Neisseria meningitidis has 13 clinically significant
serogroups, classified according to the antigenic structure of their polysaccharide capsule. Six serogroups, A, B, C, Y, W-135, and X, are responsible for virtually all cases in humans. Serogroup B is a major cause of
meningococcal disease in younger children and adolescents.
Pentavalent (serogroups A, B, C, W, and Y) There are two pentavalent vaccines available in the United States targeting serogroups A, B, C, W, and Y: •
Penbraya was approved for use in the United States in October 2023. It combines the vaccines Trumenba and Nimenrix. Penbraya was authorized for medical use in the European Union in November 2024. It is approved for use in individuals 10 through 25 years of age. Penmenvy is approved for use in people aged 10 through 25 years of age. It is a freeze-dried conjugate vaccine, recommended as a single intramuscular dose, and is available as 1-dose and 5-dose vials.
Quadrivalent (serogroups A, C, W-135, and Y) There are three quadrivalent vaccines available in the United States targeting serogroups A, C, W-135, and Y: • three
conjugate vaccines (MCV-4), Menactra, Menveo, and Menquadfi. Menveo and Menquadfi are approved for medical use in the European Union.
Menactra and Menveo The first meningococcal conjugate vaccine (MCV-4), Menactra, was licensed in the US in 2005, by
Sanofi Pasteur; Menveo was licensed in 2010, by
Novartis. Both MCV-4 vaccines are approved by the
Food and Drug Administration (FDA) for people 2 through 55 years of age. Menactra received FDA approval for use in children as young as 9 months in April 2011, while Menveo received FDA approval for use in children as young as two months in August 2013. The
Centers for Disease Control and Prevention (CDC) has not made recommendations for or against its use in children less than two years.
Menquadfi Menquadfi, manufactured by
Sanofi Pasteur, was approved by the US
Food and Drug Administration in April 2020, for use in individuals two years of age and older.
Menomune Meningococcal polysaccharide vaccine (MPSV-4), Menomune, has been available since the 1970s. It may be used if MCV-4 is not available, and is the only meningococcal vaccine licensed for people older than 55. Information about who should receive the meningococcal vaccine is available from the CDC.
Nimenrix Nimenrix (developed by GlaxoSmithKline and later acquired by
Pfizer), is a quadrivalent conjugate vaccine against serogroups A, C, W-135, and Y. In April 2012 Nimenrix was approved as the first quadrivalent vaccine against invasive meningococcal disease to be administered as a single dose in those over the age of one year, by the European Medicines Agency. In 2016, they approved the vaccine in infants six weeks of age and older, and it has been approved in other countries including Canada and Australia, among others. It is not licensed in the United States.
Mencevax Mencevax (
GlaxoSmithKline) and
NmVac4-A/C/Y/W-135 (
JN-International Medical Corporation) are used worldwide but have not been licensed in the United States.
Limitations The duration of immunity mediated by Menomune (MPSV-4) is three years or less in children aged under five because it does not generate
memory T cells. Attempting to overcome this problem by repeated immunization results in a diminished, not increased,
antibody response, so boosters are not recommended with this vaccine. As with all polysaccharide vaccines, Menomune does not produce
mucosal immunity, so people can still become colonised with virulent strains of meningococcus, and no
herd immunity can develop. For this reason, Menomune is suitable for travellers requiring short-term protection, but not for national public health prevention programs. Menveo and Menactra contain the same antigens as Menomune, but the antigens are conjugated to a
diphtheria toxoid polysaccharide-protein complex, resulting in anticipated enhanced duration of protection, increased immunity with booster vaccinations, and effective herd immunity.
Endurance A study published in March 2006, comparing the two kinds of vaccines found that 76% of subjects still had passive protection three years after receiving MCV-4 (63% protective compared with controls), but only 49% had passive protection after receiving MPSV-4 (31% protective compared with controls). As of 2010, there remains limited evidence that any of the current conjugate vaccines offer continued protection beyond three years; studies are ongoing to determine the actual duration of immunity, and the subsequent requirement of booster vaccinations. The CDC offers recommendations regarding who they feel should get booster vaccinations.
Bivalent (serogroups C and Y) In June 2012, the FDA approved a combination vaccine against two types of meningococcal disease and
Hib disease for infants and children 6 weeks to 18 months old. The vaccine, Menhibrix, prevents disease caused by
Neisseria meningitidis serogroups C and Y and
Haemophilus influenzae type b. This was the first meningococcal vaccine that could be given to infants as young as six weeks old. Menhibrix is
indicated for active immunization to prevent invasive disease caused by
Neisseria meningitidis serogroups C and Y and
Haemophilus influenzae type b for children 6 weeks of age through 18 months of age.
Serogroup A A vaccine called
MenAfriVac has been developed through a program called the
Meningitis Vaccine Project and has the potential to prevent outbreaks of group A meningitis, which is common in sub-Saharan Africa.
Serogroup B There are two licensed vaccines against serotype B meningococcal disease; Bexsero (GSK) 4-component MenB vaccine (4CMenB) and Trumenba (Pfizer), a bivalent factor H binding protein vaccine (MenB-FHbp). In the UK, the MenB vaccine (Bexero) is given routinely as part of childhood vaccines as infants are at greatest risk from meningitis B. The protection offered is short (around 3 years). In the US, both vaccines are only approved for ages 10-25 and only given to certain risk groups. Until recently, there was no vaccine to protect against serogroup X
N. meningitidis disease. In 2024, Nigeria became the first country in the world to roll out the new vaccine ==Side effects==