First Use of a Serogroup B Meningococcal Vaccine in the US in Response to a University Outbreak

Abstract

Background In 2013–2014, an outbreak of serogroup B meningococcal disease occurred among persons linked to a New Jersey university (University A). In the absence of a licensed serogroup B meningococcal (MenB) vaccine in the US, the Food and Drug Administration authorized use of an investigational MenB vaccine to control the outbreak. An investigation of the outbreak and response was undertaken to determine the population at risk and assess vaccination coverage. Methods The epidemiologic investigation relied on compilation and review of case and population data, laboratory typing of meningococcal isolates, and unstructured interviews with university staff. Vaccination coverage data were collected during the vaccination campaign held under an expanded access Investigational New Drug protocol. Results Between March 25, 2013 and March 10, 2014, 9 cases of serogroup B meningococcal disease occurred in persons linked to University A. Laboratory typing results were identical for all 8 isolates available. Through May 14, 2014, 89.1% coverage with the two-dose vaccination series was achieved in the target population. From the initiation of MenB vaccination through February 1, 2015, no additional cases of serogroup B meningococcal disease occurred in University A students. However, the 9th case occurred in March 2014 in an unvaccinated close contact of University A students. Conclusions No serogroup B meningococcal disease cases occurred in persons who received 1 or more doses of 4CMenB vaccine, suggesting 4CMenB may have protected vaccinated individuals from disease. However, the 9th case demonstrates that carriage of serogroup B Nesisseria meningitidis among vaccinated persons was not eliminated.

The Global Meningococcal Initiative: global epidemiology, the impact of vaccines on meningococcal disease and the importance of herd protection

“…Subcapsular MenB vaccines are now available and have been used effectively in outbreak control [101,102,110], and are also now included in routine infant vaccination recommendations in the United Kingdom. To evaluate the level of coverage provided by these vaccines, such as in an outbreak situation, accurate data on presence and expression of the various vaccine-related antigens in the active strain are required.…”

“…Vaccination uptake rates of 97% (first dose) and 92% (second dose) were achieved. Carriage was not formally assessed, but the occurrence of a ninth case in an unvaccinated Princeton student who had close contact with vaccinated undergraduates implies that the strain continued to circulate after vaccination [102,103]. Since September 2015, Bexsero has been introduced into the United Kingdom's routine infant immunization strategy [63] and enhanced surveillance -that includes genotyping and MATS -is ongoing as part of this program [104].…”

“…In one area in Quebec, MenB MD incidence reached >3.5/100,000 in the period 2006-2012, and a decision was taken to use Bexsero ® based on several strands of evidence, including phenotyping and genotyping of strains. More than 50,000 people between the ages of 2 months and 20 years were vaccinated on a two-dose schedule [102]. The vaccine uptake rate for one dose was 82%, but this went down to 70% for at least two doses, mainly due to low uptake in older adolescents and young adults [102].…”

“…More than 50,000 people between the ages of 2 months and 20 years were vaccinated on a two-dose schedule [102]. The vaccine uptake rate for one dose was 82%, but this went down to 70% for at least two doses, mainly due to low uptake in older adolescents and young adults [102]. Based on a modeling analysis, it was estimated that the vaccination campaign reduced disease incidence by 77% [110].…”

Comparison of Phenotypic and Genotypic Approaches to Capsule Typing of Neisseria meningitidis by Use of Invasive and Carriage Isolate Collections

“…The overall incidence rates in Canada (2011 data) and Europe (2012 data) were 0.55 cases/100,000 population and 0.68 cases/100,000 population, respectively (15,16). In outbreak and epidemic settings, the case rates are considerably higher, i.e., 100 cases/100,000 population to 1,000 cases/100,000 population (17,18).…”