Addressing Barriers to MenB and MenACWY Vaccination

Despite over a decade of routine recommendations for quadrivalent meningococcal conjugate (MenACWY) vaccination and more recent guidance for serogroup B (MenB) vaccination, uptake remains inconsistent.

A review published in Infectious Diseases and Therapy synthesizes findings from the Advancing Strategies to Prevent Meningococcal Disease (ARTEMIS) initiative, which convened in 2022 to assess meningococcal disease prevention strategies in U.S. adolescents and young adults (AYA).

Here is a quick look at the review.

The Need for Change
Recent surveillance data reveal persistent immunization gaps and a rising disease burden of invasive meningococcal disease (IMD). In 2022, while 89 percent of adolescents aged 13 to 17 had received at least one MenACWY dose, only 61 percent of 17-year-olds had completed the two-dose series. Just 29 percent had received a MenB vaccine dose, and fewer than 13 percent had completed the MenB series.

While IMD incidence remains low—0.10 to 0.20 per 100,000 in 16 to 23-year-olds—it carries significant mortality, devastating morbidity for survivors, as well as system-wide economic cost. Serogroup B causes roughly one-third of cases in AYA, with additional risk observed among college students and individuals with HIV, asplenia, or complement deficiencies. A resurgence in national case counts, from 208 in 2021 to 477 in 2024, and multiple regional outbreaks—particularly of serogroups B, C, and Y—have highlighted the urgency of improving vaccination infrastructure.

Barriers to Vaccination
Knowledge gaps remain a consistent obstacle among patients and providers. Healthcare providers require up-to-date information on MenB disease burden and specific recommendations in shared clinical decision-making (SCDM). Surveys cited in the review found that half of clinicians were unaware that serogroup B is the most common cause of IMD in AYA, and over half did not know that MenB vaccination is recommended under SCDM. Parental knowledge was similarly lacking; however, most parents expressed willingness to vaccinate once made aware of disease risk and vaccine availability. Adolescents themselves reported low confidence in their knowledge, even in communities that had experienced recent MenB outbreaks.

Structural issues creating barriers and disparities in health care compound these knowledge gaps. States without MenACWY school entry requirements report lower vaccination rates, and very few states have any MenB vaccine mandates. County-level data from Indiana, for instance, show MenB coverage varying from 12 percent to 69 percent depending on local access to primary care and insurance rates.

Adolescents aged 16 and older are also less likely to attend preventive care visits, further reducing opportunities for vaccination. And providers cite time constraints, inconsistent messaging from professional bodies, and reimbursement concerns as disincentives to initiate vaccine discussions during brief visits.

Vaccine Reform
A potentially simplifying innovation is the introduction of MenABCWY combination vaccines, first approved in the U.S. in 2023. The formulation combining MenACWY and MenB antigens was incorporated into ACIP’s platform later that year, allowing its use in place of both the MenACWY booster and the first MenB dose when administered at the same visit. This Q–P–B schedule reduces the number of injections from four to three, and may encourage broader MenB uptake among patients already receiving MenACWY boosters.

However, logistical complexities remain. Providers must stock three distinct products—MenACWY, MenABCWY, and MenB-fHbp—and patients receiving the pentavalent vaccine still require a second MenB dose to complete the series. A broader ACIP review, underway through 2025, may produce updated recommendations that reduce the number of products required and increase clarity for clinicians. Such changes could enhance vaccine completion rates by eliminating choice paralysis and streamlining clinic workflows.

Greater Alignment in Delivery
ARTEMIS members emphasized a multipronged approach. Enhancing provider education and providing clear, actionable prompts within electronic health records may improve SCDM consistency. Public messaging, school-based outreach, and pharmacist-administered vaccination could help reach populations with limited access to primary care. Referrals to the Vaccines for Children program and expanded adolescent consent laws may address structural inequities, especially for uninsured youth and those outside the college system.

As MenABCWY vaccines enter broader use and new policy options are considered, the opportunity exists to address longstanding lapses in meningococcal disease prevention. The clinical and societal costs of IMD remain high despite its rarity, and simplifying the vaccination process may prove critical in protecting vulnerable adolescent populations from an unpredictable and severe disease.

Reference:

1. Presa J, Carrico R, Fergie JE, Hanenberg S, Marshall GS, Rivard K. Preventing meningococcal disease in US adolescents and young adults through vaccination. Infect Dis Ther. 2025 Jun 3;14(7):1381–1403. doi:10.1007/s40121-025-01166-7