Changes to the adolescent meningococcal vaccination schedule could be on tap as a Centers for Disease Control and Prevention committee plans to continue reviewing revisions designed to optimize protection against meningitis.
Several options were discussed during the Advisory Committee on Immunization Practices (ACIP) meeting Thursday, and committee members could vote on the proposals in February 2025.
The current schedule recommends children receive their first dose of meningococcal conjugate (MenACWY) vaccine at ages 11-12 years and a second dose at 16 years. Those who are not at increased risk of meningococcal disease could receive two doses of serogroup B meningococcal disease (MenB) vaccine between 16 and 23 years of age (preferably at 16-18 years old), following a discussion between a health care provider and patient or the patient’s parent/guardian.
ACIP Meningococcal Work Group members presented four options for revising the meningococcal vaccine schedule. One option included only one dose of MenACWY vaccine to be given at 16 years of age and eliminating the dose at 11-12 years.
Work group members preferred options 1 and 3 but sought feedback on all four options.
Option 1 calls for MenACWY doses 1 and 2 to remain unchanged. MenB doses 1 and 2 would be administered as routine vaccinations at 16 years and 17-18 years, respectively.
Option 3 calls for only one dose of MenACWY at 16 years of age. MenB doses 1 and 2 would be offered at 16 years and 17-18 years, respectively, based on risk instead of routinely.
Presenters noted meningococcal disease incidence in the United States had been declining prior to MenACWY and MenB vaccine use. However, 416 confirmed and probable cases of meningitis occurred in 2023, the highest number of cases since 2014. While cases were declining pre-vaccines, presenters noted the number of cases averted due to vaccination noticeably increased after vaccinations initially were offered.
Amy B. Middleman, M.D., M.P.H., M.S.Ed., FAAP, liaison from the Society for Adolescent Health and Medicine (SAHM) to ACIP, said a recent discussion among some SAHM members showed many were not in favor of removing vaccine doses from the schedule.
“There was pretty clear concern about potentially eliminating the 11- to 12-year vaccination for multiple reasons. I think the health and safety of our adolescents is obviously paramount but also the integration of the platform is important,” Dr. Middleman said. “Immunization platforms are there to remind people that it’s time to think about vaccines and specific vaccines. I think the reason childhood platforms are so successful is they haven’t been changed in a long time. To change the platform would take significantly more data than we have that would indicate it would be a benefit to the health of our teens.”
Several ACIP members voiced initial support for option 1, given the increasing number of meningitis cases reported.
“I also favor option 1, especially in the setting of the highest number of cases since 2014, understandably, in a very young age group,” said Camille N. Kotton, M.D., FIDSA, FAST, clinical director, transplant and immunocompromised host infectious diseases at Massachusetts General Hospital. “Nonetheless, I don’t think now is the time to reduce vaccination for severe disease in a population that, overall, has done well with vaccination.”
Some members, however, expressed support for administering doses to older children, particularly with data showing serogroup B disease risk is higher among college students, peaking at 19 years and declining after age 20.
“In terms of looking at the data for MenACWY, the incidence at age 11-12 is very, very low,” said Oliver T. Brooks, M.D., chief medical officer of Watts HealthCare Corp. in California. “Incidence is so low. I’m comfortable with removing the 11- to 12-year-old (doses) altogether and changing the schedule.”
Sean T. O’Leary, M.D., M.P.H., FAAP, chair of the AAP Committee on Infectious Diseases, said he would like to see data on how often children are visiting their pediatricians, which may help guide when to offer vaccines.
“One of the reasons to continue giving the first dose of MenACWY at 11-12 years of age is that historically, younger adolescents have tended to come into the office more than older adolescents, but that pattern may have changed over the years,” Dr. O’Leary said. “I think that would help inform decision-making. If we see, for example, that visits in those ages are one-third or half of what they are at the younger ages, that may be helpful in saying this is really going to present some equity issues in terms of who can get vaccinated because they’re not coming in.”
ACIP is scheduled to continue discussions in June and October.
