Trust­ed pro­tec­tion: Why the cur­rent meningo­coc­cal vac­ci­na­tion sched­ule shouldn’t change with­out strong ev­i­dence

When some­thing is work­ing ex­treme­ly well, we should de­mand very com­pelling ev­i­dence be­fore chang­ing it. I be­lieve that’s why a re­cent Ip­sos sur­vey on meningo­coc­cal menin­gi­tis shows that many doc­tors who treat ado­les­cent pa­tients sup­port the cur­rent CDC-rec­om­mend­ed vac­ci­na­tion sched­ule: They know their pa­tients. And they know what works.

The cur­rent ado­les­cent meningo­coc­cal vac­ci­na­tion sched­ule is to ad­min­is­ter a first dose of a Men­ACWY vac­cine at age 11-12 years, with a boost­er at age 16. The cur­rent ado­les­cent meningo­coc­cal vac­ci­na­tion sched­ule helps pro­vide pro­tec­tion ear­ly in ado­les­cence at the be­gin­ning of an uptick in dis­ease risk. Re­cent­ly, the Ad­vi­so­ry Com­mit­tee on Im­mu­niza­tion Prac­tices (ACIP) of the Cen­ters for Dis­ease Con­trol and Pre­ven­tion has un­der­tak­en a re­view of the ado­les­cent meningo­coc­cal vac­ci­na­tion sched­ule. Among sev­er­al pro­posed sched­ules are two that would re­move the first dose of Men­ACWY at age 11-12.

Suc­cess that earns trust.

At a time when pub­lic health ini­tia­tives – es­pe­cial­ly vac­cines – are sub­ject to un­prece­dent­ed push-back, of­ten us­ing un­found­ed or dis­proven in­for­ma­tion, no change to a suc­cess­ful rec­om­men­da­tion should be tak­en light­ly. This is par­tic­u­lar­ly true of a plat­form that has earned the trust of the physi­cians who know these pa­tients best. A re­cent Ip­sos sur­vey of hun­dreds of pe­di­a­tri­cians and fam­i­ly prac­ti­tion­ers who care for a large group of ado­les­cents found that these clin­i­cians see val­ue in the cur­rent rec­om­men­da­tion. Eighty-sev­en per­cent of the Health Care Pro­fes­sion­als sur­veyed find the cur­rent vac­ci­na­tion sched­ule is ap­pro­pri­ate. A sim­i­lar per­cent­age of sur­vey re­spon­dents, 83%, agree that they have a sense of ur­gency to vac­cine their 11-12 year old pa­tients against meningo­coc­cal dis­ease. Nine­ty-six per­cent be­lieve there is some im­pact on dis­ease re­duc­tion from the 11-12 year old dose, with 57% cat­e­go­riz­ing the im­pact on dis­ease re­duc­tion as “sig­nif­i­cant.”

Rec­og­niz­ing tan­gi­ble pro­tec­tion.

We have very good rea­son for our con­fi­dence in this long­stand­ing rec­om­men­da­tion: it has worked. Since the meningo­coc­cal vac­cines sched­ule was in­tro­duced in 2005, it has con­tributed to a 90% de­cline in meningo­coc­cal dis­ease rates among ado­les­cents.

That is a suc­cess that we should not take for grant­ed. Be­cause the cur­rent rec­om­men­da­tions con­tributed to such a dra­mat­ic re­duc­tion in meningo­coc­cal dis­ease, it may be easy to for­get just how dan­ger­ous these in­fec­tions can be. A case of in­fec­tious meningo­coc­cal dis­ease ad­vances very quick­ly, can caus­ing its great­est dam­age with­in 24 hours. Fa­tal­i­ty rates can be as high as 18%. One in five sur­vivors of IMD will have long-term ef­fects from the dis­ease, such as loss of limbs, sen­so­ry im­pair­ment, brain dam­age, and ner­vous sys­tem prob­lems.

The val­ue of per­son­al ex­pe­ri­ence.

Like many oth­er pe­di­a­tri­cians, I be­lieve that the prac­tice of pro­vid­ing an im­mu­niza­tion plat­form at age 11-12 years has ben­e­fits that go be­yond pre­vent­ing dis­ease. As these vis­its have be­come a stan­dard part of on­go­ing care, they have come to be an an­chor point. They pro­vide an op­por­tu­ni­ty to check in on the child’s health and de­vel­op­ment, re­in­force stan­dards of care with fam­i­lies, and en­gage with ques­tions and con­cerns about health and well­ness. As ado­les­cents get old­er, many of them come in­to the doc­tor’s of­fice less of­ten, if at all. This ob­ser­va­tion is re­flect­ed in the de­crease in Men­ACWY vac­ci­na­tion cov­er­age rates seen be­tween younger and old­er ado­les­cents – it de­creas­es from 88% cov­er­age at the 11-year-old dose to just 60% for the dose at age 16.

School-re­lat­ed re­quire­ments for im­mu­niza­tions and for med­ical clear­ances for par­tic­i­pa­tion in sports and oth­er ac­tiv­i­ties have cre­at­ed a struc­tured, pre­dictable ca­dence for reg­u­lar vis­its to the doc­tor. These en­coun­ters give pe­di­a­tri­cians an op­por­tu­ni­ty to hear ques­tions and con­cerns from fam­i­lies, pro­vide sci­ence-ground­ed an­swers and in­sights, and po­ten­tial­ly counter er­ro­neous in­for­ma­tion that may be spread­ing through on­line com­mu­ni­ties. The re­la­tion­ships and cred­i­bil­i­ty we build through these reg­u­lar ap­point­ments can be vi­tal­ly im­por­tant to pro­tect­ing health.

Con­fi­dence in sci­ence.

Gaps in care are not the on­ly po­ten­tial risk that could arise from a need­less change. We could al­so weak­en con­fi­dence in all rec­om­men­da­tions. In that same Ip­sos sur­vey, re­spon­dents re­spond­ed to an in­quiry around a con­cern that re­vers­ing long­stand­ing guid­ance – with­out strong ev­i­dence of med­ical ben­e­fit – could re­in­force vac­cine hes­i­tan­cy that has lin­gered since the pan­dem­ic. When re­spon­dents were queried as to whether they thought this change might in­crease hes­i­tan­cy for rou­tine vac­cines, 63% agreed, the re­port says.

It’s nat­ur­al for fam­i­lies to have ques­tions about med­i­cine, and es­pe­cial­ly vac­cines. Sci­ence has the an­swers they seek. Fol­low­ing the sci­ence, we can and should change rec­om­men­da­tions on­ly when there is com­pelling ev­i­dence of a clear ad­van­tage. It should be a slam-dunk. Mak­ing a change based on any­thing less than the strongest da­ta risks weak­ing the cred­i­bil­i­ty and trust that the ex­ist­ing rec­om­men­da­tion has earned. Do­ing so car­ries too much risk of sow­ing con­fu­sion.

Stay­ing with what’s worked.

At a time when peo­ple work­ing to pro­tect chil­dren’s health are chal­lenged by a mael­strom of mis­in­for­ma­tion, we must build our rec­om­men­da­tions on­ly on the most com­pelling ev­i­dence. That is why I be­lieve ACIP should keep the cur­rent Men­ACWY rec­om­men­da­tion.

To learn more or to make your voice heard, you may vis­it: https://www.cdc.gov/acip/meet­ings/CDC_AAref_Val=https://www.cdc.gov/vac­cines/acip/meet­ings/in­dex.htm

This ar­ti­cle was pub­lished with the sup­port of Sanofi.

MAT-US-2500497-v1.0-02/2025