In December 2013 Bexsero® became available in Germany for vaccination against 
serogroup B meningococci (MenB). In August 2015 the German Standing Committee on 
Vaccination (STIKO) endorsed a recommendation for use of this vaccine in persons 
at increased risk of invasive meningococcal disease (IMD). This background paper 
summarizes the evidence underlying the recommendation. Bexsero® is based on 
surface protein antigens expressed by about 80% of circulating serogroup B 
meningococci in Germany. The paper reviews available data on immunogenicity and 
safety of Bexsero® in healthy children and adolescents; data in persons with 
underlying illness and on the effectiveness in preventing clinical outcomes are 
thus far unavailable.STIKO recommends MenB vaccination for the following persons 
based on an individual risk assessment: (1) Persons with congenital or acquired 
immune deficiency or suppression. Among these, persons with terminal complement 
defects and properdin deficiency, including those under eculizumab therapy, are 
at highest risk with reported invasive meningococcal disease (IMD) incidences up 
10,000-fold higher than in the general population. Persons with asplenia were 
estimated to have a ~ 20-30-fold increased risk of IMD, while the risk in 
individuals with other immune defects such as HIV infection or 
hypogammaglobulinaemia was estimated at no more than 5-10-fold higher than the 
background risk. (2) Laboratory staff with a risk of exposure to N. meningitidis 
aerosols, for whom an up to 271-fold increased risk for IMD has been reported. 
(3) Unvaccinated household (-like) contacts of a MenB IMD index case, who have a 
roughly 100-200-fold increased IMD risk in the year after the contact despite 
chemoprophylaxis. Because the risk is highest in the first 3 months and full 
protective immunity requires more than one dose (particularly in infants and 
toddlers), MenB vaccine should be administered as soon as possible following 
identification of the serogroup of the index case.