Four meningococcal vaccines are available. There are two vaccines with coverage against meningococcal serogroups A, C, Y, and W-135 and two with coverage against meningococcal serogroup B. The two vaccines effective for meningococcal serogroups A, C, Y, and W-135 are the meningococcal polysaccharide vaccine (MPSV4), indicated for vaccination of persons over age 55, and the conjugate vaccine (MCV4), indicated for persons aged 2–55 years. The two vaccines against meningococcal serogroup B are MenB-FHbp and MenB-4C; they are approved for persons aged 10–25 years and are not interchangeable.
The Advisory Committee on Immunization Practices recommends immunization with a dose of MCV4 for preadolescents aged 11–12 with a booster at age 16 (see www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html). For ease of program implementation, persons aged 21 years or younger should have documentation of receipt of a dose of MCV4 not more than 5 years before enrollment to college. If the primary dose was administered before the sixteenth birthday, a booster dose should be administered before enrollment. Vaccine is also recommended as a two-dose primary series administered 2 months apart for persons aged 2 through 54 years with persistent complement deficiency, persons with functional or anatomic asplenia, and for adolescents with HIV infection. All other persons at increased risk for meningococcal disease (eg, military recruits, microbiologists routinely exposed to isolates of N meningitidis, or travelers to an epidemic or highly endemic country) should receive a single dose. One of the meningococcal serogroup B vaccines may be administered to persons 10 years of age or older who are at increased risk for meningococcal disease. These persons include those with persistent complement deficiencies; persons with anatomic or functional asplenia; microbiologists; and persons identified to be at increased risk because of a serogroup B meningococcal disease outbreak. Vaccination of persons aged 16–23 years may provide short-term protection against most strains of serogroup B meningococcal disease.
Eliminating nasopharyngeal carriage of meningococci is an effective prevention strategy in closed populations and to prevent secondary cases in household or otherwise close contacts. Rifampin, 600 mg orally twice a day for 2 days, ciprofloxacin, 500 mg orally once, or one intramuscular 250-mg dose of ceftriaxone is effective. Cases of fluoroquinolone-resistant meningococcal infections have been identified in the United States. However, ciprofloxacin remains a recommended empiric agent for eradication of nasopharyngeal carriage. School and work contacts ordinarily need not be treated. Hospital contacts receive therapy only if intense exposure has occurred (eg, mouth-to-mouth resuscitation). Accidentally discovered carriers without known close contact with meningococcal disease do not require prophylactic antimicrobials.