Meningitis Immunisations for People with HIV

The updated 2026 BHIVA Immunisation guidelines are currently being prepared for public consultation. The new guidelines recommend that unvaccinated adults with HIV should be offered meningococcal vaccination with:

• a single dose of MenACWY conjugate vaccine, (irrespective of CD4 count and viral load)
• and one dose of 4CMenB, be administered at the same time as MenACWY, followed by a second 4CMenB dose ≥4 weeks later and up to 12 months after the first dose.

Booster doses of both MenACWY conjugate vaccine and 4CMenB are recommended every 5 years for individuals at increased risk of exposure (e.g. MSM, travellers and those living in crowded settings) and for individuals with a current or nadir CD4 count <200 cells/mm.

However, in light of the current invasive meningitis B outbreak in South East England (1), there is a risk of vaccine shortage. Therefore, BHIVA recommends that currently the above recommendations for adults with HIV should be temporarily limited to people with risk factors for severe disease, which includes:

• Current or nadir CD4 <200 cell/mm³
• Asplenia or splenic dysfunction
• Complement deficiency
• Use of C5 inhibitors (e.g. eculizumab)
• Immunosuppression
• Older age (>65 years)

BHIVA recommends that general guidance for post-exposure prophylaxis, including the appropriate use of antibiotics and vaccination, as per UKHSA (1,2) should be followed for adults with HIV.

1. Outbreak of invasive meningococcal disease, South East England

2. Guidance for public health management of meningococcal disease in the UK 2025

For further information please contact Jo Josh on +44 (0) 7306 391875 or email [email protected]