Debating the benefits and risks of vaccination against meningococcal disease
Although many pediatricians in the U.S. recommend vaccinating against serogroup B meningococcal disease to the parents of their patients, questions of efficacy, safety and cost-effectiveness have led to hesitance among a significant minority of clinicians.
Michael T. Brady, MD, professor of pediatrics at The Ohio State University and associate medical director at Nationwide Children’s Hospital, used meningococcal disease to show the value of vaccination during a presentation at the 2016 Infectious Diseases in Children Symposium in New York City.
There have been several highly publicized outbreaks of meningococcal disease on college campuses since 2009, including 41 cases and three deaths. Approximately 40% to 70% of the serogroup B cases occur in the 18 to 23 age group. Each year there are about 40 to 50 cases of meningococcal serogroup B in adolescents and young adults aged between 16 and 23 years, according to Brady.
“If you were to start a cohort at 11 or 12 years and gave them booster at 16 years, you would prevent a total of 40 cases per year and 40 deaths,” he said. “If you started at 16, you would prevent 27 cases and 3 deaths. At 18 years, 28 cases prevented and three deaths, and in college cases only there would be 10 cases per year and one death. You can see there is a huge magnitude of difference in the risk of benefit in the vaccines.”
However, according to Mark H. Sawyer, MD, professor of clinical pediatrics at University of California San Diego School of Medicine and Rady Children’s Hospital San Diego, this approach could prove unsafe, particularly in the younger age groups, as there are two meningococcal vaccines, the meningococcal ACWY and MenB vaccine. These vaccines are made with live components of the outer RNA membrane protein, and experts do not have sufficient information on the correlates of protection to outer membrane proteins and which strains of meningitis the vaccine will protect the immune system against.
“[This recommendation] of [meningococcal serotype B (MenB)] may be administered to adolescents and young adults 16 through 23 years of age to provide short-term protection against most strains of serogroup B meningococcal diseases — you don’t know which strain the vaccine will prevent a child from,” he said during the presentation. “Both these vaccines are meant to be routine but only protect children from four out of five serotypes; it’s difficult to tell parents and your staff that the vaccine only yields protection against certain strains but not others.”
This gap in protection contributes to doubts about the value and cost effectiveness of vaccination, Sawyer said.
“Quarantining a college outbreak [of MenB] is very challenging,” he said. “We don’t even know if the vaccine is going to cover the strain, it is very expensive and we don’t know how long the outbreak will last.”
The only problem with the MenB vaccine is insurance companies may or may not pay for it, but there is not an issue requesting and receiving doses from a safety standpoint, Brady said.
“A question these manufacturers have to ask themselves is ‘Will insurance companies pay for it?’” he said. – by Kate Sherrer
Brady MT and Sawyer MH. “When recommendations to use vaccines aren’t black and white: how does the pediatrician deal with it?” Presented at: IDC NY; Nov. 19-20, 2016; New York.
Disclosure: Brady reports receiving royalties from Up-to-Date chapter on HHV-6. Sawyer reports no relevant financial disclosures.