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Princeton University to immunize students with meningitis B vaccine licensed in Europe, Australia
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Pending final CDC approval, Princeton University plans to recommend immunization for all students with a serogroup B meningococcal vaccine currently approved for use outside the United States, according to a statement from the university.
Barbara Reynolds, PhD, director of the CDC’s division of public affairs, told Infectious Disease News that the CDC is in the process of making final immunization recommendations to the university.
In response to the meningococcal serogroup B outbreak that began in March, university official said they expect to make the first of the two-dose series of the vaccine (4CMenB; Bexsero, Novartis) available in early December. The second dose should be available in February, according to the statement.
The university said it will cover the cost of the vaccine for all students who receive it. Students younger than 18 years will need a signed consent form from their parent or guardian before receiving the vaccine.
The CDC is expected to recommend that all Princeton University undergraduate students receive the vaccine. This includes students who live in dormitories and off campus, and graduate students who live in dormitories, as well as members of the university community who have functional and anatomic asplenia (including sickle cell disease) and late complement component deficiencies.
The vaccine would be made available only to these groups, and it would not be administered anywhere else.
As of Nov. 14, there have been seven cases of invasive meningococcal disease among six students and one visitor to the campus. The last case was reported 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.
Per the New Jersey Immunization of Pupils in School law, all students born on or after Jan. 1, 1997, who are aged at least 11 years 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 4-year institution and who reside in a campus dormitory, as per higher education immunization regulations. — Cassandra A. Richards
Perspective
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Paul A. Offit, MD
An outbreak of meningococcal disease is defined as three or more cases in one location during one period of time. Princeton University just reported its seventh case, a major outbreak. All of the cases were caused by meningococcal serogroup B, a strain not contained in any of the three conjugate meningococcal vaccines currently licensed in the United States.
The problem with making an effective serogroup B vaccine is that the capsular polysaccharide of serogroup B mimics a neural cell adhesion molecule. As a consequence, the B polysaccharide is in part recognized as “self,” and therefore poorly immunogenic. To make a serogroup B vaccine, manufacturers have used meningococcal outer membrane proteins, such as the factor H binding protein, porins, and Neisseria cell adhesion and heparin-binding proteins. One such serogroup B vaccine, Bexsero (Novartis), licensed in Europe and Australia, is now being used to help stop the spread of the outbreak at Princeton University.
Given that serogroup B meningococcal infections are the most common meningococcal type infecting young children, and an important cause of disease in adolescents, it will be of value to have this vaccine licensed in the United States.
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