitution (Menveo, Penbraya, Penmenvy), store lyophilized and liquid components of the vaccine (which are packaged together) together in the refrigerator.

• For meningococcal vaccines that require reconstitution (Menveo, Penbraya, Penmenvy), do NOT use if the reconstituted vaccine cannot be resuspended with agitation.
  • Only use the antigen-containing liquid component provided by the manufacturer to reconstitute the corresponding lyophilized component for the vaccine. Do not use any other diluent.
  • Never use stock vials of normal saline to reconstitute these vaccines.

• Discard vaccine vials according to your state requirements for disposal.
• Medical waste disposal requirements are set by state environmental agencies. Contact the state or local immunization program or state environmental agency for guidance.

Do not use any meningococcal vaccine or diluent (if applicable) beyond the expiration date printed on the label.

Prior to administration, visually inspect the vaccine for particulate matter and/or discoloration. If these conditions exist, do NOT use.

Administer meningococcal conjugate (MenACWY), serogroup B meningococcal (MenB), and pentavalent meningococcal (MenABCWY) vaccines by the intramuscular route. The preferred site for infants and young children is the vastus lateralis muscle in the anterolateral thigh. The preferred injection site in older children and adults is the deltoid muscle. Use a needle length appropriate for the age and size of the person receiving the vaccine.

MenACWY vaccines

Administer MenACWY vaccines (Menveo[either one- or two-vial presentation] or MenQuadfi) to adolescents as 1 primary dose at 11 to 12 years of age. Administer 1 booster dose at 16 years of age. The minimum interval between doses is 8 weeks.

Patients 2 years of age or older in certain situations should receive a 2-4 dose primary series 2 months apart and regular booster doses if they remain at increased risk.

The number of doses and schedule for patients under 2 years of age varies by vaccine product. See Child Immunization Schedule Notes.

For patients at prolonged increased risk for meningococcal disease, CDC recommends MenACWY booster doses after completion of the primary series. For patients who received their most recent dose before age 7 years, administer the booster dose 3 years later. For patients who received their most recent dose at age 7 years or older, administer the booster dose 5 years later. Administer boosters every 5 years thereafter throughout life for as long as the person remains at increased risk for meningococcal disease.

MenB vaccines

Both MenB vaccine products (Bexsero and Trumenba) require more than 1 dose for maximum protection. Patients must receive a vaccine product from the same manufacturer for all doses, including booster doses.

• Administer 2 or 3 doses (primary series).
  • Administer 3 doses to people 10 years of age or older who are at increased risk for meningococcal disease. This includes during outbreaks of serogroup B meningococcal disease. Administer the second dose 1 to 2 months after the first dose. Administer the third dose 6 months after the first dose.
  • Based on shared clinical decision-making, providers can administer 2 doses to healthy adolescents and young adults (ages 16 – 23 years) who are not at increased risk for serogroup B meningococcal disease. Administer the second dose 6 months after the first dose.

For patients at prolonged increased risk for meningococcal disease, CDC recommends MenB booster doses after completion of the primary series. Administer a booster dose of MenB vaccine 1 year after series completion and then every 2 to 3 years thereafter.

MenABCWY vaccines

If a patient is receiving MenACWY and MenB vaccines at the same visit, a MenABCWY vaccine (Penbraya, Penmenvy) may be given instead. The minimum interval between MenABCWY doses is 6 months.

MenB vaccine products are not interchangeable. When a MenABCWY vaccine is administered, subsequent doses of MenB must be from the same manufacturer. For example: If a patient receives Penbraya vaccine, which includes Trumenba, then administer:

• Trumenba for additional MenB dose(s) when MenACWY isn't indicated
• Any MenACWY vaccine when MenB isn't indicated

Similarly, if a patient receives Penmenvy, they should receive Bexsero for additional MenB dose(s) when MenACWY isn't indicated.

Patients at prolonged increased risk for serogroup A, C, W, or Y and B meningococcal disease need booster vaccination. However, the recommended interval between doses varies by age and vaccine type. MenABCWY vaccine can be used only when both MenACWY and MenB vaccines are indicated at the same visit. Otherwise, MenACWY and MenB vaccines should be given separately as appropriate.

Do not predraw vaccine doses. There are no data on the stability of vaccines stored in syringes filled by healthcare professionals. Do not open vaccine vials until time of administration. Do not freeze.

After reconstitution, administer Menveo two-vial presentation within 8 hours or discard.

After reconstitution, administer Penbraya immediately, store it between 2°C and 30°C (36°F and 86°F) and use within 4 hours, or discard.

After reconstitution, use Penmenvy immediately.

Vaccine providers may administer MenACWY (Menveo, MenQuadfi) and MenB (Trumenba, Bexsero) vaccines during the same visit, but at a different injection site, if feasible. If eligible, MenABCWY vaccine (Penbraya, Penmenvy) can be given in place of the two separate vaccines.

Providers can also administer meningococcal and other vaccines during the same visit, but at a different injection site, if feasible. Administer each vaccine with a separate syringe.