COMMENTARY

Meningococcal Disease: The Good News and the Bad News

William T. Basco, Jr., MD, MS

Disclosures

June 07, 2019

Anyone old enough to remember the devastation wrought by meningococcal sepsis or meningitis welcomed the introduction of quadrivalent meningococcal vaccine, which provides protection against the A, C, W, and Y strains and which became available in the United States in 2005. Immunization schedules recommend that two doses be given, the first at age 11-12 years and the second at 16 years. Although uptake is not perfect, estimates are that over 83% of college-aged students had been approximately vaccinated as of 2016.[1]

In 2014-15, two different meningococcal serogroup B (MenB) vaccines became available. Recommendations for MenB vaccine are risk-based; young people 16-23 years of age who are determined to be at risk for this illness should be offered this new product.

But who exactly is at risk? Previous epidemiologic studies have found that college students living in residence halls are at increased risk for meningococcal disease. But it is unclear if college-aged young adults who are not in college are also at higher risk.

A recent study sought to answer this question.[2] The investigators utilized data from the National Notifiable Diseases Surveillance System, which collects data in 45 states. Confirmed and probable cases among 18- to 24-year-olds that occurred between 2014 and 2016 were included in the study. College status was determined by self-report.

There were 1174 confirmed or probable meningococcal cases during the years included in the study; 166 of those (14.1%) occurred in people 18-24 years old. Over half (58.3%) of all of these cases were due to serogroup B.

However, the percentage of cases caused by serogroup B in college compared with non-college young adults was widely disparate. Over three quarters (76.9%) of the cases among college students were due to serogroup B while only about a third (38.1%) of cases in non-college young adults were caused by this organism.

During the calendar years studied, there were six outbreaks of MenB disease on college campuses and no outbreaks due to non-B serogroups. There were four outbreaks of non-B serogroups among non-college young adults.

Overall, the incidence of meningococcal disease from all strains was 0.17 cases/100,000 population—exactly the incidence in college students. But in non-college young adults, incidence was dramatically lower (0.05 cases/100,000 population). The relative risk for MenB infection in college students was a whopping 3.54.

The peak activity of serogroup B disease in college students occurred between 18 and 20 years of age. By the age of 22 years, even if still attending college, risk was similar to that of non-college young adults.

So while overall incidence of meningococcal disease is low in college-aged young adults, they do appear to be at increased risk for this life-threatening infection, primarily due to serogroup B disease.

Viewpoint

The good news here is that the widespread use of meningococcal vaccines to protect against A, C, W, and Y is working. The risk for illness with those strains in college students is now essentially the same as the risk in their non-college, same-age peers.

I agree with the authors, however, that their data suggest that coverage by vaccines against serogroup B cases should, at a minimum, be actively discussed between pediatric providers and their patients as they enter high-school ages. This disease may be relatively uncommon but the consequences are too serious for us to not prevent every case that we can.

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