Meningitis B Vaccine: Recommendations for College Students

Meningococcal disease is a serious bacterial illness that can lead to meningitis (infection of the brain and spinal cord), bacteremia (blood infection), and septic arthritis (joint infection). College students, especially first-year students living in dormitories or participating in Greek life, are at increased risk. Vaccination is an effective way to prevent meningococcal disease, and this article provides key information about meningococcal disease and the MenB vaccine for college students.

Understanding Meningococcal Disease

Meningococcal disease is caused by the bacterium Neisseria meningitidis, which can infect the meninges (tissue surrounding the brain and spinal cord) and cause meningitis, or infect the blood or other body organs. The onset of the illness can be sudden, and even with antibiotic treatment, 10-15% of those infected may die. Among survivors, 10-20% may experience long-term complications such as loss of limbs, hearing impairment or deafness, nervous system problems, or seizures and strokes.

Symptoms of Meningitis and Bacteremia

The most common symptoms of meningitis include:

High fever
Headache
Stiff neck
Nausea
Vomiting
Sensitivity to light
Confusion
Extreme tiredness

Symptoms of meningococcal blood infections (bacteremia) include:

Fever
Extreme tiredness
Chills
Cold hands and feet
Severe aches or pain
Rash
Pain and swelling in and around the joint (if a joint infection is present)

Immediate medical attention is crucial if any of these symptoms are present.

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How Meningococcal Disease Spreads

The bacteria spread through the exchange of respiratory and throat secretions during close contact, such as:

Kissing
Sharing silverware
Drinking from the same container
Sharing a cigarette or lipstick
Living in the same household

Practicing good hygiene, such as washing hands, covering coughs, and staying home when sick, can help prevent the spread of the disease.

Meningococcal Vaccines: MenACWY and MenB

There are two main types of meningococcal vaccines available in the United States: MenACWY and MenB.

MenACWY: Protects against four strains of meningococcal bacteria (A, C, W, and Y).
MenB: Protects against serogroup B meningococcal disease.

Availability of MenACWY Vaccines

Several MenACWY vaccines are available:

Menactra (Sanofi) - Discontinued in 2023.
Menveo (GSK)
MenQuadfi (Sanofi)

Availability of MenB Vaccines

The two FDA-approved vaccines for meningitis B are:

Bexsero (GSK)
Trumenba (Pfizer)

Penbraya (MenABCWY, Pfizer)

Penbraya is a pentavalent vaccine that combines both MenACWY and MenB vaccines into one shot, protecting against serogroups A, B, C, W, and Y. It can be used for people aged 10-25 years when both vaccines are indicated at the same visit.

Recommendations for Meningococcal Vaccination

Recommendations for meningococcal vaccination vary based on age and risk factors.

MenACWY Vaccine Recommendations

The MenACWY vaccine is recommended for:

All 11- to 12-year-old adolescents, with a booster dose at age 16.
First-year college students living in dormitories or participating in Greek life, if they have not received a dose on or after their 16th birthday.
People with certain high-risk conditions, such as those with a damaged spleen or persistent complement component deficiency.
Travelers to countries where meningococcal disease is common.
Military recruits.

If the initial MenACWY vaccine dose was given between the ages of 13 and 15, the booster should be administered between 16 and 18 years.

MenB Vaccine Recommendations

The MenB vaccine is not routinely recommended for all college students. However, the Advisory Committee on Immunization Practices (ACIP) recommends that a MenB series may be administered to people 16 through 23 years of age (preferred age 16 through 18 years) on the basis of shared clinical decision-making. This means that healthcare providers should inform patients of the option to be vaccinated against meningococcal serogroup B disease, and the decision to vaccinate should be made jointly by the provider and patient. Some colleges and universities may require MenB vaccination for incoming students.

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The MenB vaccine is recommended for people over age 10 years with certain high-risk conditions, including:

Those with a damaged spleen or whose spleen has been removed.
Those with persistent complement component deficiency.
Microbiologists who routinely work with N. meningitidis.
People who may have been exposed to meningococcal disease during an outbreak.

Meningococcal Vaccination in Massachusetts

Massachusetts law requires the following students to receive quadrivalent meningococcal conjugate vaccine (unless they qualify for an exemption):

Secondary School (grades 9-12): newly enrolled full-time students living in a dormitory or other congregate housing licensed or approved by the secondary school must provide documentation of having received a dose of meningococcal conjugate vaccine at any time in the past.
Postsecondary Institutions (colleges): newly enrolled full-time students 21 years of age and younger must provide documentation of having received a dose of quadrivalent meningococcal conjugate vaccine on or after their 16th birthday, regardless of housing status.

Dosing Schedules for MenB Vaccines

Both Bexsero and Trumenba are typically given as a 2-dose series, with doses administered at least 6 months apart. However, a 3-dose schedule is recommended for people who need rapid protection against MenB due to an increased risk of MenB disease.

Bexsero: Two doses, 6 months apart.
Trumenba: Two doses, 6 months apart.
3-Dose Schedule (Bexsero or Trumenba): 0, 1-2 months, and 6 months.

Important Notes on MenB Dosing:

The same MenB vaccine product (Bexsero or Trumenba) should be used for all doses in the series, including booster doses.
If the brand of a previous dose is unavailable or cannot be determined, restart the primary series with the available brand.
If accelerated protection is desired for a person who is not at high risk of MenB disease, it is permissible to use the 3-dose MenB schedule so that the student may receive 2 of 3 doses before leaving for college.

Booster Doses

Because the effectiveness of the quadrivalent meningococcal conjugate vaccine wanes over time, a booster is recommended at age 16, after the initial dose at age 11-12. This protects young people during their late teens and early twenties, when they are most at risk.

For people with prolonged increased risk for serogroup A, C, W, or Y and B meningococcal disease, regular boosters are needed. However, the recommended interval between doses varies by age and vaccine type.

MenACWY: A booster dose every 5 years for those at continued risk.
MenB: The first booster dose is recommended one year after completion of the primary series, with a subsequent booster dose administered every 2-3 years thereafter, as long as risk remains.

Safety and Risks of Meningococcal Vaccines

Meningococcal vaccines are generally safe. Most people experience only mild side effects, such as:

Redness or pain where the shot was given
Fever

Serious side effects, such as severe allergic reactions, are rare. The risk of getting the meningococcal vaccine is much lower than the risk of contracting the disease itself.

Access to Free or Low-Cost Meningococcal Shots

If you do not have insurance or your insurance does not cover the cost of the meningococcal vaccines, you may be able to find free or low-cost shots. Note that there may still be an administration fee.

If you are 18 years old or younger: Talk to your doctor or clinic to see if they participate in the Vaccines for Children Program.
If you are 19 years old or older: Visit your state's health department website to search for a clinic near you that offers low-cost vaccines for eligible adults.
Talk to your city or county health department. They may be able to provide low-cost meningococcal shots.

Meningococcal Informing Law

California State law mandates that Universities of California (UCs) with on-campus housing inform students about meningococcal disease and vaccine. UCs must also document students’ receipt of information and whether they choose to get immunized (Health and Safety Code Sections 120395-120399).

Additional Recommendations for College Students

In addition to meningococcal vaccines, college students should consider other immunizations and health practices:

Complete primary tetanus, diphtheria, pertussis series: Tdap or Td booster every 10 years after the initial series.
Hepatitis B vaccine series: Recommended for all students. Students enrolled in academic courses which result in an increased risk of contracting Hepatitis-B will be immunized against this disease prior to potential exposure.
Mumps & Measles vaccine: Two doses of MMR vaccine are now required for all on-campus students.
HPV vaccine: The CDC recommends the HPV vaccine for all male and female students between 9 and 26 years of age.
Tuberculosis (TB) Risk Assessment: All incoming students should be assessed for their risk of developing TB.

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