Meningococcal Outbreak Highlights Need for New Vaccine
Nov 22, 2013

Earlier this week, news reports started pouring in of a meningococcal outbreak among students at Princeton University.  The number of cases and the lack of any direct connection among the cases helped define the outbreak, and suggested that there would likely be more cases.  And while it is not uncommon to hear of meningitis cases among college students, this specific outbreak was concerning to parents and public health officials for one very specific reason.
In the seven cases of meningococcal disease related to this Princeton University outbreak which began in March 2013, all seven were identified to be caused by meningococcal bacteria know as serogroup B.  While we are fortunate to have a meningococcal vaccine that is currently recommended for adolescents in the U.S., it only protects against four different serogroups (“strains”) of the disease known as A, C, Y and W.  Therefore even vaccinated children will lack protection against the B strain noted in this particular outbreak. That is an unfortunate reality to acknowledge when we consider that serogroup B is responsible for approximately one third of all the bacterial meningococcal cases in the U.S.

So why doesn’t the U.S. meningococcal vaccine offer protection from the B strain and what is being done about it?

The first priority in this recent outbreak has been for Princeton University, the NJ State Department of Health and the Centers for Disease Control and Prevention (CDC) to work together to propose a solution that could help prevent this outbreak from spreading.  They have since requested that the FDA allow the use of a vaccine that has not been licensed in the U.S., but has met safety and efficacy standards for licensure in Europe and Australia.  Considering the vaccine has been approved by regulatory agencies in other countries, the FDA has agreed to offer the vaccine for use to address this specific situation only.  In moving ahead, the University expects to make the vaccine available to students free of charge.  Since two doses of the vaccine are required for maximum protection, they will begin administering the first dose in December, with the second dose to follow in February.  The vaccine will be offered to all Princeton undergraduate students, all graduate students living in dormitories, and individuals with the specific high risk conditions.
While this action may help to control this specific outbreak, we must also consider another pressing question.

Why is the vaccine available in other countries, but not in the U.S.?  And when can we expect a meningococcal vaccine in the U.S. that will offer protection from the B strain for our children?

According to the CDC, there is a a serogroup B meningococcal vaccine that has completed phase II clinical studies in the United States. After carefully reviewing the requirements for licensure, existing vaccination schedules, and feedback from public health experts, the company which manufactures this vaccine has decided to advance in their phase III trials with the intent to eventually bring a new meningococcal vaccine to market that will protect against five serogroups (A, B, C, Y, and W).  While such a vaccine would be of great interest, the timeline for vaccine approval here in the U.S. is still largely undetermined, as FDA licensure can be a lengthy process.

What are parents to do in the meantime?

Of course, the best preventive measure we can take is to continue to ensure that our children receive the CDC recommend meningococcal vaccine at age 11-12 and again at 16.  While many states have begun adopting legislation that require students residing on college campuses to be vaccinated, it’s recommended that children receive the vaccine regardless of whether it is required by their college or not.  All we need to do is look to the various news reports each day to see that meningococcal disease is impacting campuses all over the country.  For instance, Monmouth University, which is located in the same state as Princeton university, just reported a case of meningitis among an employee and has yet to determine which strain is involved.  There were even reports of three meningitis cases at UCLA’s Santa Barbara campus in the papers just yesterday. And sadly, tomorrow there will probably be more.
As my own daughter heads off to college in the fall and I worry about the lack of serogroup B coverage, I’ve discussed my concerns with my friend Lynn Bozof.  After losing her son Evan at the age of 20,  she became the founder of The National Meningitis Association (NMA) which works to educate the public, medical professionals and others about the disease and its prevention and you can hear her story below.
[youtube=http://www.youtube.com/watch?v=hNiwn2Z8Du4#t=115]
Recently Lynn has spoken out in support of  this collaborative public health effort at Princeton to help protect people during a time of high-risk of infection.

“The National Meningitis Association is thrilled that the CDC, FDA, Novartis, and Princeton University have collaborated to stop the Meningitis B outbreak on campus.  As an organization made up of families who have suffered from meningococcal disease, we welcome all opportunities to protect our children.  I would be first in line for the vaccine, if offered.
Many teens think that they are invincible, but that is not the case, and especially with this disease.  Those vague, flu like symptoms can turn on a dime.   We encourage all students to take advantage of this exceptional opportunity.”

The NMA network also provides critical emotional support for families who have been affected by meningococcal disease as evidenced by the stories shared by Alicia and Patti earlier this week on their Parents Who Protect blog.  Not only did both these mothers vaccinate their teenage daughters, they both ultimately succumbed to serogroup B meningococcal infection.  Patti’s words are painful for any parent to hear.  She says,

The frightening part is that she didn’t have the classic symptoms of meningococcal disease just hours before going into the hospital.  She didn’t have a stiff neck.  She didn’t have a bad headache.  She wasn’t sensitive to light.  She didn’t have a rash initially. She wasn’t confused.   She had body aches and fever of 101.  That’s it.  AND she was vaccinated.  I thought she was safe.  But she contracted serogroup B which the current U.S. vaccine does not protect against.  This bacteria is so aggressive and invades the body so rapidly. In my daughter’s case, quick medical intervention could not even save her.

How can we limit our child’s risk of this disease when we know vaccines can’t do it all?

Parents and students need to be aware of the causes and symptoms related to meningococcal disease.  The bacteria is spread from person to person through the exchange of respiratory and throat secretions like saliva, through close or lengthy contact, especially with people living in the same dorm.  It’s important for people to cover their coughs and wash their hands frequently, as well as eat healthy, get plenty of rest and refrain from sharing anything that comes in contact with the mouth, including water bottles, lip balm, toothbrushes, towels, drinking glasses, eating utensils, cosmetics, smoking materials, or food and drink from common sources.  While we can expect to recognize the people who are “sick” that we should avoid, there are approximately 5-25% of people who carry the meningococcal bacteria in their nose or throat without getting sick.  These people are still capable of spreading the disease to others even if they never develop symptoms, reminding us to take preventive measures with everyone we encounter.
It’s also important to recognize the symptoms of meningococcal disease.  While it may first present with flu-like symptoms such as fever, achiness, and headache, there are other worrisome symptoms that may appear to include rash, pain when looking at bright lights, and a stiff neck. Meningococcal disease is also very dangerous because it can come on extremely fast, often leading to death or disability within hours. Parents and students must be knowledgeable about these symptoms if they are to help ensure that those infected get prompt medical treatment.
There are lots of helpful resources on meningitis.  Check out those listed below and be sure to share other resources or personal stories you may have in the comment section below.
Centers for Disease Control and Prevention
National Meningitis Association
Personal Stories of Meningitis via Shot by Shot
Meningitis Angels
Serogroup B Meningococcal Vaccine Questions and Answers

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