University-Based Outbreaks Highlight Importance of MenB Vaccination

A review of 10 university-based outbreaks of meningococcal disease caused by serogroup B provide information about responses that underscore the importance of MenB vaccinations and could serve to guide universities in the future, according to the US Centers for Disease Control and Prevention (CDC).

The review, published in the CDC's journal Emerging Infectious Diseases, looked at outbreaks in 7 states between 2013 and 2018 that included 39 cases and 2 deaths.

"The main purpose of this study was to gather as much information as we could and put it in one place to be a really helpful resource for universities that might experience an outbreak in the future," study author Heidi Soeters, PhD, MPH, an epidemiologist with the CDC, told Contagion^®.

Rapidly achieving high rates of vaccination is key to controlling outbreaks, Dr. Soeters said. Two vaccines are available for group B, but are not part of routine vaccination schedules. Rather, the CDC recommends the vaccine for individuals with increased risk of meningococcal disease and leaves the decision about its use up to practitioners and patients.

The outbreaks occurred at universities ranging in size from 3600-5000 undergraduates

to up to 35,000 undergraduate students, with the number of cases ranging from 2 to 9. Student populations are mostly unvaccinated, with only 2% of universities requiring MenB vaccination, the study noted.

Affected universities mounted campaigns to increase vaccination rates. Responses involved coordinated efforts involving student health clinics, state and local health departments, and the CDC.

Two of the outbreaks occurred before MenB vaccines were approved for use, and the CDC provided MenB-4C through an investigational new drug protocol in response to those outbreaks in California and New Jersey. The remaining 8 outbreaks happened after 2014, when MenB vaccines were licensed, with 3 universities primarily using MenB-FHbp, and 5 universities primarily using MenB-4C in their responses.

First-dose coverage ranged from 14% to 98%.

"I would say that the biggest surprise overall might be the fact that some of the larger universities face a lot more challenges in rapidly achieving high vaccination," Dr. Soeters said of the review. "I think there are definitely lessons learned and different approaches that schools have tried."

Universities have mounted campaigns to offer MenB vaccination themselves, with some tying their vaccinations with seasonal flu vaccination efforts and some partnering with pharmacies to administer the vaccines.

One of the most effective approaches came in response to a 2016-2017 outbreak in Oregon, where first-dose vaccination coverage was increased from 8% to 98% after the university opted to require proof of MenB vaccination for registration. In Wisconsin, first-dose coverage reached 67% with help from federal funds that relieved financial hurdles to acquiring the vaccine.

Outbreaks lasted from 0 to 376 days, and half of them ended after vaccination efforts, with additional cases occurring among unvaccinated students or close contacts in the other half of outbreaks.

Responses also included administering chemoprophylaxis to close contacts, increased detection efforts, and communication campaigns to raise awareness and dispel myths.

"I think the main thing that doesn't come across in the paper is just the immense mobilization and resources required to address these outbreaks and the emotional toll it takes on campus," Dr. Soeters told Contagion^®.

The CDC is coordinating with states to investigate risk factors and whether certain university students are at higher risk for meningococcal disease than others, she said.

The CDC leans on vaccine providers for information about overall effectiveness of the vaccine and duration of protection. The vaccine isn't widely used, so more time is needed to explore these questions.

In April 2018, the US Food and Drug Administration granted Breakthrough Therapy designation to Pfizer Inc.’s meningococcal group B (MenB) vaccine, Trumenba, for children.

The importance of vaccination was highlighted by a recent study in Spain that found that cases of invasive meningococcal disease fell dramatically between 1977 and 2013 after vaccines became available there.