Meningococcal Disease: Focus on Serogroup B
Why is serogroup B meningococcal disease of particular concern?
Serogroup B is unique because it is the most common cause of meningococcal disease in US adolescents and young adults, and until recently, there was no vaccine approved in the US to protect against it.
- Meningococcal serogroup B vaccination may be recommended by healthcare professionals for certain individuals age 16-23 years, with a preferred age of 16-18 years. Individuals in this age group are encouraged to talk with their healthcare professional about vaccination.
- Routine vaccination with meningococcal A, C, W, Y vaccines is recommended for all individuals at age 11-12 years, with a booster dose at age 16 years.
Why is there a separate vaccine to protect against serogroup B disease?
The vaccine against serogroup B was more difficult to develop because the outer coating on serogroup B bacteria behaves differently than the outer coatings on other serogroups. But scientists eventually overcame this challenge and two serogroup B vaccines are now approved for use in the US. Eventually, scientists may figure out how to combine serogroup B into the other vaccine, but for now, serogroup B vaccines are monovalent, meaning they protect only against this one serogroup.
- In addition to the permissive recommendations for serogroup B vaccination in ages 16-23 years, the vaccine is recommended for all college students on campuses experiencing serogroup B outbreaks.
What happened in the recent serogroup B meningococcal outbreaks on college campuses?
- A serogroup B outbreak began in early 2015 at the University of Oregon. To date it has sickened seven people and killed one student. The most recent case was confirmed by Oregon public health officials in late May 2015. Although university and public health officials are recommending serogroup B vaccine for all University of Oregon undergraduate students and graduate students who live in dormitories, vaccine uptake has been slow.
- Two serogroup B cases occurred at Providence College in the first week of February 2015. Both students survived and there have been no additional cases. Serogroup B immunization began very quickly on this campus, with the first campus vaccine clinic held the week of February 8.
- There was an outbreak at Princeton University that included nine cases and one death over a one year period (March 2013 to March 2014). Not all cases occurred on the Princeton campus, but all were tied to the identical serogroup B strain.
- An outbreak at the University of California, Santa Barbara (UCSB) included five cases, four of which happened within a 10-day period in November 2013. One student suffered bilateral foot amputations.
- At the time of the Princeton and UCSB outbreaks, the serogroup B vaccines had not yet been approved for use in the US which meant that the campuses needed special government approval to offer the vaccines.
- There have also been isolated serogroup B cases on other college campuses. In 2014, one undergraduate student at Georgetown University and one at San Diego State University died of serogroup B disease.
- Because it is impossible to know whether one case will be isolated or if it signals the start of an outbreak, even one case can cause considerable concern on and around campuses.
- Following any case, campus and local health officials generally identify and give preventive treatment to people who were in contact with the student, examine the bacteria isolated from the student to determine if these cases are related to any others (i.e., are part of an outbreak), and monitor closely for additional cases. Campus-wide, and often community-wide educational and awareness programs are often also put in place.
Is serogroup B disease more severe than other serogroups?
- Serogroup B meningococcal disease is of similar severity to disease caused by other serogroups. It is of greater concern because it is not included in current routine vaccine recommendations against serogroups A, C, W, and Y.
- Meningococcal disease, regardless of serogroup, is marked by rapid progression (typically hours, but occasionally days) from symptom onset to severe outcomes, even when it is treated quickly.
- The death rate from meningococcal disease, even with rapid and appropriate treatment, is 10 to 15 percent.
- Long-term complications will affect 11 to 19 percent of survivors and include hearing loss, skin scarring, brain damage, kidney failure, and limb amputations among others.
Will insurance cover vaccines against serogroup B disease?
- With a permissive (Category B) recommendation from CDC, the Vaccines for Children (VFC) program will provide serogroup B vaccines at no cost for eligible children who might not otherwise be vaccinated due to an inability to pay. Private insurers are also likely to cover serogroup B vaccines; however, it may take time for the coverage to be implemented. Check with your individual insurance provider for coverage information.