Document text
Revising the Adolescent Meningococcal Vaccine Schedule:
Term of Reference and Considerations
Sarah Schillie, MD, MPH, MBA
February 29, 2024National Center for Immunization & Respiratory Diseases
The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official
position of the Centers for Disease Control and Prevention.
▪Vaccine recommendations and coverage
▪Epidemiology
▪Duration of vaccine -induced protection
▪Options for changing the immunization scheduleOutline
2 of 24
*Both (all) doses must be from same manufacturerAdolescent Meningococcal Vaccine Recommendations
▪MenACWY :
•Dose #1: 11 –12 years
•Dose #2: 16 years
▪MenB * (shared clinical decision -making)
•2- or 3-dose series between 16 –23 years of age (preferred range: 16 –18 years)
▪MenABCWY :
•Recommended when both MenACWY and MenB indicated at same visit
3 of 24
▪MenACWY
–≥1 dose at 13 years: 84.5% (81.3% -87.2%)*
–≥1 dose at 16 years: 89.8% (87.4% -91.8%)
–≥2 doses at 17 years: 60.8% (57.5% -63.9%)**
▪MenB
–≥1 dose at 17 years: 29.4% (26.5% -32.4%)
–≥2 doses at 17 years: 11.9% (10.0% -14.1%)2022 Meningococcal Vaccine Coverage
*Coverage varies by metropolitan statistical area, poverty status, race/ethnicity, and health insurance status, although conf idence
intervals largely overlap
**Does not include adolescents who received 1st dose of MenACWY vaccine at age ≥16 years
Pingali C, et al. MMWR Morb Mortal Wkly Rep 2023: http://dx.doi.org/10.15585/mmwr.mm7234a34 of 24
Meningococcal Disease Incidence ― United States, 1996 -2022*
x
5 of 24
*2021 -2022 NNDSS data are preliminary
Average Annual Meningococcal Disease Incidence by
Age-Group and Serogroup ― United States, 2020 -2022*
6 of 24
Average Annual Meningococcal Disease Incidence by
Age-Group and Serogroup ― United States, 2012 -2021*
7 of 24
▪Preliminary data indicate 416* cases in 2023
–Highest number of cases since 2014
▪Rates of disease greatest in children <1 year of age
▪Second peak in adolescence; among cases in 2021:
–19 of 210 (9.0%) total cases in 11 -23 year -oldsIncreasing Case Counts
*Confirmed and probable cases8 of 24
▪Among adolescents 11 -15 years old, incidence decreased:
–16.3% (12.1% -20.3%) during prevaccine period
–27.8% (20.6% -34.4%) during post -primary dose period
▪Among adolescents 16 -22 years old, incidence decreased:
–10.6% (6.8% -14.3%) during post -primary dose period
–35.6% (29.3% -41.0%) during post -booster dose period
▪Estimated 222 cases of serogroup C,W,Y disease averted
through vaccination of adolescents from 2006 -2017Cases Averted Due to Vaccination
Mbaeyi S, et al. JAMA Pediatr 2020 9 of 24
Incidence of Meningococcal Disease by Serogroups Following
MenACWY Vaccine Implementation
Source: National Notifiable Diseases Surveillance System (NNDSS) data with additional serogroup data from Active Bacterial Co re surveillance (ABCs) and state health departments ACWY disease incidence substantially
decreased in adolescentsB disease incidence was similar in
adolescents over time
00.050.10.150.20.250.3
11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26Incidence per 100,000
AgeSerogroups A, C, W, Y
2006-2010 2015-201900.050.10.150.20.25
11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26Incidence per 100,000
AgeSerogroup B
2006-2010 2015-2019 10 of 24
▪College students have a 3.5 -fold (95% CI: 2.2 -5.4) higher risk of serogroup B
disease than non -college students
▪Serogroup B incidence peaks for 19 year -old college students and declines
after age 20
Serogroup B Disease Risk is Higher among
College Students
Mbaeyi S, et al. Pediatr 2019 11 of 24
Additional Factors Associated with
Increased Risk among College Students
▪4-year college students had a 5.2-fold (95% CI: 3.6 -7.7) higher risk of serogroup B
disease than non -undergraduates aged 18 -24 years
–Risk among 2 -year college students was comparable to non -undergraduates (RR 1.0,
95% CI: 0.4 -2.1)
▪First -year students were at 3.8-fold (95% CI: 2.4 -6.0) higher risk of serogroup B
disease than non -first-year students
▪On-campus residents at 2.9-fold (95% CI: 1.8 -4.6) higher risk of serogroup B
disease than off -campus residents
▪Students participating in Greek life were at 9.8-fold (95% CI: 4.6 -21.2) higher risk
of serogroup B disease than other students during outbreaks
Weil L, et al. OFID 2023 12 of 24
▪MenACWY
–Protection wanes 3 to <8 years postvaccination
•<1 year: 79%
•1 to <3 years: 69%
•3 to <8 years: 61%
▪MenB
–Protection wanes 1 -2 years following primary vaccinationDuration of Vaccine -Induced Protection
Mbaeyi S, et al. MMWR Recomm Rep 2020 https://www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6909a1 -H.pdf ; Stephens D, et al.
in Plotkin’s Vaccines 8th edit 2024; Dretler A, et al. Hum Vacc & Immuno 2018; Cohn A, et al. Pediatr 2018
13 of 24
▪Bexsero is recommended for prevention of serogroup B
meningococcal disease
–Some protection against gonorrhea is also likely
▪N. meningitidis and N. gonorrhoeae closely genetically
related
– ~80 to 90% sequence homology
▪Potential for outer membrane vesicle (OMV) -containing
MenB vaccines (e.g., Bexsero) to provide protection against
N. gonorrhoeae
Petousis -Harris H, et al. Lancet 2017; Wang B, et al. Lancet 2022; Abara W, et al. Lancet 2022; Bruxvoort K, et al. CID 2023Effectiveness of Bexsero against Gonorrhea
14 of 24
▪Revisions to the schedule should optimize protection
against meningitis
▪Considerations for meningitis protection include:
–Ages at higher risk for meningitis
–Recent meningitis epidemiology
–Duration of vaccine -induced protection
15 of 24Revising the
Adolescent Meningococcal Vaccine Schedule
▪Maintaining harmonization with existing adolescent
vaccination platform
▪Pentavalent vaccine provides opportunity to reduce
number of injections
16 of 24Revising the
Adolescent Meningococcal Vaccine Schedule, cont.
▪MenACWY
–Possibly eliminate 11 -12 year -old dose
–Change recommended age given recent epidemiology
▪MenB
–Change recommended age to increase protection upon college entry
–Routine or risk -based recommendation
•If risk -based recommendation, include permissive language for vaccination of persons
in age group requesting protection but who may lack risk factors such as college
attendance (equity considerations) Options for Revising
Adolescent Meningococcal Vaccine Schedule
17 of 24
Schedule Options for Further Consideration
OptionACWY
Dose#1ACWY
Dose#2B Dose#1 B Dose#2
Current
recomm .11–12 yrs 16 yrs16 yrs – 23 years (preferred 16 –18 yrs)
SCDM
1 11–12 yrs 16 yrs 16 yrs 17–18 yrs
2 11–12 yrs 16 yrs 16 yrs risk-based 17–18 yrs risk-based
3 No dose 16 yrs 16 yrs risk -based 17–18 yrs risk-based
4 15 yrs 17–18 yrs 17–18 yrs 17–18 yrs
Proposed recommendations are for routine vaccination unless specified as
“risk -based”; option numbers do not represent ordering of preference
SCDM, shared clinical decision -making 18 of 24
Schedule Options for Further Consideration, etc.
OptionACWY
Dose#1ACWY
Dose#2B Dose#1 B Dose#2
Current
recomm .11–12 yrs 16 yrs16 yrs – 23 years (preferred 16 –18 yrs)
SCDM
1 11–12 yrs 16 yrs 16 yrs 17–18 yrs
2 11–12 yrs 16 yrs 16 yrs risk-based 17–18 yrs risk-based
3 No dose 16 yrs 16 yrs risk -based 17–18 yrs risk-based
4 15 yrs 17–18 yrs 17–18 yrs 17–18 yrs
Proposed recommendations are for routine vaccination unless specified as
“risk -based”; option numbers do not represent ordering of preference
SCDM, shared clinical decision -making 19 of 24
Schedule Options for Further Consideration, etc.
OptionACWY
Dose#1ACWY
Dose#2B Dose#1 B Dose#2
Current
recomm .11–12 yrs 16 yrs16 yrs – 23 years (preferred 16 –18 yrs)
SCDM
1 11–12 yrs 16 yrs 16 yrs 17–18 yrs
2 11–12 yrs 16 yrs 16 yrs risk-based 17–18 yrs risk-based
3 No dose 16 yrs 16 yrs risk -based 17–18 yrs risk-based
4 15 yrs 17–18 yrs 17–18 yrs 17–18 yrs
Proposed recommendations are for routine vaccination unless specified as
“risk -based”; option numbers do not represent ordering of preference
SCDM, shared clinical decision -making20 of 24
▪Variability in desire to keep vs. eliminate 11 –12 year -old dose of
MenACWY
–Favor keeping: Has taken years to ingrain the 11 –12 year -old platform, 11 –12
year -old dose may have reduced carriage and ‘worked’
–Favor eliminating: Epi seems to support starting series at 16 years
▪Consider administering MenB dose #1 at age 15 years*
▪Try to achieve acceptable efficacy for duration of disease incidence peak in
young adulthoodSynthesis of Work Group Comments
*Not among 4 options for consideration 21 of 24
▪Oppose SCDM recommendations
–Poor uptake, missed opportunities, implementation challenges, lack of strong
recommendation prevents many institutions from implementing policies, not
understandable to clinicians
–Interest in changing MenB to risk -based or routine recommendation
▪Harmonization of MenACWY and MenB schedules may reduce number of
injections
–Extra antigen administration (as may occur with administration of pentavalent
vaccine) has not been a concern before
▪Change in schedule may impact school requirements Synthesis of Work Group Comments, cont.
22 of 24
▪Does ACIP concur with the 4 schedule
options for further assessment?
▪What additional information will help ACIP
determine the preferred option?Discussion
23 of 24
Acknowledgements
▪Lucy McNamara
▪Jennifer Collins
▪Samuel Crowe
▪Sancta St. Cyr
24 of 24