by H. Cody Meissner, M.D., FAAP
Two novel vaccines have been licensed for prevention of disease caused
by Neisseria meningitidis serogroup B
(MenB). Unlike the protein-poly-saccharide conjugate vaccines for
prevention of disease caused by meningococcal serogroups A,C,W,Y,
the available MenB vaccines target
protein antigens that are anchored in
the polysaccharide capsule. The serogroup B polysaccharide shares similar
structural and antigenic properties
with proteins found on cells of the
central nervous system, making the B
polysaccharide poorly immunogenic
and making a conjugate polysaccharide B vaccine impractical. Even in
people who experience MenB disease,
only a limited immune response to
the polysaccharide capsule occurs.
Which of the following statements are correct?
a) In recent years, MenB has caused fewer than
100 cases of invasive disease annually in the
b) The highest rates of MenB disease occur in the
first 12 months of life.
c) MenB vaccines are licensed for use starting at
2 months of age.
d) Similar to the vaccines for meningococcus
A,C,W,Y, meningococcus B vaccines have
been demonstrated to reduce nasopharyngeal
e) Following administration of a MenB vaccine
series, detectable antibody lasts five years in
fewer than 50% of vaccinees.
Since 2012, fewer than 600 cases of meningococcal disease have been reported annually in the United
States. The decline in all serogroup meningococcal
disease among all age groups began in the late 1990s,
prior to licensure of the first meningococcal protein
conjugate vaccine in 2006. While MenACWY conjugate vaccines likely have contributed to the continuing decline in rates of meningococcal disease in
the United States, other unknown factors are playing
an important role.
Approximately 20% of the annual meningococcal
cases (70 to 110 cases/year) in the United States are
caused by MenB. In an effort to partly reduce the
number of cases, administration of a MenB series for
people 10 years of age and older is recommended for
people with the following conditions:
• persistent complement component deficiencies
(C3, C5-9, properdin, factor D, factor H);
• recipients of eculizumab (Solaris), a complement
inhibitor licensed for use in patients with par-
oxysmal nocturnal hemoglobinuria or atypical
hemolytic uremic syndrome;
• functional or anatomic asplenia;
• people 10 years of age or older who are present
and at risk during an outbreak of disease caused
by serogroup B;
• people who have prolonged exposure to N. men-
ingitidis (such as microbiologists who routinely
work with N. meningitidis); and
• adolescents and young adults 16 through 23
years who wish to be vaccinated.
A number of questions regarding MenB vaccines
are unanswered. For example, the ability of MenB
vaccines to prevent disease is not known. Because
of the rarity of serogroup B disease, a vaccine effectiveness trial was not possible. Instead, licensure of
MenB vaccines was based on the vaccines’ ability to
produce a serum antibody response that is believed
to be a measure of protection.
Protection against all strains of MenB is not expected from MenB vaccines. Experience in a re-al-world setting was provided during an outbreak
of MenB in 2013-’ 14 on a college campus in New
Jersey. Following administration of a vaccine series,
one-third of vaccine recipients did not develop a
protective antibody concentration against the circulating strain of MenB (Basta NE, et al. N Engl J
The Centers for Disease Control and Preven-
tion (CDC) estimates 15-29 cases and two to five
deaths could be prevented annually with a routine
adolescent MenB vaccine program at 11, 16 or 18
years of age. This would require a vaccination series
for more than 600,000 adolescents to prevent one
death attributable to MenB (or 1. 6 deaths/1 mil-
lion adolescents). The CDC has estimated the risk
of anaphylaxis is 1. 3 cases/1 million doses follow-
ing administration of any vaccine.
Thus, the vaccine benefit from pre-
vention of death from MenB disease
is approximately equal to the risk of
anaphylaxis from MenB vaccine ad-
Other uncertainties regarding
vaccination against MenB are unanswered. Duration of immunity
is short-lived and likely to be limited to a few years. Need for booster
dose(s) to maintain protection is unknown. Particularly for those who
continue to be at increased risk of
MenB infection, a booster dose is
likely to be necessary. But data are
unavailable regarding the timing of
a booster dose(s).
An effect on reduction in naso-
pharyngeal colonization by MenB
is necessary for community (herd)
immunity but appears unlikely.
At current pricing, the cost of dis-
ease prevention is more than 20 times greater than
the cost for other routinely recommended vaccines
(in terms of cost per quality adjusted life years saved).
Without question, the severity of invasive meningococcal disease can be staggering. However,
the small burden of disease that might be prevented
following use of these expensive vaccines requires
thoughtful consideration in this era of increasingly
Dr. Meissner is professor of pediatrics
at Floating Hospital for Children, Tufts
Medical Center. He also is an ex officio
member of the AAP Committee on Infectious Diseases and associate editor of
the AAP Visual Red Book.
Ans w er: a, b and e are correct
MenB vaccines: a remarkable technical
accomplishment but uncertain clinical role
Courtesy of the Centers for Disease Control and Prevention
Neisseria meningitidis is an aerobic gram-negative diplococcus that colonizes the
nasopharynx of 5%-10% of healthy people.