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New Recommendation for Meningococcal Type B Immunization

By Dr. Arthur Lavin

The January 2019 issue of Pediatrics offers two important updates on the prevention of diseases caused by the germ called the meningococcus, Type B, or the Men B germ.

In prior posts on the question of whether we recommend all adolescents receive immunization against Men B, we reported that the CDC committee charged with devising these recommendations decided against recommending all adolescents receive this vaccine for two reasons- the vaccines on the market did not yet meet their threshold for working well enough, or even being safe enough.

Now comes this report from Pediatrics.  http://pediatrics.aappublications.org/content/143/1/e20182130

What is Men B, what diseases does it cause?

Men B is one of 5 types of the germ called Neisseria meningitidis, a group of germs whose nickname is the meningococcus.   The word meningococcus comes from two words: meninges which is the sac in which the brain and spinal cord float, and coccus, which means round ball.  It has this name because all the meningococcus germs, the meningococci, can cause infections of the meninges called meningitis, and because they have the shape of round balls.

The meningococci, as noted, can cause a very serious infection of the brain and spinal cord called meningitis, but also can cause overwhelming infections of the bloodstream called sepsis.

Both these infections are quite deadly, and come on very rapidly.

Notice that we mentioned there were 5 types of the meningococcus, they are known as Groups A, C, Y, W-135, and B.  Each Group is immunized against only be an immunization against that group.  So a shot to protect against Men A will not protect against Men C.  For many years a vaccine that protected against 4 of these Types has been used, called Menactra, and protected against A, C, Y, and W-135, but not B.

As a result, the proportion of meningococcal infections caused by Men B has gone up, as people get immunized for A, C, Y, and W-135.

What does the new study on Men B show?

The new study shows that the chance of getting meningococcal infections from Men B is rising.  It remains rare, in the entire United States, all types of meningococcal infection totaled 166 cases in people 18-24 years old, that includes all five Groups.  But that number is higher than it has been.

In a commentary on the article, evidence that the Men B vaccines are much more effective and now are safer was presented and a standard for giving all adolescents the Men B vaccine after they turn 16 was proposed.

Our New Recommendation

Now that the Men B vaccine is working well and safer, and given that the chance of getting a Men B infection in college is on the rise, we are issuing a new recommendation:

All adolescents in 11th grade should receive the Men B vaccine.  It is called Bexsero and it is a 2 shot course, with the second shot given 1 or more months after the first.

Given with the Menactra vaccine, now all adolescents can enter college protected against all 5 Groups of the dangerous meningococcus germ.

BOTTOM LINES

  1. There is  a group of bacteria called the meningococci that cause very serious and deadly infections, such as sepsis and meningitis.  The meningococci exist in 5 Groups called A, C, Y, W-135, and B.
  2. Some years ago a vaccine to prevent infection from 4 of these Groups, namely, A, C, Y, W-135, was adopted for universal use, and has been given to all who agree to receive it here at Advanced Pediatrics, under the brand name Menactra.  That left Men B out and not protected against.
  3. When the Men B vaccine was first released for use, the CDC decided it was effective and safe enough to approve for use, but not enough to recommend universal use.  We decided against recommending it until it was proven to be more effective and safe.
  4. In January, 2019, it was reported that the chance of getting a Men B infection was rising in college and that the Men B vaccine is indeed more effective.
  5. THEREFORE, we are now recommending that all youth in 11th grade receive the Men B vaccine, Bexsero, which involves a 2 shot series, with the second given 1 or more months after the first.

 

The infections from the meningococcal bacteria are dangerous, we have been pleased to prevent those caused by 4 of the 5 groups, and now that the need has increased and the efficacy is better, we are pleased to make the Men B vaccine a routine recommendation now as well.

To your health,
Dr. Arthur Lavin

 

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