Meningococcal B

Infants and adolescents in countries with national MenB programs (UK from 2 months, Australia, Italy, others). Adolescents and young adults 16–23 years (shared clinical decision-making, ACIP). Persons with complement deficiency, properdin deficiency, factor D deficiency. Functional or anatomic asplenia. Persons receiving complement inhibitor therapy (eculizumab, ravulizumab). Microbiologists routinely exposed to N. meningitidis isolates. Outbreak response in communities or institutions.

Severe allergic reaction (anaphylaxis) to a previous dose or any vaccine component. Moderate to severe acute illness (defer until recovery). No contraindication based on immunocompromised status (non-live vaccine).

Bexsero — Very common (≥1/10): injection site pain (86%), erythema (80% infants), induration, fever (69% in infants when co-administered with routine vaccines — give prophylactic paracetamol). Common: irritability, unusual crying (infants), headache, nausea, myalgia, arthralgia. Trumenba — Very common: injection site pain (85%), fatigue (44%), headache (35%), myalgia (35%). Rare: febrile seizures in young infants (when co-administered). Kawasaki disease: signal detected but not confirmed as causal.

Bexsero: Infants 2–5 months: 3 doses (2, 4, 6 months) + booster at 12–15 months. Infants 6–11 months: 2 doses ≥2 months apart + booster in 2nd year. Adolescents/adults: 2 doses ≥1 month apart. Trumenba: 2 doses ≥6 months apart (routine), or 3 doses at 0, 1–2, 6 months (outbreak/high risk). Dose: 0.5 mL IM in deltoid (adults/older children) or anterolateral thigh (infants).

Bexsero: 68–91% strain coverage by MATS (varies by country). UK infant program: 75% effectiveness against MenB disease (2-dose primary + booster). hSBA seroresponse: ≥84% for each antigen after primary series. Trumenba: hSBA response against 4 test strains: 82–90% after 2 or 3 doses. Duration: antibody waning observed after 12–24 months, booster recommended for ongoing risk.

Can be co-administered with MenACWY, Tdap, HPV, and inactivated influenza vaccines at different injection sites. Prophylactic paracetamol/acetaminophen recommended when co-administered with routine infant vaccines to reduce fever incidence (does not reduce immunogenicity — confirmed in clinical trials). No significant drug interactions. Immunosuppressive therapy may reduce response.

Pregnancy: insufficient human data. Animal studies (Bexsero): no adverse developmental effects. Administer only if clearly needed during outbreak. Breastfeeding: unknown whether vaccine antigens are excreted in breast milk; expected to be safe (non-live vaccine). Use if indicated.

Breastfeeding: Meningococcal B vaccines (Bexsero®, Trumenba®) are recombinant protein vaccines (non-live) and are considered compatible with breastfeeding. There are no data on the presence of vaccine antigens in human milk. As non-live vaccines, they pose no theoretical risk to the nursing infant. No interruption of breastfeeding is necessary.

Bexsero approved from 2 months of age. Trumenba approved from 10 years. Infants: prophylactic antipyretic recommended when co-administered with routine vaccines. Higher reactogenicity in younger infants. Febrile seizures: slightly increased risk when given with DTaP-containing vaccines.

Adults ≥65 years: limited data. Immunogenicity may be reduced in elderly. Consider vaccination for those with functional asplenia or complement deficiency regardless of age.

Bexsero and Trumenba are NOT interchangeable — complete the series with the same product. Strain coverage varies by region: Meningococcal Antigen Typing System (MATS) or hSBA predict ~66–91% coverage of circulating strains (varies geographically). Vaccination does NOT replace MenACWY — serogroup B is a separate target. Fever management: pre-dose paracetamol for infants receiving Bexsero with routine vaccines.