What Pediatricians Need to Know About the New Meningococcal B Vaccine

What Pediatricians Need to Know About the New Meningococcal B Vaccine 150 150 Michael T. Brady, MD

Michael T. Brady, MD, infectious diseases specialist at Nationwide Children’s Hospital and primary author of the recent American Academy of Pediatrics position paper on the meningococcal B vaccine, shares what you need to know about this controversial vaccine.

Meningococcal serotype B (MenB) causes the majority of invasive meningococcal disease in infants and young children. Though not the major cause of the disease in young adults, a few highly-publicized MenB outbreaks on college campuses have led to worries among college-age adolescents and their families.

Two MenB vaccines have recently been licensed for use in patients ages 10-25, and the U.S. Centers of Disease Control and Prevention has given them a first-of-its-kind “Category B” recommendation – meaning the vaccines are covered by federal and commercial insurance but not routinely recommended for most people. (There is a “Category A” or routine recommendation, for an entire population or specific risk groups).

The American Academy of Pediatrics has issued these guidelines for the vaccine’s use:

  • The MenB vaccine should be routinely used in patients who are at increased risk of MenB disease – that is, patients with complement deficiency; patients with anatomic or functional asplenia; and healthy patients who live in an area with a MenB disease outbreak.
  • The MenB vaccine is not recommended for routine use for those are not in the at-risk categories listed above.
  • The MenB vaccine may be given to patients ages 16-23 (though the preferred range is 16-18) to provide short-term protection against MenB.

Important for physicians to know as they consult with families:

  • Meningococcal disease caused by all serogroups ( B, C and Y) is at historically low levels in the United States.  We don’t know why the decline began in the 1990s, even before the MenACWY vaccine was available. That means cases could rise just as unexpectedly.
  • The incidence of MenB disease is not higher in college students than in the general population of the same age, despite a few well-known college outbreaks.
  • Preliminary data show that 60 percent of MenB vaccine recipients maintain antibody levels at two years after vaccination. We do not know the long-term safety profile, but no unusual safety issues are expected
  • Because the MenB vaccine is the first with a “Category B” designation, it’s not clear yet what liability a physician may have if she recommends the vaccine, has a family decline it and then the child is infected with MenB. Best practice is to document discussions with the family if they decide against the vaccine.

It is reasonable to give the MenB vaccine to young adults when they (or their families) are concerned about risk and ask for it. It’s also reasonable to inform families of availability even if they don’t ask.

The challenge is determining the importance of MenB vaccine when there are so many other important conversations to have with young adults. A pediatrician may need to decide whether the limited time available with a patient may be better spent on other conversations, or advocating for routine vaccines with clear proven benefits, such as MenACWY, the HPV series and influenza.


About the author

Michael T. Brady, MD, is associate medical director at Nationwide Children’s Hospital, co-medical director for Patient Safety, a member of the hospital’s Division of Infectious Diseases and a Professor of Pediatrics at The Ohio State University College of Medicine. An infectious disease specialist for more than three decades, Dr. Brady began focusing on the emerging HIV epidemic in the mid-1980s and its implications for infants, children and adolescents. He created the country’s first family-centered pediatric HIV program at Nationwide Children’s in 1987. While still involved with the HIV program, his interests in recent years have included promoting immunization in children, reducing healthcare associated infections and providing guidance on emerging infections.

Dr. Brady served as physician-in-chief at Nationwide Children’s from 2005 to 2013 and chair of the Department of Pediatrics at OSU’s College of Medicine from 2006 to 2013. Under his leadership, OSU’s Pediatrics faculty nearly doubled in size. Dr. Brady also oversaw the development of Physician Direct Connect at Nationwide Children’s, a service that puts community pediatricians in nearly immediate contact with specialists for consultations. He is a long-time member of Nationwide Children’s Graduate Medical Education Committee, influencing the training of the next generation of physicians.

At the national level, Dr. Brady has served as chair of the American Academy of Pediatrics’ Committee on Infectious Diseases. He is currently the associate editor of Red Book, the comprehensive infectious disease reference from the AAP. He is also a member of the editorial panel for Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children: Recommendations from the NIH, CDC, HIV Medicine Association, PIDS and AAP. Other activities have involved global immunization advocacy, ongoing education of pediatricians across the country and service on task forces handling issues ranging from circumcision to meningococcal vaccines.