Are Physicians Confused About MenB Vaccinations?

According to a new study, a majority of 660 physicians are not discussing meningococcal serogroup B  (MenB) vaccine during routine 16- to 18-year-old visits.

This study’s findings indicate that approximately 50 percent of pediatricians and 33 percent of family physicians report often or always initiating a discussion about the MenB vaccine for 16- to 18-year-olds.

A leading issue associated with not recommending the MenB vaccine by these physicians was the fact that the MenB vaccines, Bexsero and Trumenba, were given a Category B, as opposed to a Category A, recommendation by the Centers for Disease Control and Prevention (CDC).

Additionally, this study found significant knowledge gaps exist regarding the MenB disease and the MenB vaccine, which appears to be a major driver of physician decisions not to discuss the vaccine with patients.

This study was conducted between October and December of 2016 among pediatricians and family physicians (FPs).

This study found many physicians, especially FPs, responded “I don’t know” to questions about factors influencing their likelihood of recommending the MenB vaccine.

The most commonly reported issues that were associated with a higher likelihood of recommending were:

• the fact that MenB outbreaks had occurred,
• the incidence of the MenB disease,
• the effectiveness and safety of the MenB vaccine,
• the duration of protection of the MenB vaccine.
• The existence of a recommendation for another meningococcal vaccine (MenACWY)
• the consistency of reimbursement was related to a lower likelihood of recommendation.

Meningococcal disease is a bacterial infection caused by Neisseria meningitidis.

Meningococcal disease usually presents clinically as meningitis (about 50% of cases), bacteremia (38% of cases), or bacteremic pneumonia (9% of cases). N. meningitidis colonizes mucosal surfaces of the nasopharynx and is transmitted through direct contact with large-droplet respiratory tract secretions from patients or asymptomatic carriers.

Some 800–1,200 people contract a meningococcal disease in the U.S. each year, a historic low, according to the National Meningitis Association. 

The fatality rate for this type-B strain is up to 15 percent even when treated, and many infected people are left with disabilities such as brain damage or need to have limbs amputated.

In 2015, 2 MenB vaccines, Bexsero and Trumenba, were licensed by the US Food and Drug Administration for persons between 10 years through 25 years of age through an accelerated approval process.

The CDC’s Advisory Committee on Immunizations Practices (ACIP) recommended MenB vaccines for adolescents and young adults not at increased risk for meningococcal B disease using a new recommendation designation, Category B, defined as a recommendation for individual clinical decision-making.

However, the incidence of MenB disease has declined by more than 90 percent in the past 2 decades and the effectiveness and long-term safety of the MenB vaccines have not yet been established.

These factors should have actually diminished the likelihood for providing a strong recommendation for MenB vaccines.

Physicians were also more likely to discuss and recommend the MenB vaccines for those entering college.

This occurred despite the fact that there was no data at the time of this survey to support an increased risk of meningococcal B disease in college students.

But, there have been recent college-based, MenB outbreaks.

On November 30th, 2017, health officials confirmed two UMass Amherst cases as meningococcal disease, since they originated from a single strain of genetically identical organisms.

This means the UMass Amherst situation was considered a meningococcal disease outbreak.

‘It’s important to recognize factors such as location when determining what vaccines you may need.  Just as countries may have different vaccine recommendations, within the same country certain areas may see a higher incidence of vaccine-preventable illness,” said Lauren Ragen, PharmD, Clinical Pharmacist, MTM and Immunization Specialist for Brookshire Grocery Company.  

“Discuss with your doctor or pharmacist the new Meningitis B vaccines to determine if you are high risk and would benefit from immunization,” recommends Ragan.

For the best protection, more than 1 dose of a serogroup B meningococcal vaccine is needed.

The same type of vaccine must be used for all doses.

Most pharmacies in the USA offer vaccination services.

Vaccine prices vary and can be researched at this CDC site.

To research vaccine discounts, please visit this page.

The opinions expressed in these study commentaries are those of the author and not necessarily those of the American Academy of Pediatrics or its Committees. There was not external study funding, and the author has indicated he has no potential conflicts of interest to disclose.