Updated recommendations for meningococcal vaccines in children under 2 years

Invasive meningococcal disease (IMD) is a rare but life-threatening disease that most often manifests as meningococcal meningitis or sepsis. Young children, particularly those under two years of age, are at highest risk of IMD, which can cause long-term complications, such as hearing loss, cognitive impairment, limb amputations and skin scarring, or death.1For routine immunization of healthy individuals aged two to 23 months, the National Advisory Committee on Immunization (NACI) has been recommending one dose of monovalent conjugated serogroup C vaccine (Men-C-C) at 12–23 months of age, regardless of any doses given during the first year of life. For individuals two to 23 months of age who are at high risk of IMD due to underlying medical conditions or increased risk of exposure to Neisseria meningitidis, NACI has been recommending Men-C-ACYW-CRM (Menveo) and/or 4CMenB (Bexsero) depending on the risk.1When Canada’s routine meningococcal vaccine program was initially recommended for children under two years of age, only Men-C-C vaccines were authorized for use in this age group. Since NACI’s last updated guidance on the use of quadrivalent conjugate meningococcal vaccines containing serogroups A, C, Y and W (Men‑C‑ACYW), two new Men‑C‑ACYW‑TT vaccines (Nimenrix and MenQuadfi) have been authorized for use in children under two years of age in Canada. In addition, all Men-C-C vaccines marketed in Canada (i.e., Menjugate Liquid, NeisVac‑C) will no longer be available for provincial purchase starting in April 2026. As a result of these developments, NACI has released updated recommendations on the use of Men-C-ACYW vaccines in children under two years of age. The updated recommendations are published in a full statement1 and in a summary format.2Updated NACI recommendations:For routine vaccination programs, NACI recommends that all children 12–23 months of age should receive one dose of Men-C-ACYW vaccine, regardless of any doses given during the first year of life. (Strong NACI recommendation)Menactra (Men-C-ACYW-DT), MenQuadfi (Men-C-ACYW-TT), Menveo (Men-C-ACYWCRM) or Nimenrix (Men-C-ACYW-TT) can be used in their authorized age groups.Men-C-ACYW vaccines can be administered concurrently with other vaccines.Toddlers who have already received a Men-C-C vaccine between 12–23 months of age are not recommended to be revaccinated with an additional dose of Men-C-ACYW.Depending on the provincial or territorial schedule and the incidence of IMD in their jurisdiction, infants may receive Men-C-ACYW doses before 12 months of age.Replacing the original Men-C-C vaccines with Men-C-ACYW vaccines will provide additional coverage for serogroups W and Y, which currently account for more reported IMD cases than serogroup C.Evidence from randomized clinical trials show that Men-C-ACYW vaccines provide comparable or superior serogroup‑C immune responses compared to Men‑C‑C vaccines, while also protecting against serogroups A, W and Y. Reactogenicity of Men-C-ACYW and Men-C-C vaccines was similar across studies reviewed by NACI.All jurisdictions should maintain the adolescent Men-C-ACYW program to sustain herd immunity and ensure individual protection during adolescence and young adulthood when the risk of IMD increases again.1In vaccination programs for individuals at high risk of invasive meningococcal disease, NACI recommends that children six weeks to 23 months of age who are at high risk of invasive meningococcal disease due to an underlying medical condition or increased risk of exposure to serogroups A, C, Y or W should be immunized using a Men-C-ACYW vaccine. (Strong NACI recommendation)Menactra (Men-C-ACYW-DT), MenQuadfi (Men-C-ACYW-TT), Menveo (Men-C-ACYWCRM) or Nimenrix (Men-C-ACYW-TT) can be used in the authorized age groups. For children who are at high risk of IMD, Table 2 in the full statement outlines the recommended vaccine dosage schedule by age. A list of individuals at high-risk of IMD is also provided in the document.Men-C-ACYW conjugate vaccines that contain different carrier proteins (i.e., DT, TT or CRM) can be interchanged. When possible, the vaccine series should be completed with the same vaccine; however, in situations where the originally used product is not available for a subsequent dose or is unknown, another Men-C-ACYW vaccine may be administered to complete the schedule.Men-C-ACYW vaccines can be administered concurrently with other vaccines.1NACI notes that individual provinces and territories will determine their vaccination programs and policies based on their unique circumstances, including local epidemiology and the timing of their transition away from Men-C-C vaccine supply.2ReferencesNational Advisory Committee on Immunization (NACI). NACI rapid response: update on the use of quadrivalent conjugate meningococcal vaccines in children under 2 years of age. An Advisory Committee Statement (ACS). (accessed June 25, 2026).National Advisory Committee on Immunization (NACI). Summary of NACI statement of May 2026: update on the use of quadrivalent conjugate meningococcal vaccines in children under 2 years of age (rapid response). (accessed June 25, 2026).

Updated recommendations for meningococcal vaccines in children under 2 years

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