University-Based Outbreaks of Meningococcal Disease Caused by Serogroup B, United States, 2013–2018

Heidi M. Soeters; Lucy A. McNamara; Amy E. Blain; Melissa Whaley; Jessica R. MacNeil; Susan Hariri; Sarah A. Mbaeyi; for the Serogroup B eningococcal Disease University Outbreak Group


Emerging Infectious Diseases. 2019;25(3):434-440. 

In This Article

Abstract and Introduction


We reviewed university-based outbreaks of meningococcal disease caused by serogroup B and vaccination responses in the United States in the years following serogroup B meningococcal (MenB) vaccine availability. Ten university-based outbreaks occurred in 7 states during 2013–2018, causing a total of 39 cases and 2 deaths. Outbreaks occurred at universities with 3,600–35,000 undergraduates. Outbreak case counts ranged from 2 to 9 cases; outbreak duration ranged from 0 to 376 days. All 10 universities implemented MenB vaccination: 3 primarily used MenB-FHbp and 7 used MenB-4C. Estimated first-dose vaccination coverage ranged from 14% to 98%. In 5 outbreaks, additional cases occurred 6–259 days following MenB vaccination initiation. Although it is difficult to predict outbreak trajectories and evaluate the effects of public health response measures, achieving high MenB vaccination coverage is crucial to help protect at-risk persons during outbreaks of meningococcal disease caused by this serogroup.


Meningococcal disease, caused by the bacterium Neisseria meningitidis, is a severe, life-threatening illness with rapid onset and progression of symptoms. Case-fatality rates can be as high as 10%–20% among treated persons;[1] 11%–19% of survivors develop major clinical sequelae, including loss of limbs, deafness, and seizures.[2] In the United States, meningococcal disease incidence has steadily declined since 1995 (1.20 cases/100,000 persons) to a historic low of 0.11 cases/100,000 persons in 2017.[3]

Of the 4 meningococcal serogroups (B, C, W, Y) that cause most cases of the disease in the United States, serogroup B is currently the predominant serogroup overall and accounts for more than half of meningococcal disease cases among persons 16–20 years of age.[1] Although the overall incidence is low, university students are at increased risk of meningococcal disease caused by serogroup B compared with other adolescents and young adults who do not attend university in the United States.[4]

Vaccination is the primary strategy for prevention of meningococcal disease. Since 2005, the US Advisory Committee on Immunization Practices has recommended quadrivalent meningococcal conjugate vaccine covering serogroups A, C, W, and Y (MenACWY) for routine use in adolescents 11–18 years of age and other groups at increased risk for meningococcal disease, including unvaccinated college freshmen living in dormitories.[5] In 2013, a serogroup B meningococcal (MenB) vaccine, MenB-4C (Bexsero; GlaxoSmithKline,,[6] became available for outbreak response via a Centers for Disease Control and Prevention (CDC)–sponsored expanded access investigational new drug protocol. In 2014–2015, MenB-FHbp (Trumenba; Pfizer,[7] and MenB-4C were licensed for use in the United States. Although these vaccines are not routinely recommended for all adolescents or college students, adolescents and adults 16–23 years of age may be vaccinated with a MenB series based on individual clinical decision-making.[8] In addition, MenB vaccine is recommended for use in persons ≥10 years of age who are at increased risk for meningococcal disease caused by this serogroup, including during outbreaks.[9] In outbreak settings, either a 2-dose series of MenB-4C (0, ≥1 month) or a 3-dose series of MenB-FHbp (0, 1–2, 6 months) is recommended.[10]

Historically, most meningococcal disease outbreaks on university campuses in the United States were caused by serogroup C.[11,12] However, serogroup B has caused all known US university-based outbreaks since 2011, likely in part because of high MenACWY coverage in adolescents.[13] We summarize university-based outbreaks of meningococcal disease caused by serogroup B in the United States in the years following MenB vaccine availability (2013–2018) and describe the resulting MenB vaccination responses.