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Outbreak of serogroup B meningitis continues at Princeton University
Seven cases of Neisseria meningitidis serogroup B infection have been reported among Princeton University students and contacts since March 22.
As of Nov. 14, there were a total of seven cases of invasive meningococcal disease among six students and one visitor to the campus. The last case was reported on Nov. 8, according to a Princeton University press release.
Five patients have recovered; information is unavailable for one patient who is being followed by another health department, and the most recent patient remains hospitalized, according to a statement from The New Jersey Department of Health (NJDOH).
Meningococcal vaccines licensed in the United States include four of the five most common serogroups: A, C, Y and W-135. However, there is currently no vaccine licensed in the United States that protects against serogroup B.
The NJDOH, local health officials, and Princeton University Health Services, in consultation with the CDC, have worked together to identify close contacts, administer prophylactic antibiotics to close contacts, and provide recommendations for appropriate public health measures, according to the NJDOH.
According to Joseph A. Bocchini Jr., MD, from the University of Louisiana, and a member of the Infectious Diseases in Children Editorial Board, because the outbreak is caused by serotype B, which is not included in any US-licensed vaccines, the public health approach of offering vaccination to unvaccinated populations during an outbreak of meningococcal disease will not be effective.
Joseph A. Bocchini Jr.
“Unfortunately, this outbreak is caused by serotype B, which is not in any US-licensed vaccines,” Bocchini, who is also a member of the Advisory Committee on Immunization Practices, said. “However, to address this outbreak, CDC has made arrangements to allow a serotype B vaccine licensed in Europe and Australia to be used in this outbreak, if approved by Princeton University authorities.”
Per the NJ Immunization of Pupils in School law, all students born on or after Jan. 1, 1997, who are at least 11 years of age and in the sixth grade, must receive one dose of a meningococcal-containing vaccine. One dose of meningococcal vaccine is required for students entering a four-year institution and who reside in a campus dormitory, as per higher education immunization regulations.
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The “outbreak” of meningitis at Princeton University appears to be seven cases occurring there since March 2013. Unlike most Neisseria meningitidis cases, these have occurred over this lengthy period of time rather than in an immediate cluster… and unlike the majority of N. meningitidis infection in young adults, these have been due to serogroup B. Serogroup B is not included in any US vaccine, but a new investigational serogroup B vaccine made by Novartis (4CMenB), with broad cross-immunogenicity across serogroup B strains, has been tested. With results of a European study including more than 3,600 infants, the vaccine was highly immunogenic, had acceptable reactogenicity and would be expected to provide coverage for 77% of strains across five European countries (Vesikari and colleagues). Recommended or being considered for approval in Europe, Canada and Australia, the vaccine has been considered a breakthrough in what has been to date the elusive control of serogroup B infection. It has been reported that the CDC has accepted the vaccine to be brought to the US for potential use in this outbreak.
For more information:
Vesikari T. The Lancet. 2013;9869:825-835.