August 11, 2016

A parent's guide to the MenB vaccine

Maybe you've been hearing about the new "MenB' vaccines — these are vaccines targeted against certain types of bacteria that can cause meningitis.

The recommendations for this new vaccine can be a little confusing, so here's a primer on what the MenB vaccines protect against, who should be getting them, and how to talk to your provider to make a decision about whether or not you or your teenager should get the MenB vaccine.

What does this vaccine protect against?

Meningococcal disease is an illness caused by group of bacteria called Neisseria meningitidis, sometimes referred to as "meningococcus."  Many people carry these bacteria in their noses, and they occasionally can invade to cause a variety of illnesses, such as infection of the blood stream, which can lead to meningitis (inflammation and infection of the lining of the brain and spinal cord). Neisseria meningitidis is most infamous for causing outbreaks in college dormitories, or any place where multiple young people live in crowded living quarters. The organism is spread from person to person, and adolescent behavior like sharing makeup or eating utensils, or crowded living quarters such as dormitories are known for spreading the bacteria more easily.

Bacterial meningitis is a very dangerous condition: meningococcal infections kill 10-15 infected people out of every 100. Ten to 20% of those who survive have significant disabilities. Thanks to current immunization programs, there are less than 1,000 cases each year in the U.S. There are multiple versions (or serogroups) of the bacteria Neisseria meningitidis — at least 12. Serogroups A, B, C, W, and Y cause most meningococcal disease.  Menactra and Menveo are meningococcal conjugate vaccines (commonly abbreviated as MCV4) that protect against Neisseria meningitidis serotypes A, C, Y and W, which typically account for about 70% of all invasive meningococcal infections. A dose of one of these is routinely recommended for all 11-12-year-olds for this reason.

Since protection from this vaccine tends to wane over the period of a few years, a booster dose is recommended at age 16 years so teens can continue being protected during high-risk periods (aka, going off to dormitory living). These vaccines have done their jobs reasonably well — we have seen decreasing rates of meningococcal disease from these serogroups. As the incidence of disease caused by serotypes A, C, Y, and W decrease, we've seen a relative increase in disease caused by Serotype B. Serotype B, as you may recall, is not prevented by MVC4. This is where the new meningococcal B vaccines come in.

MenB vaccines protect against Neisseria meningitidis Serotype B. There are two different ones currently available, called Trumenba and Bexsero. Both are administered in a two-dose series, though Trumenba requires a third dose during outbreaks. As with any vaccine or medication, there are side effects that can occur with the MenB vaccine. The most common are soreness, redness, or swelling at the injection site, fatigue, headache, muscle or joint pain, or fever and chills. Symptoms are usually mild and go away on their own within three to seven days.

Overall, meningococcal disease and meningitis caused by serotype B Neisseria meningitidis is still very rare. However, over the past several years there have been several outbreaks reported, especially at college campuses. Santa Clara University, the University of Oregon, Providence College, Princeton University, and the University of California at Santa Barbara have all had outbreaks since 2013.

So, to recap: there are multiple serotypes of Neisseria meningitidis, which can cause serious infections. These infections tend to be somewhat more common in teenagers. The MVC4 vaccines are routinely recommended at ages 11-12 with a booster at age 16, and protect against four of these serotypes. The new MenB vaccines protect against serotype B.

Who should get the MenB vaccine?

There are a few easy answers: the MenB vaccine is definitely recommended for people with certain conditions that put them at higher risk for such infections. These include:

  • People with certain immune deficiencies, including complement deficiencies, people taking eculizumab (Soliris), and people with anatomic or functional asplenia (including sickle cell disease)

  • Microbiologists routinely exposed to Neisseria meningitis

  • People who are at risk because of an outbreak of serogroup B meningococcal disease (ie, a college student at the site of a known outbreak)

There is also a large group of healthy people who could benefit from vaccination, even though the disease is relatively rare. The Advisory Committee on Immunization Practices, is a group of medical and public health experts that develop recommendations on the use of vaccines in the United States. These recommendations are then passed to the Secretary of Health and Human Services and implemented by the Centers for Disease Control. They recommend that all persons age 16-23 be offered the opportunity to be vaccinated. However, the preferred age for vaccination is age 16-18, especially for kids who will be going off to college or any form of dormitory living. This recommendation for MenB vaccine is called a "category" recommendation — essentially, there is evidence that the vaccine is protective and may be beneficial, but the evidence isn't yet there to support it being cost-effective enough to routinely give to every teenager. Part of this is because it is still unclear how long the protection lasts after administration of the vaccine. 

Providers are suggested to discuss the vaccine with all their teenage patients based on their clinical judgment and experience. In other words, everyone (both patients and providers) should be aware that this vaccine is available, and make decisions for receiving the vaccine based on their own experiences and beliefs. As a result, there is no universal recommendation for everyone to get the vaccine.

UW Health has made the vaccine available in all clinics that care for adolescents and young adults. It should be discussed with all people at high risk for infection, all patients ages 16-18, and also considered for other individuals up to age 23 years. Like all other childhood and adolescent vaccines, these are covered by the Vaccines for Children Program, and all insurers. If you think your child might benefit from the MenB vaccine, or just want more information, talk to your provider.