ACIP Approves the First Pentavalent Meningococcal Vaccine

Column Author: Maria Martinez, RN, BSN, MSN, MBA, CPN | Immunization Coordinator

Column Editor: Angela Myers, MD, MPH | Pediatric Infectious Diseases; Division Director, Infectious Diseases; Medical Director, Center for Wellbeing; Professor of Pediatrics, University of Missouri-Kansas City School of Medicine; Clinical Assistant Professor of Pediatrics, University of Kansas School of Medicine

On Oct. 25, 2023, after significant review and discussion, the Advisory Committee on Immunization Practices (ACIP) voted to approve the use of Penbraya, the first pentavalent meningococcal vaccine that targets serogroups A, B, C, W and Y, the top serogroups that lead to most cases of invasive meningococcal disease. Pfizer, manufacturer of the new vaccine MenABCWY/ Penbraya, combined MenACWY/ Nimenrix, which has been used in Europe since 2017, with MenB/ Trumenba to develop this new vaccine.¹

The most recently available data, from 2021, shows 210 reported cases of meningococcal disease in the United States.² (Figure 1) While cases are rare and have been declining over the past several decades, the impact of invasive meningococcal disease can be significant. The highest incidence is in the first year of life. (Figure 2) Invasive meningococcal disease causes meningitis and/or septicemia. An average of 10%-20% of patients experience sequelae such as neurological disorders and limb loss. The fatality rate is approximately 5%-10%, and death typically ensues within 24-48 hours from symptom onset.³ In the United States, the vaccination rate for ≥ 1 dose of MenACWY is 89%, while the vaccination rate for ≥ 1 dose of MenB is 31%.⁴

Current recommendations for meningococcal vaccines in most individuals are that MenACWY be administered at 11-12 years of age with a booster at 16 years of age. A two-dose series of Men B is recommended based on shared clinical decision-making between 16 and 23 years of age.

With the ACIP’s recent approval, MenABCWY/ Penbraya can be administered as follows:

• When both MenACWY and MenB vaccine are indicated at the same visit.⁵
  • Most 16-year-old adolescents may be due for this dose.
  • Providers should consider the best timeframe for initiation of MenB.
• For individuals aged 10 years and older who are at high risk for meningococcal disease due to certain medical conditions, a single dose of MenABCWY/ Penbraya may be administered as an alternative to separate administration of MenACWY and MenB when a patient is due for both vaccines at the same visit.¹

The ACIP meningococcal work group acknowledged that this new product and its current recommendations require further discussion and may require changes in the future for best implementation. Some additional considerations that will be discussed at the 2024-2025 ACIP meetings include:

• Should the MenACWY series be started at an older age (noting low case rates at 11-12 years of age)?
• Should the MenB series be started at an older age?
• How might shared clinical decision-making best be evaluated for these products?⁶

References:

1. Jenco M. CDC committee OKs recommendations for pentavalent meningococcal, mpox vaccines. AAP News. Published October 25, 2023. Accessed November 28, 2023. https://publications.aap.org/aapnews/news/27054/CDC-committee-OKs-recommendations-for-pentavalent
2. Meningococcal disease surveillance. Centers for Disease Control and Prevention. Last Reviewed July 10, 2023. Accessed November 30, 2023. https://www.cdc.gov/meningococcal/surveillance/
3. Meningitis. World Health Organization. Accessed November 30, 2023. https://www.who.int/health-topics/meningitis
4. Pingali C, Yankey D, Elam-Evans LD, et al. Vaccination coverage among adolescents aged 13–17 years — National Immunization Survey–Teen, United States, 2022. MMWR Morb Mortal Wkly Rep. 2023;72:912-919. Accessed November 30, 2023. http://dx.doi.org/10.15585/mmwr.mm7234a3
5. Weldon R. CDC committee recommends new pentavalent meningococcal vaccine. Healio.com. Published October 25, 2023. Accessed November 28, 2023. https://www.healio.com/news/pediatrics/20231025/cdc-committee-recommends-new-pentavalent-meningococcal-vaccine
6. McNamara L. Plan for revisiting the adolescent schedule for meningococcal vaccines. Presented at the Advisory Committee on Immunization Practices meeting; October 25, 2023. Accessed November 30, 2023. https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2023-10-25-26/02-Meningococcal-McNamara-508.pdf

(Figure 1.)

(Figure 2.)