Meningococcal disease is a life-threatening invasive infection caused by Neisseria meningitidis. Two vaccines against serogroup B are licensed in the United States: MenB-4C (Bexsero, GSK) and MenB-FHbp (Trumenba, Pfizer), along with one combined MenABCWY vaccine (Penbraya, Pfizer) — all for ages 10–25.
What changed
- August 2024: based on new immunogenicity data — not safety concerns — the Food and Drug Administration changed Bexsero's label from two doses at 0 and at least 1 month to two doses at 0 and 6 months, and added a three-dose schedule at 0, 1–2 and 6 months.
- October 24, 2024: the Advisory Committee on Immunization Practices (ACIP) updated its recommendations to match — which also brings Bexsero into line with Trumenba. Guidance on Trumenba, Penbraya and booster doses is unchanged.
| Who | Bexsero schedule now |
|---|---|
| Healthy adolescents and young adults, 16–23, by shared clinical decision-making | 2 doses: 0 and 6 months |
| People 10 and older at increased risk | 3 doses: 0, 1–2 and 6 months |
Increased risk means people with anatomic or functional asplenia, complement component deficiencies or on complement inhibitors; microbiologists routinely handling N. meningitidis; and people at risk during an outbreak.
Shared clinical decision-making means the vaccine is not recommended for everyone in the age group, but decided case by case between the provider and the patient or parent. Things to weigh: how serious the disease is, how few serogroup B cases occur, protection that wanes within 1–2 years, and the higher risk among college students — especially freshmen, students at four-year universities, those in on-campus housing and members of sororities and fraternities.
The evidence
- Immunogenicity: data from 1,803 people aged 10–25 (about 30% in the U.S.) who got at least one dose. The share reaching seroresponse — measured by serum bactericidal activity against four indicator strains — was 54%–97% after the second dose of a 0-, 2-, 6-month schedule, 57%–95% after the second dose of a 0- and 6-month schedule, and 57%–99% after the third dose of the 0-, 2-, 6-month schedule.
- Safety: the most common reactions were injection-site pain (at least 87%), fatigue (at least 45%) and headache (at least 37%), about equally after every dose.
- Completion worries: a longer interval could mean fewer people finish the series, and hit some groups harder. In 2022, among adolescents not eligible for the Vaccines for Children program, 49.6% finished Bexsero and 35.5% Trumenba by 17; among eligible adolescents, 51.4% and 16.2%. Among commercially insured teens in 2017–2023, 67% and 60% finished by 19. ACIP weighed the possible harm to equity against the practical gain of matching the two vaccines.
How to give it
- Don't mix brands. Vaccines from different manufacturers are not interchangeable — every dose, including boosters, from the same maker. If both were given, complete a full series of one, counting none of the other's doses, at least the recommended interval after that maker's last dose and at least 4 weeks after any dose.
- Already vaccinated on the old schedule? No extra doses are recommended for people who got Bexsero at 0 and 1 month before October 24, 2024. Anyone who stays or becomes at increased risk after a primary series should get boosters, from the same maker.
- Two-dose series (Bexsero or Trumenba): doses 6 months apart. If the second comes sooner, give a third at least 4 months after the second. A second dose later than 6 months still counts.
- Three-dose series: no third dose is needed if the second came at least 6 months after the first. A third dose given less than 4 months after the second should be repeated at least 4 months later — unless it came at least 6 months after the first.
- Need protection fast? People getting the vaccine by shared decision-making — such as students starting less than 6 months before college — may use the three-dose schedule for either vaccine. Note that Vaccines for Children eligibility ends at 19.
Complement inhibitors
People on complement inhibitor therapy probably stay at substantially higher risk even when fully vaccinated or on antibiotic prophylaxis. Vaccination may not fully protect them, but they should still be vaccinated as recommended. Those who are not up to date and urgently need a complement inhibitor should get antimicrobial prophylaxis; with little data on how long, providers may consider continuing it for as long as the complement inhibitor is used.
Report adverse events — any clinically significant event, even if the vaccine may not be the cause, and vaccination errors — to the Vaccine Adverse Event Reporting System (vaers.hhs.gov, 1-800-822-7967).
Sources
Based on "New Dosing Interval and Schedule for the Bexsero MenB-4C Vaccine: Updated Recommendations of the Advisory Committee on Immunization Practices — United States, October 2024," by Sarah Schillie, Jamie Loehr, Wilbur H. Chen, Charlotte A. Moser, Gabrielle Cooper, Cheryl Isenhour and Lucy A. McNamara, Morbidity and Mortality Weekly Report 73(49), Centers for Disease Control and Prevention; a work of the United States government in the public domain.
Licence: CC0 1.0 (public domain) · Adapted from www.cdc.gov
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