Should we recommend an A, C, Y, W vaccine over a B vaccine, or vice-versa?

For best protection against all meningococcal disease, separate vaccinations against groups A, C, Y and W disease and group B disease are available.

Health professionals are not advised to recommend an A, C, Y, W vaccine over a B vaccine or vice versa, a B vaccine over an

A, C, Y, W vaccine. Health professionals cannot accurately predict who will get meningococcal disease or which meningococcal group could be the cause.

How long does protection last after immunisation?

In general, children aged under 7 years when vaccinated are expected to have around 3 years of protection. In older children, adolescents and adults, protection is expected to last for around 5 years after vaccination.

Those who received MeNZB are no longer expected to have protection against this type of group B disease.

Can we give less doses of Bexsero if a person has a history of MeNZB vaccination?

No. Two doses of Bexsero are recommended for older children, adolescents and adults regardless of a history of MeNZB vaccination.

Can Bexsero be given at the samevisit as Menactraor Nimenrix?

Yes. Menactra or Nimenrix and Bexsero can be administered at the same visit using different sites.

Is a minimum interval required between administration of Bexsero and Menactra or Nimenrix?

No. When Menactra or Nimenrix and Bexsero are not coadministered, no minimum interval is required before administration of the subsequent vaccine.

Is a minimum interval required between administration of Bexsero, Menactra or Nimenrix and any other vaccine? Menactra** or Nimenrix and Bexsero can be administered at the same visit as any other vaccine or any interval before/after any other vaccine.

**except when Menactra and Prevenar® 13 are being administered, a minimum interval of 4 weeks is required between administration of these two vaccines.

Can a combination of Menactra and Nimenrix be used to deliver a primary course of meningococcal A, C, Y and W vaccines in children aged under 24 months?

Yes. Menactra is approved for use as a two-dose vaccine course in children aged 9–23 months (inclusively). A child in this age group who receives one dose of Menactra can receive either Menactra or Nimenrix a minimum of three months later to complete their primary vaccine course.

Can a pregnant woman receive Bexsero, Menactra or Nimenrix?

Yes. There are no safety concerns around administration of Nimenrix, Menactra or Bexsero at any stage of pregnancy. These are non-live vaccines and the advice is consistent with the recommendation for a pregnant woman to receive non- live vaccines when she has an increased risk of disease, for example influenza vaccination is recommended at any stage of pregnancy because they have an increased risk of influenza disease and complications.

Is a minimum interval required between administration of NeisVac-C and Menactra or Nimenrix?

No minimum interval is required between administration of NeisVac-C (meningococcal C only vaccine) and administration of a subsequent Menactra or Nimenrix. However, when Menactra is administered in place of the second NeisVac-C dose in children aged under 12 months a minimum interval of 8 weeks between the first NeisVac-C and administration of Menactra could be considered. In this situation, a second Menactra administered

3 months later would still be recommended to complete the primary vaccine doses for the meningococcal A, Y and W antigens.

Who should receive meningococcal vaccination?

• A small group of individuals with a high-risk medical condition listed on the Pharmaceutical Schedule, e.g. pre-/post- splenectomy, NeisVac-C (aged under 9 months), Menactra (aged 9 months or over), and Bexsero are recommended and funded.
• Individuals aged 13–25 years inclusively who are entering within the next three months, or are in their first year of living in boarding school hostels, tertiary education halls of residence, military barracks, or prisons, Menactra is recommended and funded.

For individuals outside these specified groups, meningococcal vaccines can be prescribed and purchased. Groups for whom meningococcal vaccination is recommended but not funded are described in the meningococcal chapter of the current Immunisation Handbook, e.g. adolescents and young adults living in group accommodation or long-term institutional care, laboratory workers and travellers to high-risk countries.

We know that children aged under 5 years, adolescents aged 15–19 years, and people who are Māori or Pacific typically have a higher risk of meningococcal disease, and that exposure to tobacco smoke, binge drinking or having another respiratory infection are associated with a higher risk of disease. Over 2018–2019, a high rate of disease cases were also seen

Other meningococcal factsheets available: Purchase of non-funded meningococcal vaccines, Bexsero: A vaccine to protect against meningococcal group B disease and Paracetamol use with Bexsero in children aged under 2 years

in young adults aged 20—29 years. However, beyond the Handbook advice it is difficult to know who to recommend purchased meningococcal vaccination to. Health professionals cannot accurately predict who will get meningococcal disease or which meningococcal group could be the cause.

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