Vaccine Update: ACIP Updates the Immunization Schedule Recommendations for Bexsero (MenB-4C)

Column Author & Editor: Angela L. Myers, MD, MPH | Division Director, Infectious Diseases; Medical Director, Center for Wellbeing

On Oct. 24, 2024, the Advisory Committee on Immunization Practices (ACIP) voted to revise the immunization schedule for Bexsero (MenB-4C). This recommendation aligns with the full product approval that the U.S. Food and Drug Administration granted Bexsero on Aug. 19, 2024. Following new immunogenicity data, the schedule recommendation was updated to provide the most optimal protection.

Figure A.¹

Bexsero is a vaccine used to prevent invasive disease caused by Neisseria meningitidis serogroup B. Invasive disease from N. meningitidis serogroup B (MenB) can lead to meningitis, sepsis and death. The disease progresses rapidly and, even with appropriate antibiotic therapy, has a case fatality rate of 10%-15%. Approximately 20% of survivors experience long-term sequelae in the form of cognitive deficits, hearing loss, and/or limb amputations.²

Previous recommendation for Bexsero was a two-dose series (at zero and one month or later) for adolescents aged 16-23 years based on shared clinical decision-making and a two-dose series for persons aged ≥10 years at increased risk for serogroup B meningococcal disease.²

The new recommendations are as follows:

For healthy adolescents and young adults aged 16-23 years (preferred 16-18), meningococcal serogroup B vaccination is currently recommended with shared clinical decision-making.  

New Recommendation: 

• Two-dose series at zero and six months. 
• Three-dose series (zero, one to two months, and six months) may be administered to optimize rapid protection (e.g., for students starting college in less than six months).

For persons aged ≥10 years at increased risk for serogroup B meningococcal disease (i.e., persons with anatomic or functional asplenia, complement component deficiencies, or complement inhibitor use; microbiologists routinely exposed to N. meningitidis isolates; and persons at increased risk during an outbreak). 

New Recommendation: 

• Three-dose series at zero, one to two months, and six months. 
  
  

  Figure B.¹

  For both healthy adolescents and persons at increased risk who were vaccinated at zero and one month or later (old schedule) prior to the new recommendation (Oct. 24, 2024), no additional doses are required. These individuals should continue to get boosters in accordance with prior recommendations.²

  Please refer to the 2025 Centers for Disease Control and Prevention Immunization Schedule for updated recommendations for Bexsero as well as other vaccines.

  References:

  1. Schillie SF. Introduction to MenB-4C (Bexsero) interval and dosing label change. Presented at the Advisory Committee on Immunization Practices meeting; October 24, 2024. Accessed November 27, 2024. https://www.cdc.gov/acip/downloads/slides-2024-10-23-24/04-mening-Schillie-508.pdf
  2. Jenco M. CDC OKs MenB vaccine schedule change, 2025 immunization schedule. AAP News. October 25, 2024. Accessed November 27, 2024. https://publications.aap.org/aapnews/news/30603/CDC-OKs-MenB-vaccine-schedule-change-2025