Meningococcal Vaccines, Which to Use and When- New ACIP Recommendations Out
Meningococcal infections can cause sepsis (a serious blood infection) that can cause hemorrhage (bleeding) in the arms and legs, especially the hands and feet, often resulting in amputation if that child survives. It is also now one of the main causes of meningitis (an infection of the covering around the brain) since the Hib vaccine virtually eliminated that major cause of meningitis in children. Traditionally, meningococcus infected about 1 in every 100,000 but about 10-15% of those infected die, so this is one of the more serious infections we hope to never see as a pediatrician. We have had good vaccines for meningococcal disease caused by strains A,C,W and Y (Menveo and Menacra) that are very safe and recommended for routine use at age 11, with a recent addition of a booster before college after age 16. Type B had not been covered by any vaccines until this year. Bexero and Trumenba are the two Type B meningococcal vaccines on the market.
These vaccines are both new and poorly tested for safety, and happen to contain huge doses of aluminum, put in the vaccine as adjuvant to stimulate the immune system. I was relieved to see that the CDC withheld it’s broadest approval over concerns of safety and have designated the Type B vaccine category B. This means that we can give it to high risk individuals and those who ask for the vaccine.
The ACIP has stated that risk of meningococcal B infection increases 200 to 1,400 times during disease outbreaks. It is for that reason that I stock the safer of the two vaccines (Trumenba) safer in my estimation because it contains less aluminum. Due to our recent outbreak at the University of Oregon, I have been recommending this vaccine for students who will live in the dorms or the apartments that were declared higher risk.
The ACIP stated there were 564 cases of all meningitis serogroups in 2013, including about 60 cases in the B serogroup. All of these cases were in individuals aged 11 through 23 years.
There have been 7 outbreaks on college campuses since 2009 and 65% of cases in 2013 and 2014 were among students, with 2 deaths each year.
You can read more about the ACIP endorsement of individual choice for this vaccine here…
To learn more about meningococcal vaccines, click here…