Aetna considers meningococcal vaccine a medically necessary preventive service according to the recommendations of the Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP).
The ACIP recommends immunization with meningococcal vaccine of all adolescents 11 through 18 years of age followed by a one-time booster dose of the vaccine 5 years later through age 21 years.
The ACIP also recommends meningococcal immunization for persons with one or more of the following risk factors:
Anatomic asplenia (surgical or congenital);
College freshmen living in dormitories;
Functional asplenia (sickle-cell disease);
Microbiologists who are routinely exposed to isolates of N. meningitidis;*
Persons who are infected with HIV;
Persons who are traveling to countries in which N. meningitidis is hyperendemic or epidemic, particularly if contact with the local population will be prolonged;* or
Persons with terminal complement component deficiencies.
Revaccination at 5-year intervals indefinitely is considered medically necessary for persons who remain in one of these increased risk groups.
ACIP recommends infants at high risk for meningococcal disease be vaccinated with HibMenCY vaccine (MenHibrix; GSK) starting at age 2 months. Infants at increased risk for meningococcal disease should be vaccinated with 4 doses of HibMenCY at 2, 4, 6, and 12 through 15 months.
Infants at increased risk include those with one or more of the following risk factors
Infants with anatomic or functional asplenia including sickle cell disease; or
Infants with complement component deficiencies such as C3, C5-9, properdin, factor H, and factor D deficiencies; or
Infants in a defined risk group for a community or institutional outbreak; or
Infants with HIV, if another indication for vaccination exists; or
Infants needing protection prior to traveling or moving to an area where meningococcal disease is epidemic or highly endemic.
Revaccination three years after the primary series is considered medically necessary for children who remain at increased risk.
Aetna considers unconjugated meningitis vaccine (Menomune, Aventis Pasteur, Swiftwater, PA) an acceptable alternative to conjugated meningitis vaccine (Menactra, Aventis Pasteur, Swiftwater, PA; Menveo, Novartis Vaccines and Diagnostics, Inc., Cambridge, MA) for medically necessary indications.
Aetna considers meningococcal vaccine medically necessary for solid organ transplant recipients.
Aetna considers meningococcal vaccine experimental and investigational for all other indications because of insufficient evidence in the peer-reviewed literature.
*Note: Some plans exclude coverage of immunizations for travel or work. Please check benefit plan descriptions for details.
Meningococcal meningitis, caused by the bacterium Neisseria meningitidis, is a potentially fatal bacterial infection that afflicts between 2500 and 3000 persons in the United States each year. Approximately 10 percent of individuals who contract meningococcal disease will die. Of survivors, up to one in five suffer long-term permanent disabilities such as hearing loss, brain damage and limb amputations.
Advisory Committee on Immunization Practices (ACIP) currently recommends tetravalent or quadrivalent meningococcal conjugate vaccine for all 11 to 18 year olds and for persons aged 2 to 55 years who are at increased risk for meningococcal disease (CDC, 2007, 2010). The previous recommendations for meningococcal conjugate vaccine administration consisted of three cohorts: 11 to 12 year olds, adolescents entering high school (or 15 year olds), and other persons at increased risk for meningococcal disease, such as incoming college freshmen who would be living in dormitories. Because many adolescents do not see a doctor regularly, the expanded recommendations allow physicians to vaccinate adolescent patients whenever the opportunity to do so arises. The revised recommendations continue to emphasize that 11 to 12 year olds should receive the meningococcal conjugate vaccine at the 11 to 12 year old preventive care visit, along with other routine adolescent vaccinations. The ACIP has stated that their goal is routine vaccination of all adolescents beginning at age 11 years.
Adolescents and young adults in particular are at increased risk of contracting meningococcal meningitis because of certain lifestyle factors, such as crowded living conditions, moving to a new residence, attending a new school with students from geographically diverse areas, sharing beverages or utensils, going to bars, active or passive smoking, and irregular sleeping patterns (NMA, 2004). A CDC study of 83 reported meningitis cases in college students from September 1998 through May 1999, a rate of 1.4 cases per 100,000 freshmen, and 3.8 cases per 100,000 freshmen living in dormitories. The rate for all 18 to 22 year olds was 1 case per 100,000. According to the American College Health Association, between 100 and 125 college students get meningitis each year, and up to 10 die. Routine vaccination with meningococcal vaccine is also recommended for other populations at increased risk (i.e., military recruits, travelers to areas in which meningococcal disease is hyperendemic or epidemic, microbiologists who are routinely exposed to isolates of N. meningitidis, patients with anatomic or functional asplenia, and patients with terminal complement deficiency).
A conjugate vaccine is developed by attaching a polysaccharide antigen to a carrier protein in order to enhance the body's immune response to the vaccine. There are 2 meningococcal conjugate vaccines approved by the U.S. Food and Drug Administration (FDA): (i) meningococcal [Groups A, C, Y and W-135] polysaccharide diphtheria toxoid conjugate (Menactra, Sanofi Pasteur Inc., Swiftwater, PA), a purified meningococcal polysaccharide conjugated with an diphtheria toxin in order to prolong the immunogenic effect of the vaccine, and (ii) meningococcal [Groups A, C, Y, and W-135] oligosaccharide diphtheria CRM197 conjugate vaccine (Menveo, Novartis Vaccines and Diagnostics, Inc., Cambridge, MA), which is similar to Menactra. Whereas standard unconjugated meningitis vaccine (i.e., Menomune meningococcal [Groups A, C, Y and W-135] polysaccharide vaccine (Sanofi Pasteur Inc.) induces protective immunity for three to four years, conjugated meningitis vaccines are expected to provide protective immunity for up to eight years. Both Menactra and Menomune are currently approved by the U.S. Food and Drug Administration (FDA) for persons aged 2 years and older. The FDA approved Menactra for use in children aged 2 to 10 years on October 17, 2007, in addition to its prior approval for use in persons aged 11 to 55 years. Menveo was approved by the FDA on February 19, 2010 for use among persons aged 11 to 55 years. Previous ACIP recommendations called for vaccination with Menomune for children aged 2 - 10 years who are at increased risk for meningococcal disease. However, ACIP revised its recommendation during its October 24, 2007 meeting to state that meningococcal conjugate vaccine is preferable to meningococcal polysaccharide vaccine for vaccination of children aged 2 - 10 years who are at increased risk for meningococcal disease. Menactra and Menveo are administered intramuscularly, while Menomune is administered subcutaneously. Generally, only a single dose of meningococcal vaccine is indicated.
The Advisory Committee on Immunization Practices states that revaccination may be indicated for persons previously vaccinated with meningococcal vaccine who remain at high risk for infection (i.e., those with terminal complement deficiencies, with anatomic or functional asplenia, those infected with HIV, travelers to hyperendemic or epidemic areas), particularly for children who were first vaccinated when they were less than 4 years of age. According to the ACIP, such children should be considered for revaccination after 2 to 3 years if they remain at high risk. For children aged 2 -10 years who have previously received meningococcal polysaccharide vaccine and remain at increased risk for meningococcal disease, ACIP recommends vaccination with meningococcal conjugate vaccine at 3 years after receipt of meningococcal polysaccharide vaccine. Children who last received meningococcal polysaccharide vaccine more than 3 years ago and remain at risk for meningococcal disease should be vaccinated with meningococcal conjugate vaccine as soon as possible. In addition, adolescents 11 through 18 years of age who routinely received the meningococcal vaccine should receive a one-time booster dose 5 years later through age 21 years. Current evidence suggests that most adolescents are not protected for more than 5 years after vaccination, which is a shorter time frame than was thought when initial reccomendations were made (Hitt, 2010). Although the need for revaccination in adults has not been determined, antibody levels decline rapidly over 2-3 years after the polysaccharide vaccine is given, and if indications still exist for vaccination, revaccination may be considered within 3-5 years. Revaccination may be considered for college freshmen who were vaccinated more than 3-5 years earlier. Routine revaccination of college students who were vaccinated as freshmen is not indicated. Revaccination of military recruits is only indicated when military personnel are traveling to countries in which N. meningitidis is hyperendemic or epidemic.
In a single, randomized, modified double-blind, controlled study of healthy U.S. children aged 2 - 10 years that compared meningococcal conjugate vaccine with meningococcal polysaccharide vaccine, serum bactericidal antibody geometric mean titers against all four serogroups were significantly higher at both 28 days and 6 months after vaccination in the children who received meningococcal conjugate vaccine. In the same study, rates of most solicited local and systemic adverse events after vaccination with meningococcal conjugate vaccine were comparable to rates observed after vaccination with meningococcal polysaccharide vaccine (Pichichero, et al., 2005). It is anticipated that more data will become available within the next 5 years to guide recommendations on revaccination for persons who were previously vaccinated with meningococcal polysaccharide vaccine.
Meningococcal vaccine is contraindicated in persons with allergy to vaccine components and persons with acute, moderate or severe illnesses with or without fever. Persons with moderate or severe illness should be immunized as soon as they have recovered from the acute phase of the illness. Minor illnesses (e.g., upper respiratory tract infection, allergic rhinitis) with or without fever should not contraindicate the use of meningococcal vaccine.
The Surgical Infection Society (Howdieshell, et al., 2006) stated that there are limited data on the use of vaccines after injury. In particular, the recommendations that all persons (aged 2 to 64 years) who have undergone splenectomy, should receive 23-valent pneumococcal vaccine and meningococcal vaccine, with Haemophilus influenzae type B vaccine administered to high-risk patients as well are grade D (very low quality recommendations).
At its February 2008 meeting, the ACIP decided not to recommend routine vaccination of children aged 2 to10 years against meningococcal disease unless the child is at increased risk for the disease. The ACIP recommends routine vaccination against meningococcal disease for all persons aged 11 to 18 years followed by a one-time booster dose of the vaccine 5 years later through age 21 years and those persons aged 2 to 55 years who are at increased risk for meningococcal disease.
In 2011, the ACIP recommended use of meningococcal vaccine in infants age 9 through 23 months at increased risk of meningococcal diseases. The ACIP recommended that specific groups of children aged 9-23 months at increased risk for meningococcal disease receive a two-dose series of meningococcal vaccine taken 3 months apart:
Infants needing protection prior to traveling or moving to an area where meningococcal disease is epidemic or highly endemic. Travelers can receive their two doses 2 months apart to accommodate travel schedules.
Infants with complement component deficiencies such as C3, C5-9, properdin, factor H, and factor D deficiencies.
Infants in a defined risk group for a community or institutional outbreak.
Infants with HIV, if another indication for vaccination exists.
A two-dose series is required for any child whose first dose was received prior to their second birthday. Those who remain at risk for meningococcal disease should receive a booster dose 3 years after the primary series.
In October, 2012 ACIP voted to recommend that infants at increased risk for meningococcal disease should be vaccinated with 4 doses of HibMenCY at 2, 4, 6, and 12 through 15 months. These include infants with recognized persistent complement pathway deficiencies and infants who have anatomic or functional asplenia including sickle cell disease. HibMenCY can be used in infants ages 2 through 18 months who are in communities with serogroup C and Y meningococcal disease outbreaks. ACIP noted that meningococcal disease incidence has declined to historically low levels since the last peak in disease in the late 1990s and about 50 of infant cases are potentially preventable by available vaccines. The revised recommendations allow for the fact that the majority of infant cases are caused by a type of the bacteria that are not prevented by meningococcal vaccines. Also, the recommendations note that the majority of infant cases occur within the first 6 months of life, which is the time period before a vaccine would likely be able to protect the infant as 3 doses are needed (at 2, 4 and 6 months) to maximize the immune response.
CPT Codes / HCPCS Codes / ICD-9 Codes
CPT codes covered if selection criteria are met:
ICD-9 codes covered if selection criteria are met:
Human immunodeficiency virus [HIV] disease
Other specified disorders involving the immune mechanism
Sickle-cell thalassemia without crisis
Sickle-cell thalassemia with crisis
282.60 - 282.69
Anomalies of spleen
Contact with or exposure to meningococcus
Contact with or exposure to other communicable diseases
Need for prophylactic vaccination and inoculation against other specified bacterial disease
Asymptomatic human immunodeficiency virus [HIV] infection status
Organ or tissue replaced by transplant, kidney
Organ or tissue replaced by transplant, heart
Organ or tissue replaced by transplant, lung
Organ or tissue replaced by transplant, liver
Other specific organ or tissue replaced by transplant, pancreas
Other specific organ or tissue replaced by transplant, intestines
Other acquired absence of organ
Person living in residential institution
Personal current military deployment status
Health examination of defined subpopulations [armed forces personnel, occupational, students]
Other ICD-9 codes related to the CPB:
Place of occurrence, residential institution
Carrier or suspected carrier of other specified bacterial diseases
Screening examination for other specified bacterial and spirochetal diseases
The above policy is based on the following references:
American Academy of Pediatrics, Committee on Infectious Diseases; Canadian Paediatric Society, Infectious Diseases and Immunization Committee. Meningococcal disease prevention and control strategies for practice-based physicians. Pediatrics. 1996;97(3):404-412.
American Academy of Pediatrics, Committee on Infectious Diseases. Meningococcal disease prevention and control strategies for practice-based physicians (Addendum: recommendations for college students). Pediatrics. 2000;106(6):1500-1504.
American Academy of Pediatrics (AAP). Meningococcal infections. In: 2003 Red Book: Report of the Committee on Infectious Diseases. G. Peter, ed. 25th ed. Elk Grove Village, IL: AAP; 2003.
Centers for Disease Control and Prevention (CDC). Control and prevention of serogroup C meningococcal disease: Evaluation and management of suspected outbreaks: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 1997;46(RR-5):1-21.
Centers for Disease Control and Prevention (CDC). Prevention and control of meningococcal disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2000;49(RR-7):1-10.
Centers for Disease Control and Prevention. Meningococcal disease and college students. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2000;49(RR-7):13-20.
Centers for Disease Control and Prevention (CDC). Recommended adult immunization schedule --- United States, 2002--2003. MMWR Morbid Mortal Wkly Rep. 2002;51(40):904-908.
Committee in Infectious Diseases, American Academy of Pediatrics. Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention; American Academy of Family Physicians. Recommended childhood immunization schedule -- United States, 2002. Pediatrics. 2002;109(1):162.
Kelleher JA, Raebel MA. Meningococcal vaccine use in college students. Ann Pharmacother. 2002;36(11):1776-1784.
Wall RA. Meningococcal disease: Treatment and prevention. Ann Med. 2002;34(7-8):624-634.
National Meningitis Association (NMA). New meningococcal immunization recommendations seek to protect adolescents and college students from potentially fatal meningococcal disease. Press Release. Lexington Park, MD: NMA; February 10, 2005.
Aventis Pasteur Inc. Menomune-A/C/Y/W-135 meningococcal polysaccharide vaccine groups A, C, Y and W-135 combined. Prescribing Information. 4813/4875. Swiftwater, PA: Aventis-Pasteur; January 2003.
Aventis Pasteur Inc. Menactra meningococcal (Groups A, C, Y and W-135) polysaccharide diphtheria toxoid conjugate vaccine. Product Labeling. 4714-5. Swiftwater, PA: Aventis Pasteur; January 2005.
Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices (ACIP), Vaccines for Children Program. Meningococcus. Vaccines to prevent meningococcal disease. Resolution No. 2/05-2. Atlanta, GA: CDC; February 10, 2005.
Centers for Disease Control and Prevention (CDC), National Immunization Program (NIP). ACIP recommends meningococcal vaccine for adolescents and college freshman. Meningococcal conjugate vaccine. Meningococcal (groups A, C, Y and W-135) conjugate vaccine (MCV-4). In the Spotlight for the Public. NIP Public Home. Atlanta, GA: CDC; February 10, 2005. Available at: http://www.cdc.gov/nip/vaccine/meningitis/mcv4/mcv4_acip.htm. Accessed February 24, 2005.
American Academy of Pediatrics Committee on Infectious Diseases. Prevention and control of meningococcal disease: Recommendations for use of meningococcal vaccines in pediatric patients. Pediatrics. 2005;116(2):496-505.
Howdieshell TR, Heffernan D, Dipiro JT; Therapeutic Agents Committee of the Surgical Infection Society. Surgical infection society guidelines for vaccination after traumatic injury. Surg Infect (Larchmt). 2006;7(3):275-303.
Patel M, Lee CK. Polysaccharide vaccines for preventing serogroup A meningococcal meningitis. Cochrane Database Syst. Rev. 2005:(1):CD001093.
Conterno LO, Silva Filho CR, Ruggeberg JU, Heath PT. Conjugate vaccines for preventing meningococcal C meningitis and septicaemia. Cochrane Database Syst Rev. 2006;(3):CD001834.
Gardner P. Clinical practice. Prevention of meningococcal disease. N Engl J Med. 2006;355(14):1466-1473.
Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices. Revised recommendations of the Advisory Committee on Immunization Practices to vaccinate all persons aged 11-18 years with meningococcal conjugate vaccine. MMWR Morb Mortal Wkly Rep. 2007;56(31):794-795.
Pichichero M, Casey J, Blatter M, et al. Comparative trial of the safety and immunogenicity of quadrivalent (A,C,Y,W-135) meningococcal polysaccharide-diphtheria conjugate vaccine versus quadrivalent polysaccharide vaccine in two- to ten-year-old children. Pediatr Infect Dis J. 2005;24:57-62.
Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices. Notice to readers: Recommendation from the Advisory Committee on Immunization Practices (ACIP) for use of quadrivalent meningococcal conjugate vaccine (MCV4) in children aged 2--10 years at increased risk for invasive meningococcal disease. MMWR Morb Mortal Wkly Rep. 2007:56(48):1265-1266.
Avery RK, Michaels M. Update on immunizations in solid organ transplant recipients: What clinicians need to know. Am J Transplant. 2008;8(1):9-14.
Centers for Disease Control and Prevention (CDC); Advisory Committee on Immunization Practices (ACIP). Updated recommendation from the Advisory Committee on Immunization Practices (ACIP) for use of 7-valent pneumococcal conjugate vaccine (PCV7) in children aged 24-59 months who are not completely vaccinated. MMWR Morb Mortal Wkly Rep. 2008;57(13):343-344.
Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). Report from the Advisory Committee on Immunization Practices (ACIP): Decision not to recommend routine vaccination of all children aged 2-10 years with quadrivalent meningococcal conjugate vaccine (MCV4). MMWR Morb Mortal Wkly Rep. 2008;57(17):462-465.
Centers for Disease Control and Prevention (CDC). Licensure of a meningococcal conjugate vaccine (Menveo) and guidance for use - Advisory Committee on Immunization Practices (ACIP), 2010. MMWR. 2010;59(09);273. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5909a5.htm. Accessed April 21, 2010.
Reisinger KS, Block SL, Collins-Ogle M, et al; Protocol 025 Investigators. Safety, tolerability, and immunogenicity of Gardasil given concomitantly with Menactra and Adacel. Pediatrics. 2010;125(6):1142-1151.
Sanofi Pasteur, Inc. Menactra® (meningococcal (groups A, C, Y and W-135) polysaccharide diphtheria toxoid conjugate vaccine) for intramuscular injection. Prescribing Information. Swiftwater, PA: Sanofi Pasteur; revised March 2011.
Centers for Disease Control and Prevention, Division of News and Electronic Media. CDC Advisory Committee on Immunization Practices Recommends HibMenCY for Infants at Increased Risk for Meningococcal Disease. Atlanta, GA: Centers for Disease Control (CDC); October 24, 2012. Available at: http://www.cdc.gov/media/releases/2012/a1024_HibMenCY.html. Accessed October 25, 2012.
Makris MC, Polyzos KA, Mavros MN, et al. Safety of hepatitis B, pneumococcal polysaccharide and meningococcal polysaccharide vaccines in pregnancy: A systematic review. Drug Saf. 2012;35(1):1-14.
Gossger N, Snape MD, Yu LM, et al; European MenB Vaccine Study Group. Immunogenicity and tolerability of recombinant serogroup B meningococcal vaccine administered with or without routine infant vaccinations according to different immunization schedules: A randomized controlled trial. JAMA. 2012;307(6):573-582.
Copyright Aetna Inc. All rights reserved. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.