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How to answer patients’ questions about ‘rare, extremely serious’ meningococcus B
CDC data show that cases of meningococcal disease caused by serogroup B in the United States is at an all-time low — only 0.11 cases per 100,000 people in 2017.
Despite the rarity of the disease, its devastating potential means it should still be discussed by primary care physicians with their teen-aged patients and their patients’ parents, according to Gary S. Marshall, MD, professor and division chief of pediatric infectious diseases at the University of Louisville School of Medicine.
“Though meningococcus B is extremely rare, it is also extremely serious. As physicians, it is our job is to tell patients and parents that the best way to prevent this potentially devastating disease is through vaccination,” he told Healio Primary Care.
Kwang Sik Kim, MD, professor and director of the pediatric infectious disease division at Johns Hopkins Children’s Center noted that though the CDC only recommends meningococcus B vaccination in patients aged 16 to 23 years and by utilizing shared- decision making, many colleges and universities require students be vaccinated against the disease before they can start attending class. In addition, a television ad campaign warns of the potential dangers from sending a child off to college without a meningococcal B vaccination
As parents prepare to send teenagers to college, they are likely to have questions about the potential for infection from meningococcal disease and the value of vaccination. Healio Primary Care discussed with Marshall and Kim questions patients and their parents might have and how PCPs can answer these queries. – by Janel Miller
Who should be vaccinated against the disease caused by meningococcus serogroup B ?
The CDC’s Advisory Committee on Immunization Practices recommends that otherwise healthy persons aged 16 through 23 years may receive the vaccine, with the preferred age range being 16 to 18. The decision whether or not to vaccinate should be based on shared clinical decision-making. There is an additional (stronger) recommendation to vaccinate all persons aged 10 years and older who are at high risk for meningococcal disease, including those who have functional or anatomic asplenia; those with persistent complement component deficiency or complement inhibitor use; microbiologists who might encounter the organism in the lab; and those at risk because of outbreaks. The Advisory Committee on Immunization Practices recently voted to recommend a booster dose for these persons 1 year after the primary series and every 2 to 3 years thereafter.
Is the meningococcal ACWY vaccine enough to protect my child from meningococcus serogroup B ?
“Meningococcal disease is a bacterial infection caused by Neisseria meningitidis. The ACWY vaccine only protects against serogroups A, C, W and Y of that bacteria and does not offer any protection against meningococcus B,” Kim told Healio Primary Care.
What should parents know about meningococcal disease in general and serogroup B in particular ?
The disease occurs year-round and is unpredictable, Marshall told Healio Primary Care.
“Teenagers are at particular risk because of their behaviors, which include close physical contact” he continued.
“Patients and parents should know that every outbreak of meningococcal disease that has occurred on a college campus since 2011 has been the serogroup B type, and that the MenACWY vaccine that children receive at 11 to 12 years12 years of age, with a booster at 16, will not protect them from B. The risk for college kids to be diagnosed with meningococcus B is about fivefold higher than in kids of the same age who are not attending college,” Marshall said.
“This is likely because you have kids from all over the country—from different, diverse backgrounds—coming together in crowded dormitories; things like attending bars and drinking and smoking also increase risk. These kids also spend a lot of time around each other, which increases the risk of transmission,” he added.
Kim provided a way for PCPs to broach the subject with patients or parents who may be vaccine hesitant.
“Tell them that by getting the vaccine — you, or your child, will have peace of mind and sleep better at night knowing you did everything possible to protect him or her from this rare but serious disease,” he said in the interview.
What are my (or my child’s ) options for receiving a meningococcal B vaccine ?
There are currently two FDA-approved injectable meningococcal vaccines for patients aged 10 to 25 years on the market, according to the FDA’s website.
Trumenba (MenB-FHbp, Pfizer) is administered in a 0.5 mL dose followed by another 0.5 mL dose at 1 to 2 months and then another 0.5 mL dose at 6 months. Or it can be administered in a 0.5 dose followed by another 0.5 mL at 6 months, according to Pfizer’s website. The choice of dosing schedule may depend on the risk for exposure to meningococcal B and the patient's susceptibility to the disease caused by meningococcal serogroup B, the company added. Bexsero (MenB-4C, GlaxoSmithKline) also comes in a 0.5 mL dose and should be administered twice, at least 1 month apart.
Marshall said even though the vaccine’s generic names and doses sound similar, the medications are not interchangeable.
“Inform your patients (or their parents) that once a patient has received one of these vaccines, switching to the other is not allowed,” he said.
The dosing regimen should be followed as closely as possible, Kim added.
“Current data indicate that administering just one dose of either vaccine is not enough,” he said in the interview.
How safe are the meningococcal B vaccines?
The most common adverse events in teenagers and young adults who received MenB-FHbp were fatigue, headache, muscle pain and pain at injection site. Nausea was reported in teenagers in early phase studies, according to Pfizer’s website.
GlaxoSmithKline’s website indicates that the most common adverse events tied to MenB-4C use were arthralgia, erythema, fatigue, headache, induration, nausea and pain at the injection site. In addition, Marshall noted that the package insert for MenB-4C indicates that the tip caps of its pre-filled syringes contain natural rubber latex that could cause allergic reactions in patients who are sensitive to this material.
Regardless of which vaccine a patient receives, there is the chance he or she will faint or fall after it is administered according to the CDC. However, these risks can be significantly mitigated by patients sitting or lying down for about 15 minutes after vaccine administration, the agency said.
Another potential hazard associated with all vaccinations is the potential for allergic reaction.
“As with all vaccines, a severe allergic reaction (for example, anaphylaxis) to a vaccine component or to a prior dose is a contraindication to further doses of that vaccine,” according to the CDC’s website.
Besides the vaccine, how else can my child avoid getting meningococcus B?
“The kinds of contact that might prevent transmission of meningococcus from one person to another cannot be avoided in daily life,” according to Marshall.
“That being said, it makes sense to practice good hygiene — not sharing eating utensils and drinking glasses, for example, and not smoking, which increases risk by breaking down the epithelial barrier in the nasopharynx. Vaccination, however, is the best protection against the disease,” he added.
How do I know if my child has meningococcus B?
Marshall said the gateway to understanding meningococcus B is understanding its symptoms.
“Common symptoms of the disease include high fever; stiff neck; severe headache that seems different than normal headaches; nausea or vomiting; confusion or difficulty concentrating; seizures; sleepiness or difficulty waking; sensitivity to light; and no appetite or thirst. The symptoms can have explosive onset, if the disease is not treated with antibiotics very early, the patient can develop serious neurodevelopmental sequelae or even succumb to the disease,” Marshall said in the interview.
“All the more reason for patients, their parents and primary care physicians have the conversations about the meningococcal serogroup B vaccine now,” he added.
References:
CDC.gov. Meningitis. https://www.cdc.gov/meningitis/bacterial.html. Accessed Aug. 5, 2019.
CDC.gov. Vaccines and preventable diseases, meningococcal vaccination: What everyone should know. https://www.cdc.gov/vaccines/vpd/mening/public/index.html. Accessed July 26, 2019.
FDA.gov. Highlights of prescribing information: Bexsero. https://www.fda.gov/files/vaccines,%20blood%20&%20biologics/published/Package-Insert---BEXSERO.pdf. Accessed July 26, 2019.
GSKpro.com. Bexsero. https://gskpro.com/en-us/products/bexsero/. Accessed July 26, 2019.
Immunize.org. Ask the experts: Meningococcal B. http://www.immunize.org/askexperts/experts_meningococcal_b.asp. Accessed July 30, 2019.
MayoClinic.org. Diagnosis and treatment. https://www.mayoclinic.org/diseases-conditions/meningitis/diagnosis-treatment/drc-20350514. Accessed July 26, 2019.
MayoClinic.org. Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/meningitis/symptoms-causes/syc-20350508. Accessed July 26, 2019.
Patton ME, et al. MMWR. 66(19);509-513.
Pfizermedicalinformation.com. Trumenba. (Meningococcal group B vaccine.) Dosage and administration.
https://www.pfizermedicalinformation.com/en-us/trumenba/dosage-admin. Accessed July 26, 2019.
Soeters HM, et al. Emerg Infect Dis. 2019;doi:10.3201/eid2503.181574/.
Vetola CL. PT. 41(7);426-436.
Disclosures: Marshall reports numerous ties to the pharmaceutical industry. Kim reports no relevant financial disclosures.