The threat of Meningitis B and how one Minnesota hospital is ensuring HCPs and patients understand the importance of vaccination

Meningococcal meningitis is a type of meningococcal disease.1 Meningococcal disease is a very serious, contagious infection caused by the bacteria Neisseria meningitidis (N. meningitidis)—also known as meningococcus.2

Meningococcal meningitis is a rare but potentially life-threatening disease that leads to inflammation of the protective membranes ("meninges") that surround the brain and spinal cord.3 Meningococcal infection can also lead to septicemia, also referred to as blood poisoning.4

Symptoms can be rapid and may include: sudden fever, headache and a stiff neck.5 Additional meningococcal meningitis and blood infection symptoms may include nausea, vomiting, sensitivity to light, confusion, cold hands and feet, abnormal skin color, difficulty breathing and a rash (typically dark purple spots on the torso, arms, or legs).6,7

Early symptoms may appear mild—similar to those of a cold or the flu—but can progress quickly and can be fatal, sometimes within 24 hours.8 About one in 10 people infected with meningococcal disease will die, while one in five survivors will suffer long-term consequences, including deafness, nervous system problems, brain damage or loss of limbs.9

Everyday behaviors can increase the risk of getting meningococcal meningitis, especially for teens and young adults, including kissing, coughing/sneezing, living in close quarters, sharing drinks and eating utensils, smoking and secondhand smoke.

According to the CDC, the majority of cases in the U.S. involve serogroup B, C, or Y.10 Combination meningitis A, C, W, and Y vaccines have been available since the 1980s, but Meningitis B vaccines have only been available in the U.S. since late 2014.

Awareness of the two different meningococcal vaccines (the ACWY and the B vaccines) remains low. In the U.S., a Harris Poll from 2015 showed that while 83 percent of parents want their children to be vaccinated against all five vaccine-preventable serogroups of the disease, including group B, 88 percent of parents whose children have received a meningitis vaccine don't know which serogroups of the disease their child is vaccinated against.11 In the U.S., The Centers for Disease Control and Prevention (CDC) and specifically their Advisory Committee on Immunization Practices (ACIP) make recommendations about who should receive vaccines. The CDC recommends meningitis B vaccination should be given (category A recommendation) for persons 10 years and older in certain groups who are at increased risk for meningitis B disease.12 In addition, the CDC says that meningitis B vaccines may be administered (category B recommendation) to young adults who are 16–23 years old, preferably to those who are 16–18 years old.13

Despite the availability of meningitis B vaccination, less than 10 percent of teens and young adults have been vaccinated, even though meningitis B accounts for 30 percent of all meningitis cases in the U.S.14,15 As a father and pediatrician and vaccine researcher, I want appropriate teens and young adults to be vaccinated to help protect them against this disease.

As new vaccines become available, clinicians must determine which products are best suited to serve their patients, systems and practice. Children's Hospitals and Clinics of Minnesota has developed a standardized method to review, assess and recommend vaccine products throughout its system providing clarity and guidance to clinicians, and allowing patients to be treated equally regardless of the location they seek care.

Children's Minnesota is made up of two hospitals totaling 381 staffed beds, an ambulatory surgery center and multiple outpatient clinic facilities, including 12 general pediatric clinics. To coordinate and standardize immunization practices across our clinics, a Vaccine Committee meets quarterly to review the ACIP guidance, discuss new vaccine products, investigate adverse events and provide recommendations. The committee consists of clinical immunization leads from our general pediatric clinics, ambulatory medical director, director of pharmacy, director of infection prevention and system immunization specialist.

As new vaccine products come into the market, Children's Vaccine Specialist has developed a one-page information flyer that provides details about the vaccine and the disease it helps to prevent. This document is reviewed and approved by the Vaccine Committee and then distributed, along with a memo explaining the committee's reasoning and preferred course of action, to clinic and hospital staff.

Based on the CDC recommendation, healthcare professionals have the option to provide or withhold meningitis B vaccination depending on their individual clinical decision making. Following this recommendation, Children's Minnesota wanted to make clear to both providers and patients our stance on both access and awareness of these vaccines. Children's Minnesota notified clinicians across the system via email, internal website postings and communications on daily leadership phone calls to encourage the medical staff to discuss the meningitis B vaccine with all eligible families. This included families with children at elevated risk for the disease, and those with children in the specified age ranges recommended by ACIP. To this end, it is the expectation that clinicians at Children's Minnesota will discuss the meningitis B vaccine with each patient eligible to receive it.

Leonard Friedland, M.D., Vice President, Director Scientific Affairs & Public Health, Vaccines, GSK

Joseph Kurland, M.P.H., Vaccine Specialist/Infection Preventionist, Children's Hospital and Clinics of Minnesota

1 CDC. Meningococcal Disease. October 2016. Available at: http://www.cdc.gov/meningococcal/index.html. Page 1, Paragraph 1, Line 1.

2 CDC. Manual for the Surveillance of Vaccine-Preventable Diseases: Chapter 8: Meningococcal Disease. April 2014. Available at: http://www.cdc.gov/vaccines/pubs/surv-manual/chpt08-mening.html. Page 1, Paragraph 1, Line 1.

3 CDC. Meningococcal Disease. October 2016. Available at: http://www.cdc.gov/meningococcal/index.html. Page 1, Paragraph 1, Line 2.

4 CDC. Meningococcal Disease. October 2016. Available at: http://www.cdc.gov/meningococcal/index.html. Page 1, Paragraph 1, Line 2.

5 CDC. Manual for the Surveillance of Vaccine-Preventable Diseases: Chapter 8: Meningococcal Disease. April 2014. Available at: http://www.cdc.gov/vaccines/pubs/surv-manual/chpt08-mening.html. Page 2, Paragraph 6, Line 3.

6 CDC. Manual for the Surveillance of Vaccine-Preventable Diseases: Chapter 8: Meningococcal Disease. April 2014. Available at: http://www.cdc.gov/vaccines/pubs/surv-manual/chpt08-mening.html. Page 2, Paragraph 6, Line 2-9.

7 CDC. Meningococcal Disease (Neisseria meningitidis). July 2015. Available at: http://wwwnc.cdc.gov/travel/diseases/meningococcal-disease. Page 1, Paragraph 2, Lines 4-6.

8 Cleveland Clinic. Disease & Conditions: Bacterial Meningitis. No date. Available at: http://my.clevelandclinic.org/health/diseases_conditions/hic_Bacterial_Meningitis. Page 2, Paragraph 2, Line 1.

9 CDC. Meningococcal Disease: Technical and Clinical Information. June 2015. Available at http://www.cdc.gov/meningococcal/clinical-info.htmlPage 1, Paragraph 4, Lines 1-3.

10 CDC. Manual for the Surveillance of Vaccine-Preventable Diseases: Chapter 8: Meningococcal Disease. April 2014. Available at: http://www.cdc.gov/vaccines/pubs/surv-manual/chpt08-mening.html. Page 1, Paragraph 3, Line 1.

11 Harris Poll. US Awareness Poll-Parents. February 2015.

12 CDC. Serogroup B Meningococcal (MenB) VIS. August 2016. Availabe at: http://www.cdc.gov/vaccines/hcp/vis/vistatements/mening-serogroup.html. Page 1, Paragraph 11, Line 1.

13 CDC. Serogroup B Meningococcal (MenB) VIS. August 2016. Availabe at: http://www.cdc.gov/vaccines/hcp/vis/vis-statements/mening-serogroup.html. Page 2, Paragraph 1, Line 1.

14 GSK, data on file.

15 CDC. Manual for the Surveillance of Vaccine-Preventable Diseases: Chapter 8: Meningococcal Disease. April 2014. Available at: http://www.cdc.gov/vaccines/pubs/surv-manual/chpt08-mening.html Page 1, Paragraph 3, Line 2.

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