In July 2026, the prescribing information for MenQuadfi, a conjugate vaccine against meningococcal serogroups A, C, W and Y, was updated.

One of the important changes concerns the vaccination schedule for children who start vaccination during the first months of life.

Previously, when vaccination was started at 6 weeks of age, a 3+1 schedule was used: three doses given 2 months apart, followed by a booster dose during the second year of life. The schedule has now been simplified for immunocompetent children:

2+1: two doses given 2 months apart + a booster dose during the second year of life.

This can be remembered as a simple “three twos” rule:
- first dose, from 6 weeks of age;
- second dose, 2 months later;
- booster, during the second year of life.

But there is an important exception.

For children with compromised immune systems, the more intensive 3+1 schedule remains recommended. This includes children with HIV infection, primary immunodeficiencies, and those receiving eculizumab therapy.

What if vaccination starts later?

When vaccination starts later, the number of doses also decreases as the child moves into the next age group:
2+1, from 6 weeks until 6 months of age;
1+1, from 6 months until 12 months of age;
0+1, from 12 months of age.
In other words, the later vaccination is started, the fewer doses are required for the primary series.

What about booster doses?

This is where things get a little more interesting.

People who have previously been vaccinated against meningococcal disease may receive a booster dose.

For people who started vaccination at 12 months of age or older, there are currently no data establishing a universal need for, or specific timing of, booster vaccination.

If the risk of infection is high, a booster may be given provided that at least 3 years have passed since the previous dose. Data for MenQuadfi show persistence of the antibody response for at least 3 years, with data available on antibody persistence for up to 7 years after the primary vaccination series.

For people with certain conditions associated with an increased risk of invasive meningococcal disease, regular booster vaccination may be recommended. This includes people with HIV infection, primary immunodeficiencies, and patients receiving eculizumab therapy.

What does this mean in real life?

It is important to distinguish between persistence of the immune response and the presence of an increased risk of disease.

Imagine a child who completed the recommended vaccination series during infancy. Data are available showing persistence of antibodies for several years, including up to 7 years. This does not mean that everyone should automatically receive another dose every 7 years.

If the child is healthy and does not belong to a high-risk group, an additional dose may not be necessary.

But the situation changes if the level of risk increases.

For example, adolescence may be associated with an increased risk of meningococcal disease in certain circumstances. Another example is a person who has had their spleen removed. People without a functioning spleen are at increased risk of invasive infections and require a different vaccination approach.

So the logic is not “one vaccination, then another dose every 7 years.”

It is more about risk-based protection: primary vaccination provides immune protection, while the need for an additional dose depends on age, individual risk factors, and current official recommendations.

Can you get vaccinated if you are not in a high-risk group?

Yes. The fact that vaccination is available does not necessarily mean that everyone needs the same vaccination schedule.

For meningococcal disease, vaccination decisions depend on age, epidemiological circumstances, individual risk factors, travel, and other considerations. Additional doses outside the groups for whom vaccination is officially recommended are therefore a matter of individual decision-making.

There is also a simple practical principle: make sure your routine vaccinations are up to date first, and then consider additional protection.

Meningococcal disease can be severe, so it is understandable that it worries parents. But this should not lead to a situation where someone gets an additional meningococcal vaccine while their routine protection against measles, tetanus, polio, and other infections is incomplete.

Additional protection makes the most sense when basic protection is also in place.

One more important change

In 2026, the European regulatory procedure for MenQuadfi was expanded: the EMA's Committee for Medicinal Products for Human Use, CHMP, recommended extending the age at which the vaccine can be used from 12 months to 6 weeks.

This means that MenQuadfi can now be considered for vaccination from the first weeks of life, and the schedule for infants has become more straightforward and consistent.

As always, the specific vaccination schedule should be determined based on the person's age, health status, previous doses, and the latest official recommendations.