Invasive Meningococcal Disease: Vaccine Updates

This transcript has been edited for clarity. Hello. I'm Dr Lee Harrison, an infectious diseases physician and professor of medicine and epidemiology at the University of Pittsburgh. I'll be speaking with you today about various current topics in invasive meningococcal disease, or IMD.IMD is, fortunately, rare. We have around 500 cases per year in the US. We used to have up to 5000 cases per year, but we have seen major spontaneous declines as well as the impact of vaccination.In addition to endemic disease, we've had numerous recent IMD outbreaks in the US, both in the community and on college campuses. Despite its rarity, it's one of the few infections in the US that can still kill an otherwise healthy adolescent in just a few hours. Even with treatment, there's a roughly 12% case fatality rate. We see frequent sequelae in about 20% of survivors, and those sequelae include hearing loss, limb amputation, among others.There are a multitude of vaccines for prevention of meningococcal disease falling into two basic types: vaccines against serogroups ACWY, and we also have separate protein-based vaccines against serogroup B. For many years, the US approach has been fairly straightforward: MenACWY at 11-12 years old with a booster at 16 years. This is a universal recommendation, meaning that all adolescents without a contraindication should receive one of these vaccines.More recently, we've seen introduction of MenB vaccines which are recommended at 16-23 years of age, with a preference for ages 16-18. This is a very different kind of recommendation based on shared clinical decision-making. Basically this means the patient and/or parent discuss the disease and the vaccines with their physician to decide whether to get vaccinated.The problem with shared clinical decision-making recommendations is that, in general, they lead to much lower immunization rates, meaning that fewer individuals are protected. There are also recommendations for high-risk patients. Very recently, we have had introduction of pentavalent vaccines that combine MenACWY and MenB components. The current recommendation from the Advisory Committee on Immunization Practices (ACIP) is to use the pentavalent vaccine when both components are indicated at the same visit.Given the recent introduction of pentavalent vaccines and more experience with MenB vaccines, ACIP had decided to revisit the meningococcal vaccine schedule, but this has been postponed by recent events. The problem right now is that the federal vaccine policy is in flux and long-standing, science-based ACIP processes have been upended. The new federal framework has attempted to shift meningococcal vaccination toward a risk-based and shared clinical decision-making recommendation which is problematic as it will likely lead to lower vaccine uptake.Executive orders, changes to ACIP, and court rulings have understandably created confusion for physicians and families. So what do I tell providers until this gets sorted out?Don't lose sight of why we vaccinate. IMD is serious. It can kill and create serious sequelae. Adolescents and young adults remain an important risk group and the shared clinical decision-making recommendation for MenB does not mean "do not vaccinate." The bottom line is to make sure you have the discussion with your patients and their parents.To conclude, there are three important points for providers. IMD is very serious, so think of it early and treat it immediately. Make sure that close contacts get appropriate chemoprophylaxis, and know whether ciprofloxacin resistance is an issue locally (your health department can help).And finally, the science and epidemiology haven't suddenly changed because of recent changes at the federal level. We still have a responsibility to protect our patients even during this period of upheaval. I'm Lee Harrison with the University of Pittsburgh, and thank you for joining.