by Michael T. Brady, M.D., FAAP
A new AAP policy statement
makes recommendations on the use
of two recently licensed meningococcal B (MenB) vaccines. MenB-FHbp
(Trumenba) and MenB-4C (Bexsero) are approved
for use in individuals 10 through 25 years of age.
The AAP recommendations are based on whether an individual is at increased risk for serogroup B
meningococcal disease and are similar to those of
the Advisory Committee on Immunization Practices
(ACIP) of the Centers for Disease Control and Prevention (CDC).
The statement Recommendations for Serogroup B
Meningococcal Vaccine for Persons 10 Years and Older,
from the AAP Committee on Infectious Diseases, is
available at http://dx.doi.org/10.1542/peds.2016-
1890 and is published in the September issue of
New vaccines target serogroup B
Neisseria meningitides causes serious and life-threatening infections in individuals of all ages. There are 12
different serogroups of N. meningitides, of which serogroups B, C and Y cause nearly all of the disease in the
U.S. Serogroup B is the predominant serogroup causing disease in infants and young children; serogroups
C and Y cause the majority of disease in adolescents.
A polysaccharide vaccine and two conjugated-poly-saccharide vaccines have been available for prevention
of A, C, W and Y meningococcal disease. However,
since the polysaccharide of serogroup B meningococcus is not immunogenic, an alternate approach to
vaccine development relying on antibodies directed
against proteins of serogroup B meningococcus was
needed in order to have an effective MenB vaccine.
Men B-FHbp is licensed as a two- or three-dose series.
The two-dose series should be given only to individuals
who are not at increased risk for serogroup B meningococcal disease. The second dose is given six months after
the first dose. For the three-dose series, the second dose
is given one to two months after the first dose, and the
third dose is given six months after the first dose.
MenB-4C is licensed as a two-dose series, with the
second dose given more than one month after the
Since each vaccine uses very different protein antigens, the entire vaccine series must be completed with
the same vaccine. If an adolescent receives one dose of
each of the two MenB vaccines without completing
the full series of either vaccine, seroprotection requires
that he or she complete the full vaccine series for one
of the vaccines. Pediatricians need to communicate to
by Ruben J. Rucoba, M.D., FAAP • Correspondent
As a practicing pediatrician for
decades, Jesse M. Hackell, M.D.,
FAAP, was tired of trying to convince
resistant parents to get their children
fully vaccinated. Though his New
York practice did not have a large number of families
refusing vaccines, they took a lot of
time and exposed other patients to
Several years ago, his practice
decided to dismiss families who
“For years, the Academy position
was not to dismiss,” Dr. Hackell
said. “Over the years, many of us
were frustrated with that being the official policy and
not stating that dismissal is also an acceptable option.”
In a new clinical report co-authored by Dr. Hackell, the Academy has officially acknowledged for the
first time that dismissal is an option in certain cir-
www.aapnews.org Volume 37 • Number 9 • September 2016
Survey: Gun violence
prevention a big issue
for most pediatricians
from the AAP Department of Research
firsthand the effects
of gun violence in the
lives of children and
their families. Nearly one in seven pediatricians
reported treating or consulting on a gun injury
in the past 12 months, and the large majority
of pediatricians (88%) agree violence prevention
should be a priority for all pediatricians, according
to an AAP Periodic Survey of Fellows.
The survey asked pediatricians to report on
their experiences providing clinical care for gun
injuries and counseling on gun injury prevention
as well as their attitudes toward practices and pol-
icies that might reduce gun injuries in children.
• Pediatricians were more likely to report treat-
ing a gun injury if they were in an inner-city
practice location (26%) compared to urban,
non-inner city (20%), rural (10%) or subur-
ban (6%) area.
• More than half of pediatricians (55%) reported gun violence is a problem in their practice
• The majority of pediatricians (70%) agreed
they are comfortable discussing firearm safety
in their practice, but only 20% agreed there
is sufficient time in patient visits to address
• Over a third of pediatricians (36%) reported
that parents resent being asked about firearms.
• The majority of pediatricians reported that in
their health supervision counseling they always
or sometimes identify families with firearms in
the home as well as recommend that parents
unload and lock firearms (see table on page 4).
Periodic Survey #86 was conducted from August 2013 to January 2014. Surveys were mailed
to 1,624 non-retired AAP members in the U.S.,
See Gun violence, page 4
In this issue
Blog about measles exposure goes viral
When his immunocompromised daughter and infant son were
exposed to measles, Timothy L. Jacks, D.O., FAAP, blogged about
his frustration. Here’s how his message educated countless people online and in the news media. Page 35
Update on top 10 resolutions
Learn what progress has been made on pediatric issues requiring urgent attention, as identified by chapter, committee, council
and section leaders during the Annual Leadership Forum last
spring. Pages 10-11.
Pediatricians should be upfront with vaccine-hesitant families and make sure they clearly understand the office policy on dismissal, according to
a new AAP clinical report.
See Hesitancy, page 4
See MenB, page 12
How to address vaccine hesitancy:
New AAP report says dismissal a last resort
AAP policy outlines when to use MenB vaccines
AAP policy on medical vs. nonmedical
exemptions, page 5.