Breaking down invasive meningococcal disease vaccines, including MenABCWY

Amin J. Barakat, MD, FAAP, is a professor of clinical pediatrics at Georgetown University Medical Center in Washington, DC, and a member of the Contemporary Pediatrics editorial advisory board.

Invasive meningococcal disease (IMD) is a life-threatening infection caused by Neisseria meningitidis. Although IMD is relatively rare in the United States, it progresses rapidly and can lead to death or long-term complications among survivors, particularly in infants and adolescents.

Recently, the CDC has reported an increase in the incidence of IMD, which has one of the highest case fatality rates among vaccine-preventable diseases, with a death rate of 10% to 15% even with appropriate treatment, sometimes occurring within 24 hours.¹ Up to 20% of survivors suffer long-term consequences, such as brain damage, limb loss, hearing loss, and neurological problems.^2.3 Adolescents are at high risk because of behaviors common in this age group, such as living in close quarters and sharing drinks.

Vaccines against the 5 major serogroups have been available and recommended for adolescents for the past decade. These include MenACWY vaccines such as Menveo (GSK), MenQuadfi (Sanofi Pasteur), which protect against serogroups A, C, W, and Y, and MenB vaccines such as Bexsero (GSK), Trumenba (Pfizer), which protect against serogroup B. On February 14, 2025, the MenABCWY vaccine was approved by the FDA. However, vaccination rates remain low, with persistent racial and geographic disparities.⁴

Currently, meningococcal vaccination in the United States typically requires 2 separate quadrivalent (A, C, W, Y) meningococcal conjugate vaccines and 2 serogroup B meningococcal vaccines. These vaccines are licensed and recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP). Only 13% of 17-year-olds have completed the vaccination series against serogroup B, the most common disease-causing serogroup at this age.^5,6

Serogroup B is the leading cause of IMD in older adolescents and young adults (aged 16 to 23 years), responsible for 53% of cases in this age group compared to 29% caused by serogroups C, W, and Y combined. As of 2023, only 32% of 17-year-olds have received at least 1 dose of the MenB vaccine, and only 13% have received both doses required for optimal protection. Continued efforts are needed to ensure vaccine access and information, focusing on populations at greatest risk, primarily older adolescents.⁵

A pentavalent vaccine could provide comprehensive protection by covering the five most common serogroups in a single shot. The MenABCWY (5-in-1) vaccine is designed to replace separate meningococcal vaccines by combining protection against Neisseria meningitidis serogroups A, B, C, W, and Y. It is recommended at ages 11 to 12 years, with a booster at age 16 years, and is also recommended for college students in dormitories, military recruits, individuals with certain medical conditions, and travelers to high-risk regions.⁷

Related: Reacting to the meningococcal ABCWY vaccine approval with Donna Hallas, PhD, PPCNP-BC

GSK’s MenABCWY is indicated as a 2-dose series for individuals aged 10 to 25 years. Currently, it is recommended for adolescents needing both a MenACWY and MenB vaccine at the same visit, typically at age 16. Adolescents must receive a MenB vaccine dose from the same manufacturer at least 6 months after the MenABCWY dose for optimal protection.

The ACIP is considering reassessing the meningococcal vaccination schedule during its 2025 meetings, and updated recommendations could increase the role of MenABCWY in adolescent immunization while maintaining options for monovalent and quadrivalent vaccines.⁸

Clinical trials have shown MenABCWY to have a safety profile comparable to existing meningococcal vaccines, with no new serious safety concerns. Its reactogenicity is similar to that of MenACWY and MenB vaccines, with side effects such as injection site reactions, fatigue, headache, muscle or joint pain, fever, chills, and nausea.⁹

In summary, GSK’s MenABCWY (5-in-1) vaccine offers comprehensive protection, simplifies the immunization schedule, improves vaccine compliance, enhances immune response, reduces healthcare visits, and protects high-risk groups. The safety profile of MenABCWY appears to be comparable to that of the currently available meningococcal vaccines.

References:

1. CDC. Meningococcal disease: diagnosis, treatment, and complications. 2020. https://www.cdc.gov/meningococcal/about/diagnosis-treatment.html. Accessed Aug 23, 2022.

2. Olbrich, K.J., Müller, D., Schumacher, S. et al. Systematic Review of Invasive Meningococcal Disease: Sequelae and Quality of Life Impact on Patients and Their Caregivers. Infect Dis Ther 7, 421–438 (2018). https://doi.org/10.1007/s40121-018-0213-2

3. CDC. Meningococcal Disease Symptoms and Complications. CDC. August 30, 2024.

4. Collins JP, et al. Use of the Pfizer Pentavalent Meningococcal Vaccine Among Persons aged >
10 Years: Recommendations of the Advisory Committee on Immunization Practices—United States, 2023. MMWR Morb Mortal Wkly Rep 2024; 73:345-350.
DOI: http://dx.doi.org/10.15585/mmwr.mm7315a4

5. Pingali, C. et at. National Vaccination Coverage Among Adolescents Aged 13–17 Years. National Immunization Survey-Teen, United States, 2023. CDC, MMWR, Weekly / August 22, 2024 / 73(33);708–714

6. Mbaeyi, S.A., et al. Meningococcal Vacination: Recommendations of the Advisory Committee on Immunization Practices, United States, 2020. CDC, MMWR. Weekly, September 25, 2020, 69 (9); 1-41.

7. Clements, DE, et al. (2024). Past, present, and future policy considerations regarding meningococcal vaccination in the United States. Expert Review of Vaccines, 23, 845-861.
https://doi.org/10.1080/14760584.2024.2397705

8. GSK’s 5-in-1 meningococcal ABCWY vaccine candidate accepted for regulatory review by US FDA. GSK. News release. Published April 16, 2024. Accessed February 13, 2025. https://www.gsk.com/en-gb/media/press-releases/gsk-s-5-in-1-meningococcal-abcwy-vaccine-candidate-accepted-for-regulatory-review-by-us-fda/

9. Beran J, et al. Immunogenicity and Safety of Investigational MenABCWY Vaccine and of 4CMenB and MenACWY Vaccines Administered Concomitantly or Alone: a Phase 2 Randomized Study of Adolescents and Young Adults. mSphere. 2021 Dec 22;6(6): e0055321. doi: 10.1128/mSphere.00553-21.