Meningococcal B and ABCWY vaccines: Bexsero, Trumenba, Penbraya and Penmenvy

The disease and why it matters

Serogroups B, C and Y cause the majority of meningococcal disease in the United States; the disease is uncommon but very serious, and its two most common syndromes are meningitis and septicemia. ^[1]

Even when treated, meningococcal disease kills 10 to 15 of every 100 infected people, and about 10 to 20 of every 100 survivors suffer disabilities such as hearing loss, brain damage, kidney damage, loss of limbs, nervous system problems or severe scars from skin grafts. ^[2]

In recent years between 20 and 50 cases of serogroup B meningococcal disease occurred each year among 16- through 23-year-old people in the United States, most commonly affecting young adults who attend a four-year university, are freshmen, live in on-campus housing or participate in sororities or fraternities. ^[3]

Video and figures

Video

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Meningococcus - VEC Vaccine Notes | Vaccine Education Center at Children’s Hospital of Philadelphia
Channel: Vaccine Education Center at CHOP · Uploaded April 15, 2026 · Confirmed available October 12, 2026 · Open on YouTubeRxEvidence has not checked every statement in this video.

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CDC lists two MenB vaccines (Bexsero and Trumenba), which protect against serogroup B only, and two MenABCWY vaccines (Penbraya and Penmenvy), which protect against serogroups A, B, C, W and Y; MenABCWY vaccine is an option for people getting MenACWY and MenB vaccines at the same visit. ^[4]

CDC says that Penbraya includes Trumenba and that Penmenvy includes Bexsero; for later doses after a MenABCWY dose, give Trumenba for additional MenB doses when Penbraya was used, and Bexsero when Penmenvy was used, in each case when MenACWY is not indicated. ^[12]

CDC's child and adolescent schedule notes (July 2, 2025) name only Penbraya among the MenABCWY vaccines, whereas FDA lists Penmenvy as approved (letter dated February 14, 2025) and CDC's March 2026 recommendations page names both products; the schedule notes pre-date or do not address Penmenvy, and the pages opened do not say which. ^{[13] [10] [12]}

Label currency as posted by FDA: the Trumenba page is marked content current as of 06/20/2024 (label revised 6/2024), the Bexsero page 08/20/2024 (label 08/2024), the Penbraya page 11/21/2024 (label 11/2024) and the Penmenvy page 08/01/2025 (label 08/2025). ^{[14] [7] [5] [6] [8] [9] [10] [11]}

Bexsero 0.5-mL doses are supplied as single-dose prefilled TIP-LOK syringes packaged without needles; Trumenba as a 0.5-mL single-dose prefilled syringe; Penbraya as a kit with a vial of lyophilized MenACWY component, a prefilled syringe containing the MenB component and a vial adapter. ^{[6] [7] [9]}

Who should get it

The CDC risk-indications page lists these factors for MenB vaccination: complement component deficiency, functional or anatomic asplenia (including sickle cell disease), complement inhibitors (for example Soliris and Ultomiris), microbiologists routinely exposed to N. meningitidis, and being part of a community experiencing a serogroup B outbreak; unlike MenACWY, HIV is not among the MenB indications on that page. ^[15]

CDC's adult schedule notes (July 2, 2025) say adolescents and young adults age 16 to 23 years (16 to 18 preferred) not at increased risk may be vaccinated based on shared clinical decision-making, and recommend MenB for adults with asplenia, persistent complement component deficiency, complement inhibitor use or routine exposure to N. meningitidis as microbiologists. ^[16]

The FDA-approved age range for Bexsero, Trumenba, Penbraya and Penmenvy is 10 through 25 years, so use in adults older than 25 years (for example an asplenic adult) is a CDC recommendation beyond the labeled age range; the label of each product states the 10 through 25 year indication. ^{[6] [7] [9] [11]}

Dosing and schedule, including catch-up

CDC's notes for people at increased risk give a 3-dose primary series at 0, 1 to 2 and 6 months with the same brand for all doses including boosters (dose 3 not needed if dose 2 was given at least 6 months after dose 1; if dose 3 is given earlier than 4 months after dose 2, give a 4th dose at least 4 months after dose 3), then a booster one year after the primary series and every 2 to 3 years if risk remains. ^[16]

For shared clinical decision-making, CDC's notes list a 2-dose series at least 6 months apart (if dose 2 is given earlier than 6 months, give dose 3 at least 4 months after dose 2); to optimize rapid protection (for example students starting college in less than 6 months) a 3-dose series (0, 1 to 2, 6 months) may be given. ^[13]

CDC says MenB vaccine protective antibodies decrease quickly (within 1 to 2 years) after vaccination, and during a serogroup B outbreak a booster is recommended for previously vaccinated people at increased risk if a year or more has passed since the most recent MenB vaccine; public health authorities may recommend a booster after 6 months in some outbreaks. ^{[4] [12]}

The minimum interval between MenABCWY doses is 6 months; MenABCWY vaccine can be used only when both MenACWY and MenB vaccines are indicated at the same visit, and otherwise MenACWY and MenB vaccines should be given separately as appropriate. ^[12]

Administration

• Bexsero: shake the syringe immediately before use to form a homogeneous suspension; do not use if it cannot be resuspended or if particulate matter or discoloration is found; give as a 0.5-mL intramuscular injection. ^[6]
• Trumenba: shake the syringe vigorously to obtain a homogenous white suspension; do not use if it cannot be re-suspended; inject each 0.5 mL dose intramuscularly with the preferred site the deltoid muscle of the upper arm; do not mix with any other vaccine in the same syringe. ^[7]
• Penbraya: reconstitute the lyophilized MenACWY component with the MenB component using the vial adapter (shake the MenB syringe vigorously first and do not use if it cannot be resuspended; swirl until the powder dissolves, less than 1 minute); after reconstitution, administer immediately or store between 2 and 30 °C and use within 4 hours, discarding unused vaccine after 4 hours. ^[9]
• Penmenvy: reconstitute the lyophilized MenACWY component with the MenB component, administer intramuscularly, and administer immediately after reconstitution. ^[11]
• MenB vaccines may be given simultaneously with MenACWY vaccines if indicated, at a different anatomic site if feasible. ^[16]

Storage and handling

• Bexsero: store refrigerated at 36 to 46 °F (2 to 8 °C); do not freeze (discard if frozen); protect from light; do not use after the expiration date. ^[6]
• Trumenba: upon receipt store refrigerated at 2 to 8 °C (36 to 46 °F); store syringes horizontally (laying flat) to minimize re-dispersion time; do not freeze (discard if frozen). ^[7]
• Penbraya: before reconstitution store refrigerated at 2 to 8 °C in the original carton, horizontally, to minimize resuspension time (a white deposit and clear supernatant may be seen in the MenB syringe); do not freeze (discard if the carton has been frozen). ^[9]
• Penmenvy: before reconstitution store refrigerated, away from the freezer compartment, at 36 to 46 °F (2 to 8 °C) in the original carton to protect from light; do not freeze (discard if the carton has been frozen); use immediately after reconstitution. ^[11]

Contraindications and precautions

The CDC appendix lists the Penbraya severe-allergy statement as tetanus toxoid-containing vaccine, whereas the Penmenvy label lists any other diphtheria toxoid-containing vaccine; the two MenABCWY vaccines therefore have different cross-reactivity contraindications. ^{[21] [11]}

Safety and adverse events

Syncope can occur with injectable vaccines including all four products, and procedures should be in place to avoid injury from fainting; appropriate medical treatment must be immediately available to manage anaphylaxis. ^{[6] [7] [9] [11]}

Guillain-Barré syndrome (GBS) has been reported in temporal relationship following another U.S.-licensed meningococcal quadrivalent polysaccharide conjugate vaccine, and the decision to give Penbraya or Penmenvy to people with a history of GBS should take into account expected benefits and potential risks. ^{[9] [11]}

Vaccination may not protect all recipients, and Bexsero and Penmenvy may not provide protection against all meningococcal serogroup B strains. ^{[6] [11]}

Trumenba pediatric use: safety and effectiveness have not been established in children younger than 10 years, and in a clinical study 90% of infants younger than 12 months vaccinated with a reduced-dosage formulation had fever. ^[7]

Special populations

Pregnancy: CDC says to delay MenB vaccination until after pregnancy due to lack of safety data in pregnant women, but MenB may be given if the person is at increased risk and the benefits of vaccination outweigh the potential risks. ^[16]

The labels state that available human data on Bexsero, Trumenba, Penbraya and Penmenvy administered to pregnant women are insufficient to inform vaccine-associated risks in pregnancy; Pfizer maintains a pregnancy exposure registry for Penbraya. ^{[6] [7] [9] [11]}

Lactation: for Bexsero, available data are not sufficient to assess the effects on the breastfed infant or on milk production or excretion, and the benefits of breastfeeding should be considered with the mother's clinical need for the vaccine. ^[6]

Complement deficiency and complement inhibitors: people with certain complement deficiencies and people receiving treatment that inhibits terminal complement activation (for example eculizumab) are at increased risk for invasive disease caused by serogroup B even if they develop antibodies after vaccination; CDC says patients taking complement inhibitors may still contract meningococcal disease despite being fully vaccinated and up to date with boosters or receiving antimicrobial prophylaxis. ^{[6] [15]}

Altered immunocompetence: some individuals with altered immunocompetence may have reduced immune responses to Bexsero, Trumenba and Penbraya, and immunocompromised persons, including those receiving immunosuppressive therapy, may have reduced immune responses to Penmenvy. ^{[6] [7] [9] [11]}

Geriatric use: for Bexsero, safety and effectiveness have not been established in adults older than 65 years. ^[6]

Counseling pearls for the pharmacy counter

• For best protection, more than 1 dose of a MenB vaccine is needed, and the same vaccine must be used for all doses. ^[2]
• MenB vaccines are safe and effective but offer only short-term protection (1 to 2 years) to those vaccinated, and protect against most strains of serogroup B circulating in the United States. ^[3]
• MenB vaccine does not protect against serogroups A, C, W and Y; a different meningococcal vaccine is available for those serogroups. ^[2]
• Tell the vaccination provider about an allergic reaction after a previous dose or any severe, life-threatening allergy, and about pregnancy or breastfeeding; MenB vaccination should be postponed for pregnant women unless the woman is at increased risk and the benefits are considered to outweigh the potential risks. ^[2]
• A low risk of exposure or infection does not mean a person cannot get a MenB vaccine; it is one consideration in shared clinical decision-making. ^[3]
• Completing the series matters: the labels advise informing recipients of the importance of completing the immunization series and of reporting adverse reactions. ^{[6] [7]}

Common patient questions

References

1. Centers for Disease Control and Prevention. Clinical overview of meningococcal disease. Page dated March 30, 2026. Accessed October 11, 2026. https://www.cdc.gov/meningococcal/hcp/clinical/index.html. Accessed October 11, 2026.
2. Centers for Disease Control and Prevention. Meningococcal B vaccine: what you need to know. Vaccine Information Statement, January 31, 2025. Accessed October 11, 2026. https://www.cdc.gov/vaccines/hcp/current-vis/meningococcal-b.html. Accessed October 11, 2026.
3. Centers for Disease Control and Prevention. Shared clinical decision-making: meningococcal B vaccination (job aid, 12/09/24). Accessed October 11, 2026. https://www.cdc.gov/vaccines/media/pdfs/2025/03/2024-isd-job-aid-scdm-menb-508-remediated.pdf. Accessed October 11, 2026.
4. Centers for Disease Control and Prevention. Types of meningococcal vaccines. Page dated March 30, 2026. Accessed October 11, 2026. https://www.cdc.gov/meningococcal/vaccines/types.html. Accessed October 11, 2026.
5. U.S. Food and Drug Administration. BEXSERO product page (content current as of 08/20/2024). Accessed October 11, 2026. https://www.fda.gov/vaccines-blood-biologics/vaccines/bexsero. Accessed October 11, 2026.
6. BEXSERO (meningococcal group B vaccine), injectable suspension for intramuscular use: prescribing information, revised 08/2024. GlaxoSmithKline Biologicals. U.S. Food and Drug Administration. Accessed October 11, 2026. https://www.fda.gov/media/90996/download?attachment. Accessed October 11, 2026.
7. TRUMENBA (meningococcal group B vaccine), suspension for intramuscular injection: prescribing information, revised 6/2024. Pfizer Inc. U.S. Food and Drug Administration. Accessed October 11, 2026. https://www.fda.gov/media/89936/download?attachment. Accessed October 11, 2026.
8. U.S. Food and Drug Administration. PENBRAYA product page (content current as of 11/21/2024). Accessed October 11, 2026. https://www.fda.gov/vaccines-blood-biologics/vaccines/penbraya. Accessed October 11, 2026.
9. PENBRAYA (meningococcal groups A, B, C, W, and Y vaccine), suspension for intramuscular injection: prescribing information, revised 11/2024. Pfizer Ireland Pharmaceuticals. U.S. Food and Drug Administration. Accessed October 11, 2026. https://www.fda.gov/media/173223/download?attachment. Accessed October 11, 2026.
10. U.S. Food and Drug Administration. PENMENVY product page (content current as of 08/01/2025). Accessed October 11, 2026. https://www.fda.gov/vaccines-blood-biologics/penmenvy. Accessed October 11, 2026.
11. PENMENVY (meningococcal groups A, B, C, W, and Y vaccine) for injectable suspension, for intramuscular use: prescribing information, revised 08/2025. GlaxoSmithKline Biologicals. U.S. Food and Drug Administration. Accessed October 11, 2026. https://www.fda.gov/media/185479/download?attachment. Accessed October 11, 2026.
12. Centers for Disease Control and Prevention. Meningococcal vaccine recommendations (for health care providers). Page dated March 30, 2026. Accessed October 11, 2026. https://www.cdc.gov/meningococcal/hcp/vaccine-recommendations/index.html. Accessed October 11, 2026.
13. Centers for Disease Control and Prevention. Child and adolescent immunization schedule notes: recommendations for ages 18 years or younger, United States, 2025. July 2, 2025. Accessed October 11, 2026. https://www.cdc.gov/vaccines/hcp/imz-schedules/child-adolescent-notes.html. Accessed October 11, 2026.
14. U.S. Food and Drug Administration. Trumenba product page (content current as of 06/20/2024). Accessed October 11, 2026. https://www.fda.gov/vaccines-blood-biologics/vaccines/trumenba. Accessed October 11, 2026.
15. Centers for Disease Control and Prevention. Meningococcal vaccine risk indications. Page dated March 16, 2026. Accessed October 11, 2026. https://www.cdc.gov/meningococcal/hcp/vaccine-recommendations/risk-indications.html. Accessed October 11, 2026.
16. Centers for Disease Control and Prevention. Adult immunization schedule notes: recommendations for ages 19 years or older, United States, 2025. July 2, 2025. Accessed October 11, 2026. https://www.cdc.gov/vaccines/hcp/imz-schedules/adult-notes.html. Accessed October 11, 2026.
17. Congressional Research Service. The 2026 Childhood Immunization Schedule (R48982). June 11, 2026. Accessed October 11, 2026. https://www.congress.gov/crs_external_products/R/PDF/R48982/R48982.1.pdf. Accessed October 11, 2026.
18. Centers for Disease Control and Prevention. CDC acts on Presidential Memorandum to update childhood immunization schedule. News release, January 5, 2026. Accessed October 11, 2026. https://www.cdc.gov/media/releases/2026/2026-cdc-acts-on-presidential-memorandum-to-update-childhood-immunization-schedule.html. Accessed October 11, 2026.
19. Centers for Disease Control and Prevention. Healthcare professionals: immunization schedules. Accessed October 11, 2026. https://www.cdc.gov/vaccines/hcp/imz-schedules/index.html. Accessed October 11, 2026.
20. American Academy of Pediatrics. AAP releases recommended childhood and adolescent immunization schedule for 2026. HealthyChildren.org news. Accessed October 11, 2026. https://healthychildren.org/English/news/Pages/AAPs-recommended-childhood-and-adolescent-immunization-schedule-for-2026.aspx. Accessed October 11, 2026.
21. Centers for Disease Control and Prevention. Child and adolescent immunization schedule appendix: contraindications and precautions (July 2, 2025 edition). Accessed October 11, 2026. https://www.cdc.gov/vaccines/hcp/imz-schedules/child-adolescent-appendix.html. Accessed October 11, 2026.