Multicomponent meningococcal B vaccination (4CMenB) of adolescents and college students in the United States.

Angelika Banzhoff

doi:10.1177/2051013616681365

Abstract

Meningococcal disease is rare, easily misdiagnosed, and potentially deadly. Diagnosis in the early stages is difficult and the disease often progresses extremely rapidly. In North America, the incidence of invasive meningococcal disease (IMD) is highest in infants and young children, with a secondary peak in adolescents, a population predominantly responsible for the carriage of disease. Neisseria meningitidis serogroup B (MenB) accounts for a large proportion of meningococcal disease in North America, with documented outbreaks in three universities in the United States (US) during 2008–2013. Vaccination is the most effective way to protect against this aggressive disease that has a narrow timeframe for diagnosis and treatment. 4CMenB is a multi-component vaccine against MenB which contains four antigenic components. We describe in detail the immunogenicity and safety profile of 4CMenB based on results from four clinical trials; the use of 4CMenB to control MenB outbreaks involving vaccination at two US colleges during outbreaks in 2013–2014; and the use of 4CMenB in a Canadian mass vaccination campaign to control the spread of MenB disease. We discuss the reasons why adolescents should be vaccinated against MenB, by examining both the peak in disease incidence and carriage. We consider whether herd protection may be attained for MenB, by discussing published models and comparing with meningitis C (MenC) vaccines. In conclusion, MenB vaccines are now available in the US for people aged 10–25 years, representing an important opportunity to reduce the incidence of IMD in the country across the whole population, and more locally to combat MenB outbreaks.

Highlights

Invasive meningococcal disease Meningococcal disease is a rare infection, with incidence of around 0.7 per 100,000 persons in Europe [European Centre for Disease Prevention and Control, 2012] and 0.14 per 100,000 persons in the United States (US) [Centers for Disease Control and Prevention, 2014]
Diagnosis in the early stages is difficult and it is misdiagnosed, partly as community physicians see few cases during their careers and partly because early symptoms are similar to that of other diseases; classical features associated with invasive meningococcal diseases (IMDs), such as hemorrhagic rash and meningism, appear relatively late during the development of illness resulting in a delay in diagnosis [Rosenstein et al 2001; Thompson et al 2006]
There are 12 serogroups and most cases of meningococcal disease globally are caused by six of them: A, B, C, W, X and Y; of these, serogroups B, C and Y are common in North America [WHO, 2015; Harrison, 2010]

Summary

Introduction

Invasive meningococcal disease Meningococcal disease is a rare infection, with incidence of around 0.7 per 100,000 persons in Europe [European Centre for Disease Prevention and Control, 2012] and 0.14 per 100,000 persons in the United States (US) [Centers for Disease Control and Prevention, 2014]. In 2015, ACIP issued a category B recommendation to vaccinate against MenB in individuals aged 16–23 years to provide short-term protection against most strains of serogroup B meningococcal disease, with a preferred vaccination age of

Results

Conclusion