ACIP Votes to ‘Harmonize’ Dosing and Interval for Meningococcal B Vaccines

The CDC’s Advisory Committee on Immunization Practices (ACIP) on Thursday unanimously endorsed revising the dosing and interval of the meningococcal group B vaccine MenB-4C (Bexsero).

In a 15-0 vote, ACIP recommended that MenB-4C be administered as a two-dose series at 0 and 6 months when given to healthy adolescents and young adults ages 16 to 23 years based on shared clinical decision-making for the prevention of serogroup B meningococcal disease.

The committee also voted to recommend that MenB-4C be administered as a three-dose series at 0, 1-2, and 6 months in people 10 years and up who are at increased risk for serogroup B meningococcal disease. Those at increased risk include persons with anatomic or functional asplenia, complement component deficiencies, or complement inhibitor use; microbiologists routinely exposed to Neisseria meningitidis isolates; and persons at increased risk during an outbreak.

Prior recommendations had called for MenB-4C as a two-dose series given at 0 and 1 month or later for both healthy adolescents and young adults and those at increased risk.

MenB-4C was originally granted accelerated approval in 2015 and received full approval from the FDA in August. The new recommendations align the dosing and intervals for GSK’s vaccine both with recent label changes and to that of Pfizer’s meningococcal group B vaccine, MenB-FHbp (Trumenba).

Aligning the dosing and intervals of the two vaccines would likely be “viewed favorably” by providers, noted Sarah Schillie, MD, MPH, MBA, a member of the ACIP working group investigating the proposed recommendations.

“I think that it’s important to harmonize,” the recommendations, said Helen Chu, MD, MPH, of the University of Washington in Seattle.

Yvonne “Bonnie” Maldonado, MD, of the Lucile Packard Children’s Hospital at Stanford in Palo Alto, California, urged the committee to shift to a “non-shared decision-making” recommendation in the future to “minimize complexity for the primary care provider.”

Meningococcal disease progresses rapidly and 10% to 15% of cases are fatal, even with the appropriate antibiotics. Additionally, 20% of those who survive the disease endure long-term sequelae including cognitive deficits, hearing loss, and limb amputations.

Since 2022, there have been nine serogroup B meningococcal outbreaks, according to the ACIP working group.

ACIP on Thursday also voted unanimously to include the revisions to the meningococcal vaccine recommendations under the Vaccines for Children program, which makes coverage free for uninsured or underinsured children.

Contraindications for the meningococcal vaccine are a severe allergy to a prior dose or component of vaccine, and precautions include pregnancy and moderate or severe acute illness.

The committee is expected to revisit and vote on the adolescent meningococcal vaccine schedule sometime in 2025.

As always, all ACIP recommendations are not considered final until they are published in the Morbidity and Mortality Weekly Report.