ACIP expands meningitis vaccine recommendations

The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) voted at its February meeting to recommend that individuals 10 years of age and older who are at increased risk of meningococcal disease should be vaccinated with serogroup B meningococcal vaccine (MenB).

See also: FDA approves second meningococcal serogroup B vaccine

People with increased risk include those with persistent complement component deficiencies or anatomic or functional asplenia, along with microbiologists routinely exposed to isolates of the bacteria that cause meningococcal disease. Those identified to be at increased risk because of a meningitis outbreak similar to some of the many outbreaks on U.S. college campuses in recent months should also be vaccinated, according to ACIP.

Jessica MacNeilVulnerable groups

In 2015 to date, meningococcal outbreaks have been reported on college campuses, including a large outbreak at the University of Oregon and smaller incidents at Yale and Providence College. From 2009 through 2013, 600,000 college students were at risk in outbreaks that occurred on various campuses, according to Jessica MacNeil, MPH, epidemiologist with the CDC.

See also: FDA approves first meningococcal B vaccine

Public commenters at the February meeting urged the ACIP to make the MenB vaccine mandatory for children. For example, at the meeting Mary Ferris, MD, student health director at the University of California – Santa Barbara, urged the CDC to establish the MenB vaccine as part of routine adolescent vaccinations in the United States, “so our students are protected before they even get to campus.”

Ferris recalled how the campus of 30,000 students, faculty, and staff was devastated by a meningitis outbreak in November 2013, when four cases were reported in a 10-day period. The cases included a lacrosse team player who had to have both legs amputated.

“There was widespread fear and panic among students, faculty, and staff. People drove in to take their students back home, and parents demanded we close the campus,” Ferris said. Although UCSB obtained emergency doses of MenB vaccine, “we would have much rather preferred to have the vaccine in advance to prevent this,” she said. “Outbreaks will happen again, and most universities will not have the resources to pay for vaccines when outbreaks do occur.”

Another group needing immunization is microbiologists who work with the disease, since the attack rate of the disease is 13 per 100,000, according to MacNeil. “There is a high fatality-case ratio, possibly due to exposure to high concentration of organisms and highly virulent strains,” she said.

The meningococcal vaccine work group will review data for use of the vaccine in children two months up to 10 years old, and may propose “expanded policy options for persons at increased risk in the future,” MacNeil said.

Influenza and HPV

ACIP also reviewed influenza recommendations and made only a minor change. ACIP did not renew the 2014 to 2015 preference for using the nasal spray flu vaccine [live attenuated influenza vaccine (LAIV)], when immediately available, instead of the flu shot [inactivated influenza vaccine (IIV)] in healthy children ages two through eight.

And, the committee voted to continue to recommend that everyone six months and older be vaccinated annually against influenza.

Researchers also provided an update on LAIV effectiveness, noting problems with one of the California strains used. Studies found that LAIV was effective against H1N1 during the 2009-2010 influenza season but not during the 2011-2012 and 2013-2014 seasons, most likely because it contained a strain that made it more susceptible to heat degradation, said Kathleen Coelingh, senior director of medical affairs at MedImmune. 

Shipping the vaccine when temperatures are higher than 80° F reduces the vaccine’s effectiveness against H1N1, she said. “To remedy this in the future, we will replace the … strain with an antigenically matched strain with a more stable HA,” Coelingh said.

In other news, ACIP voted to recommend that the 9-valent human papillomavirus (HPV) vaccine (Gardasil 9; Merck) be included as one of the HPV vaccines that can be used to vaccinate females and males in the currently recommended age groups. According to the committee, 9-valent HPV offers prevention against five more types of HPV infection - translating into an additional 14% of women's HPV cases and an additional 5% of men's HPV cases.

The recommendation comes after vaccine licensure by FDA and a year of review of HPV9 data by the ACIP.