ACIP Updates Meningococcal B Vaccine Recommendations

The Advisory Committee on Immunization Practices (ACIP) has updated its 2015 recommendations regarding the use of the two- and three-dose schedules of MenB-FHbp serogroup B meningococcal vaccine (Trumenba, Pfizer, Inc). Recommendations for use of MenB-4C serogroup B meningococcal vaccine (Bexsero, GlaxoSmithKline Biologicals), which is given in a two-dose series, are unchanged.

Both vaccines are approved for individuals aged 10 to 25 years in the United States. The updated recommendations were published in the May 18 issue of the Morbidity and Mortality Weekly Report.

In April 2016, the US Food and Drug Administration approved changes allowing for both a two-dose series (given at 0 and 6 months) and a three-dose series (given at 0, 1 - 2, and 6 months) of MenB-FHbp. "In addition, the package insert now states that the choice of dosing schedule depends on the patient's risk for exposure and susceptibility to serogroup B meningococcal disease," Monica E. Patton, MD, from the Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues write.

"Either MenB vaccine can be used when indicated; ACIP does not state a product preference," the authors write. "The two MenB vaccines are not interchangeable; the same vaccine product must be used for all doses in a series," they caution.

Recommendations

ACIP recommends routine use of MenB vaccines among persons aged 10 years and older "who are at increased risk for serogroup B meningococcal disease (Category A recommendation), including persons with persistent complement component deficiencies; persons who have anatomic or functional asplenia; microbiologists who routinely are exposed to Neisseria meningitidis isolates; and individuals known to be at increased risk because of a serogroup B meningococcal disease outbreak." If using MenB-FHbp, three doses should be given at 0, 1 to 2, and 6 months to provide earlier protection. If the second dose of MenB-FHbp is given at an interval of 6 months or longer, a third dose is not necessary.
Healthy adolescents with no increased risk for meningococcal disease can receive two doses of MenB-FHbp at 0 and 6 months. If the second dose of MenB-FHbp is given sooner than 6 months after the first dose, a third dose should be given 4 months or longer after the second dose.
Recommendations for use of MenB-4C vaccine are unchanged.
The two MenB vaccines are not interchangeable, and the same product must be given for all doses in a series.
Either MenB vaccine may be given concomitantly with other vaccines appropriate for this age, but preferably at a different anatomic site.
Defer vaccination in women known to be pregnant or lactating unless the woman is at increased risk for serogroup B meningococcal disease, and if her healthcare provider determines that the benefits of vaccination outweigh the potential risks.