Recommendations for Use of Meningococcal Conjugate Vaccines in HIV-Infected Persons

What is currently recommended?

The Advisory Committee on Immunization Practices (ACIP) currently recommends routine vaccination with meningococcal conjugate vaccine for all adolescents and for certain groups of persons at increased risk for meningococcal disease: persons who have persistent complement component deficiencies; persons who have anatomic or functional asplenia; microbiologists who routinely are exposed to isolates of Neisseria meningitidis; persons identified to be at increased risk because of a meningococcal disease outbreak attributable to serogroup A, C, W, or Y; military recruits; first-year college students living in residence halls; and persons who travel to or reside in areas in which meningococcal disease is hyperendemic or epidemic. In addition, ACIP recommends routine vaccination with serogroup B meningococcal (MenB) vaccine for persons who have persistent complement component deficiencies; persons who have anatomic or functional asplenia; microbiologists who routinely are exposed to isolates of N. meningitidis; and persons identified to be at increased risk because of a serogroup B meningococcal disease outbreak.

Why are the recommendations being modified now?

A growing body of evidence supports an increased risk for meningococcal disease in human immunodeficiency virus (HIV)–infected persons. The evidence supporting the use of meningococcal conjugate vaccines in HIV-infected persons was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework.

What are the new recommendations?

All HIV-infected persons aged ≥2 months should routinely receive meningococcal conjugate vaccine; children aged <2 years should be vaccinated using a multidose schedule. Persons aged ≥2 years with HIV who have not been previously vaccinated should receive a 2-dose primary series of meningococcal conjugate vaccine. Persons with HIV who have been previously vaccinated with meningococcal conjugate vaccine should receive a booster dose at the earliest opportunity (at least 8 weeks after the previous dose) and then continue to receive boosters at the appropriate intervals. If the most recent dose was received before age 7 years, a booster dose should be administered 3 years later. If the most recent dose was received at age ≥7 years, a booster should be administered 5 years later and every 5 years thereafter throughout life.