COMMENTARY

Serogroup B Meningococcal Vaccine: Who Should Get It?

Paul A. Offit, MD

Disclosures

November 19, 2014

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Hi. My name is Paul Offit and I am speaking to you today from the Vaccine Education Center at the Children's Hospital of Philadelphia, in Pennsylvania.

Within the past few weeks, the US Food and Drug Administration licensed a serogroup B meningococcal vaccine (Trumenba®) for use in the United States. The vaccine consists of two factor H binding proteins and is now licensed as a three-dose vaccine for everyone between age 10 and 25 years.

Another vaccine, called Bexsero®, is also likely to be licensed soon. This vaccine consists of four different proteins: a Neisseria meningitidis adhesion molecule, one factor H binding protein, a heparin binding antigen, and a porin protein that is associated with an outer membrane vesicle. That will be a two-dose vaccine and also will likely be licensed for persons between age 10 and 25 years.

In the United States, only approximately 50 people will get serogroup B meningococcal disease in that age group. With such low numbers, to whom will we recommend this vaccine? I believe there are a few possibilities.

Who Should Be Vaccinated?

The vaccine could be recommended only for high-risk groups, which is to say those who have persistent complement deficiencies, comprising about 100,000 people in the United States. It could also be recommended for those who have functional or anatomic asplenia, especially sickle cell patients, which includes about 90,000 people in all, and for those microbiologists who work with N meningitidis serogroup B in both the research and the clinical setting, which would be thousands of people.

The vaccine could be recommended for those who are in the midst of an outbreak; for example, recent outbreaks of serogroup B meningococcal disease on the Princeton University campus necessitated vaccinating an additional 5000 people at the time. Similarly, an outbreak of serogroup B meningococcal disease at University of California, Santa Barbara, necessitated inoculating 20,000 people. In fact, virtually all of these outbreaks are now caused by serogroup B meningococcus, because we have a vaccine to prevent other, more common serotypes, namely serotypes C and Y in that age group.

Finally, we could recommend the vaccine for all college students, as is the case for the current meningococcal vaccine. Of interest, however, is that an 18- to 23-year-old who is not in college is more likely to get serogroup B meningococcal disease than one who is in college.

Thus, I believe that the ACIP, the Advisory Committee on Immunization Practices, which will meet in February, has a tough task ahead. At what level do you make a universal recommendation when, in this case, only about 50 people in the United States will get this infection every year? Remember that although it is low-risk, this is a very high-impact disease; roughly 10% of those who are infected will be killed by this bacterium, and a significant percentage will be permanently harmed by it.

We look forward to seeing what happens in February. Thank you.

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