Recommendations for Serogroup B Meningococcal Vaccine for Persons 10 Years and Older

Abstract

This policy statement provides recommendations for the prevention of serogroup B meningococcal disease through the use of 2 newly licensed serogroup B meningococcal vaccines: MenB-FHbp (Trumenba; Wyeth Pharmaceuticals, a subsidiary of Pfizer, Philadelphia, PA) and MenB-4C (Bexsero; Novartis Vaccines, Siena, Italy). Both vaccines are approved for use in persons 10 through 25 years of age. MenB-FHbp is licensed as a 2- or 3-dose series, and MenB-4C is licensed as a 2-dose series for all groups. Either vaccine is recommended for routine use in persons 10 years and older who are at increased risk of serogroup B meningococcal disease (category A recommendation). Persons at increased risk of meningococcal serogroup B disease include the following: (1) persons with persistent complement component diseases, including inherited or chronic deficiencies in C3, C5–C9, properdin, factor D, or factor H or persons receiving eculizumab (Soliris; Alexion Pharmaceuticals, Cheshire, CT), a monoclonal antibody that acts as a terminal complement inhibitor by binding C5 and inhibiting cleavage of C5 to C5A; (2) persons with anatomic or functional asplenia, including sickle cell disease; and (3) healthy persons at increased risk because of a serogroup B meningococcal disease outbreak. Both serogroup B meningococcal vaccines have been shown to be safe and immunogenic and are licensed by the US Food and Drug Administration for individuals between the ages of 10 and 25 years. On the basis of epidemiologic and antibody persistence data, the American Academy of Pediatrics agrees with the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention that either vaccine may be administered to healthy adolescents and young adults 16 through 23 years of age (preferred ages are 16 through 18 years) to provide short-term protection against most strains of serogroup B meningococcal disease (category B recommendation).

Knowledge and Attitudes Regarding Category B ACIP Recommendations Among Primary Care Providers for Children

“…15 It suggested that Category B recommendations should be considered in the context of a clinician-patient interaction and that discussion include the balance between desirable (benefits, savings) and undesirable effects (harms, costs) of the vaccine in question. Although the AAP’s Committee on Infectious Diseases 16 has more directly addressed how to discuss the MenB vaccine specifically, additional guidance about how to communicate with patients and families about Category B recommendations in general is lacking.…”

Contribution of factor H-Binding protein sequence to the cross-reactivity of meningococcal native outer membrane vesicle vaccines with over-expressed fHbp variant group 1

“…Antibodies directed against fHbp are bactericidal, and can both activate the complement cascade, and block the recruitment of fH by bacteria [5, 6, 9–13]. fHbp is included in licensed protein-based vaccines against group B meningococcus [14, 15]. …”

Vaccinations in pediatric kidney transplant recipients

“…In general, this consists of one dose of MenACWY (for protection against serogroups A, C, W, and Y) at age 11 with a booster dose at age 16 [49]. Serogroup B meningococcal vaccine (MenB) can be considered starting at age 16, especially during outbreaks and for students living in residency halls [50]. There is very little information on the immunogenicity of meningococcal vaccines in SOT recipients.…”

“…High-risk children older than 10 years should additionally receive MenB [54]. Patients receiving eculizumab should receive both MenACWY and MenB at the initiation of treatment [50]. KT candidates and recipients who are at high risk of invasive meningococcal infections should receive boosters of MenACWY every 5 years [53].…”