Shared clinical decision making important for MenB vaccines

Abstract

CDC's Advisory Committee on Immunization Practices (ACIP) has published its 2020 recommendations for meningococcal vaccination, which cover use of the three quadrivalent conjugate vaccines—meningococcal serotypes A, C, W, and Y (MenACWY)—and two available meningococcal serogroup B (MenB) vaccines. The recommendations call on shared clinical decision making for the MenB vaccine for adolescents and young adults ages 16 to 23 years and highlight the importance of these vaccines for patients at increased risk. Shared clinical decision making allows providers and patients an opportunity to discuss the risks of infection and the benefits of vaccination suitable to each individual's needs. For the MenB vaccines, ACIP recommends a shared clinical decision making approach for those ages 16 to 23 years, with considerations given to the serious nature of meningococcal infections; the increased risk among college students, especially first-year students attending a 4-year university; and the protection provided by the MenB vaccines against most strains of serogroup B Neisseria meningitidis. “Pharmacists are in a unique position to have a shared clinical decision conversation with patients about the risks of serogroup B meningococcal disease,” said Adam C. Welch, PharmD, MBA, FAPhA, associate professor of pharmacy practice at East Tennessee State University Bill Gatton College of Pharmacy. “Pharmacists can use the strong relationships they have with their patients to inform MenB shared clinical decision making. They’ll know if someone's son or daughter is joining a fraternity or sorority and therefore will be at higher risk.” Shared decision making in health care is not a new concept. The Agency for Healthcare Research and Quality (AHRQ) developed The SHARE Approach: Essential Steps of Shared Decisionmaking, which can be applied to vaccinations. This tool outlines five steps health professionals can take to ensure that they are using shared decision making effectively with patients during clinical encounters (see sidebar at right). If patients decide to receive the MenB vaccination series, clinicians should be aware that two vaccines are available: MenB-FHbp (Trumenba—Pfizer) and MenB-4C (Bexsero—GlaxoSmithKline). Each requires two doses to be given at different times. The MenB-FHbp is given at 0 and 6 months, and the MenB-4C is given as two doses at least 1 month apart or longer. The preferred age for vaccination is between 16 and 18 years, and it is important to note that the MenB-FHbp and MenB-4C are not interchangeable. ACIP also recommends the use of MenB vaccines for patients ages 10 years or older who are at increased risk for MenB disease. These patients include those who have persistent complement component deficiencies, those receiving a complement inhibitor, those who have anatomic or functional asplenia, microbiologists routinely exposed to isolates of N. meningitidis, and those at high risk because of an outbreak. Both MenB vaccines are FDA approved for use in patients ages 10 years to 25 years. The ACIP recommendations also cover the appropriate use of MenACWY vaccination, with routine vaccination recommended for adolescents at age 11 or 12 years and a booster at age 16. In addition, routine vaccination is recommended for patients ages 2 months or older who are at increased risk for meningococcal disease. Three quadrivalent meningococcal conjugate vaccines are FDA-approved: MenACWY-D (Menactra—SanofiPasteur), MenACWY-CRM (Menveo—GlaxoSmithKline), and MenACWY-TT (MenQuadfi—Sanofi Pasteur). The three MenACWY vaccines are interchangeable, but use of the same vaccine is recommended (not required) for all doses. The SHARE Approach: Essential Steps of Shared Decisionmaking▪Step 1: Seek your patient's participation.▪Step 2: Help your patient explore and compare treatment options.▪Step 3: Assess your patient's values and preferences.▪Step 4: Reach a decision with your patient.▪Step 5: Evaluate your patient's decision. The SHARE Approach: Essential Steps of Shared Decisionmaking ▪Step 1: Seek your patient's participation.▪Step 2: Help your patient explore and compare treatment options.▪Step 3: Assess your patient's values and preferences.▪Step 4: Reach a decision with your patient.▪Step 5: Evaluate your patient's decision. “It is important to maintain complete documentation, preferably in an immunization information system [like a registry], as many of the meningococcal vaccines have timing considerations with other vaccines such as DTaP and PCV13 [pneumococcal 13-valent conjugate vaccine],” said Welch. He also noted that special care should be taken in documenting which MenB vaccine was administered, as the two formulations are not interchangeable.