MenB May Linger on Campus After an Outbreak

Meningococcal serogroup B under-vaccinations limit herd immunity protection

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According to a new study, when dealing with university-based meningococcal serogroup B  (MenB) outbreaks, it is difficult to predict if or when additional cases may occur. 

In some MenB ‘outbreaks’ on campuses, cases occurred over a prolonged period of time. 

According to this 10-campus study, outbreaks ranged from 0 to 376 days in duration. 

And, additional MenB cases occurred mainly among unvaccinated students. 

This study highlights the importance of MenB vaccination since 10 to 15 percent of meningitis B patients ultimately die from an infection. 

This study’s authors identify under-vaccinations as a cause of not developing ‘herd protection’ following an outbreak. 

‘Decisions about whether, when, and how to offer a MenB vaccine during an outbreak remain challenging and should be tailored to the unique epidemiology of each outbreak.’ 

‘At the same time as vaccination discussions begin, appropriate chemoprophylaxis, enhanced case detection, and communication efforts should be promptly initiated.’ 

‘Efforts are underway to better understand MenB vaccine effectiveness and duration of protection, MenB vaccine strain coverage, and current risk factors for meningococcal disease among university students.'

‘This information, along with lessons learned when implementing MenB vaccination campaigns, could help guide and improve university responses to future outbreaks.’ 

These researchers said ‘it is difficult to determine whether university-based outbreaks have increased in frequency in recent years, as reporting of outbreaks to CDC has historically been incomplete and disease surveillance began collecting data only in 2015.' 

The good news is outbreaks of meningococcal disease are rare in the United States. In fact, only about 2 to 3 out of every 100 cases are related to outbreaks, says the CDC. 

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Meningococcal disease is found worldwide, with the highest incidence of disease found in the ‘meningitis belt’ of sub-Saharan Africa. In this region, major epidemics occur every 5 to 12 years with attack rates reaching 1,000 cases per 100,000 population. 

In the meningitis belt, serogroup A has historically accounted for 90% of meningococcal disease cases and the majority of large-scale epidemics. 

Separately, a January 2019 analysis confirmed long-standing fears about meningitis B outbreaks at a university. 

These investigators found that students who were aged between 18 to 24 were 3.5 times more likely to contract MenB than their peers who were not attending college. 

This is important news since ‘one-third of meningitis infections occur among young Americans aged 16 to 23’, says the Centers for Disease Control and Prevention (CDC). 

The CDC reported during 2016, there was a total of about 370 cases of all forms of meningococcal disease across all age groups in the United States. 

Two serogroup B meningococcal vaccines — Bexsero® and Trumenba® — have been licensed by the US Food and Drug Administration. 

MenB vaccines can help prevent meningococcal disease caused by serogroup B. Other meningococcal vaccines are recommended to help protect against serogroups A, C, W, and Y. 

These vaccines are recommended routinely for people 10 years or older who are at increased risk for serogroup B meningococcal infections. 

All 10 universities in this study used MenB-FHbp and 7 or MenB-4C vaccines.

Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia. No conflicts of interest were reported.