Who Should Receive the Meningococcal Group B Vaccine?
The serogroup B meningococcal (MenB) vaccine has expanded the ability to prevent meningococcal disease, a rare but potentially very serious and rapidly progressive clinical entity. Current vaccination strategies aim to protect adolescents from all of the commonly implicated meningococcal serogroups (ie, A, C, W, Y, and B).
Professor of Pediatrics
"The MenB vaccine is safe and is now mostly covered by insurance, so cost is not the driving decision-making factor that it once was. Until a pentavalent meningococcal vaccine is available, I would say that, barring a contraindication, every adolescent and young adult should get the MenB vaccine in addition to the MenACWY vaccine.”
Meningococcal disease is rare, occurring in approximately 1 in 1 million persons in the United States annually; however, the onset of illness can be rapid and extremely severe or fatal, even in young, otherwise healthy adolescents. The 2 most common types of meningococcal infections are meningitis and septicemia. Both of these types of infections are very serious and can be deadly in a matter of hours. Patients may transition from being healthy to being in shock in fewer than 12 hours, especially those with meningococcal septicemia (ie, meningococcemia), because the immune system has not had time to develop a good response and becomes overwhelmed.
The highest incidence of meningococcal disease occurs during the first 2 years of life, after which the incidence decreases significantly until around 16 years of age. A second peak occurs from around 16 years of age until around 23 years of age, and then the incidence goes down again. Interestingly, the incidence of meningococcal disease began to drop in the United States even before the routine use of meningococcal vaccines for reasons that are not completely understood.
There are currently 2 different vaccines that are available to prevent meningococcal disease in the United States: the meningococcal conjugate (MenACWY) vaccine, which targets serogroups A, C, W, and Y, and the MenB vaccine, which targets serogroup B. Circulating meningococcal serogroups vary geographically and temporally, and also by patient age group. Differing vaccination programs may be in place in, for instance, the United Kingdom, the United States, and Egypt at any given time or over a span of years. In the past, serogroup C had been a problem in the United Kingdom, leading the United Kingdom to become the first to introduce the MenC vaccine (also known as the meningococcal group c vaccine). In the United States, serogroup B has been the most prevalent serotype for many years. In a recent survey of global invasive meningococcal disease incidence, MenB was common in Europe, North America, and the Western Pacific.
Globally, the MenB vaccine has been used effectively to control outbreaks. In New Zealand, for instance, an epidemic of meningococcal group B disease began in the early 1990s, and a vaccine targeting serogroup B worked very well to control it. In the United States, the outbreaks have been much smaller. The birth cohort in the United States is approximately 3.5 million per year, so it has been difficult to clearly demonstrate how well the MenB vaccine prevents disease. This may be the reason for the recommendation from the Centers for Disease Control and Prevention (CDC) for shared decision making regarding whether a patient should receive this vaccine.
The initial vaccination recommendations for meningococcal disease in the United States targeted adolescents and young adults. We want to get them vaccinated before going to college, as we see an increased risk of meningococcal disease in dormitories, military bootcamps, or essentially any crowded settings where young adults are in close contact with each other. Current CDC recommendations include that adolescents should receive a first dose of the MenACWY vaccine at age 11 or 12 years and a booster at age 16 years. According to the CDC, adolescents may also receive the MenB vaccine. The preferred age to administer the MenB vaccine is 16 to 18 years. Adolescents with complement component deficiencies, asplenia, or sickle cell disease; who are taking a complement inhibitor; or who are identified as being at an increased risk due to an outbreak should also receive the MenB vaccine.
The administration of the meningococcal disease vaccines during the first year of life, to address the early peak in incidence, has been under consideration, but I think that there is some uncertainty about whether we can continue to boost without the patient losing the benefits later in life. Will individuals continue to get a response to, say, a third, fourth, or fifth dose? We do not know. Still, one might argue that if the incidence is so high in the first 2 years of life, then strategies should be developed to address that. At present, however, since the immune response to the vaccine appears to last only 3 to 5 years and we are unsure about the number of times we can boost, the recommendation has remained to begin vaccination during adolescence.
As we look to the future, changes may be coming. Data have recently been presented to the CDC's Advisory Committee on Immunization Practices on a pentavalent vaccine that added serogroup B to the MenACWY vaccine. It demonstrated a good immune response to meningitis serogroups A, B, C, W, and Y. I think that we will have a licensed pentavalent vaccine soon, which will get rid of the issue of needing both the MenB and the MenACWY vaccines to cover the most prevalent circulating serogroups. There will just be a meningococcal vaccine, not a MenB vaccine and a MenACWY vaccine.
A lot of diseases may be rare, but if we can prevent them, that is what we are trying to do with all vaccines: to take away those small likelihoods. Meningococcal disease can be overwhelming and can kill you before you even really know what is going on. The MenB vaccine is safe and is now mostly covered by insurance, so cost is not the driving decision-making factor that it once was. Until a pentavalent meningococcal vaccine is available, I would say that, barring a contraindication, every adolescent and young adult should get the MenB vaccine in addition to the MenACWY vaccine.
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