Meningitis

Fungal Infections Following Surgical Procedures in Mexico

The U.S. Centers for Disease Control and Prevention (CDC) today announced some people returning from Matamoros, Mexico, were diagnosed with suspected fungal meningitis infections in the U.S. that have led to severe illness and death.

Travelers with these infections had medical or surgical procedures that involved the injection of an anesthetic into the area around the spinal column performed at clinics in Matamoros, including River Side Surgical Center and Clinica K-3.

These locations are located adjacent to Brownsville, Texas.

On May 16, 2023, the CDC issued an Alert - Level 2, Practice Enhanced Precautions, to notify visitors to Mexico of this health risk.

The CDC suggests canceling any procedure that involves an epidural injection of an anesthetic in Matamoros, Mexico until there is evidence that there is no longer a risk for infection at these clinics.

As with any medical and surgical procedures, complications can occur regardless of where treatment is received.

Fungal meningitis can develop after a fungal infection is accidentally introduced during a medical or surgical procedure. Although anyone can get fungal meningitis, people with weakened immune systems are at increased risk.

Fungal meningitis is treated with medications, depending on the type of fungus.

Additionally, the CDC stated today:

If you had a procedure involving an epidural injection of an anesthetic in Matamoros, Mexico, any time since January 1, 2023, monitor yourself for symptoms and consider consulting a healthcare professional.
If you travel to another country for a procedure, do not delay seeking medical care if you suspect any complications during travel or after returning home.
Obtaining medical care immediately can lead to earlier diagnosis and treatment and a better outcome.

Furthermore, any U.S.-based provider who encounters a patient who has had a medical or surgical procedure in Matamoros, Mexico, and is experiencing symptoms of meningitis, contact your local health department and CDC (fungaloutbreaks@cdc.gov) to evaluate the possibility of fungal meningitis.

Updated - CDC Health Alert Network, CDCHAN-00491, May 17, 2023, 4:00 PM ET. As of May 12, 2023, five patients have been diagnosed with suspected fungal meningitis; all have been hospitalized, and one has died.

Sub Title:

Fungal meningitis can develop after a fungal infection

References:

U.S. CDC - Fungal Meningitis

Outbreak of Suspected Fungal Meningitis in U.S. Patients who Underwent Surgical Procedures under Epidural Anesthesia in Matamoro

Texas Health Department Alerts Public, Clinicians About Suspected Fungal Infections

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U.S. CDC fungal meningitis infections May 2023

Africa's Meningitis Belt Most Fatal in Nigeria

Karen McClorey Hackett — Thu, 27 Apr 2023 21:16:05 +0000

Reviewer:

WHO: Meningitis - Nigeria April 2023

The World Health Organization (WHO) today announced the Federal Republic of Nigeria's meningitis outbreak had caused severe concerns this year.

The WHO reported on April 27, 2023, between October 2022, and April 16, 2023, Nigeria confirmed 1,686 suspected cases of meningitis, including 124 deaths, for a case fatality ratio (CFR) of 7%.

Unfortunately, the highest proportion of reported cases is among children aged 1 to 15.

And the Jigawa state accounts for 74% of all suspected meningitis cases.

This Nigerian state borders the Zinder region in Niger, where a meningitis outbreak has been reported since October 2022.

The extended meningitis belt of sub-Saharan Africa, stretching from Senegal in the west to Ethiopia in the east, includes 26 countries, with Nigeria reporting the highest disease rates.

Meningitis in these countries follows a seasonal pattern.

Most outbreaks occur during the dry season (December through June), with a peak between March and April when persistent low air humidity and high dust loads are believed to damage the pharyngeal mucosa and ease the colonization of the nasopharyngeal epithelium by the meningococci.

Several different bacteria can cause meningitis. The most frequent are Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis. However, N. meningitidis, causing meningococcal meningitis, is the one with the potential to produce large epidemics.

Meningococcal meningitis is transmitted from person to person through droplets of respiratory and throat secretions, usually by asymptomatic carriers. Close, prolonged contact with an infected person or living with a bacteria carrier facilitates the spread of the disease.

The average incubation period is four days but can range between two and ten days.

From a prevention perspective, vaccines can help prevent meningococcal disease. There are two types of meningococcal vaccines, says the U.S. CDC.

Nigeria has implemented interventions to combat meningitis, including introducing the meningococcal A (MenA) conjugate vaccine from 2011-2022.

Through preventive campaigns, Nigeria has vaccinated over 100 million people, and the vaccine has been included in the country's routine immunization schedule since 2019.

Among MenA vaccinated populations in countries of the meningitis belt, the incidence of serogroup A meningitis has declined by more than 99%, and no serogroup A case has been confirmed since 2017.

However, annual reports of meningitis cases in Nigeria are still associated chiefly with meningococcus serogroup C.

Nigeria is also confronting other disease outbreaks, such as yellow fever, measles, and polio, in 2023.

These travel vaccines are available at clinics and pharmacies in Texas.

Sub Title:

Nigeria meningitis case fatality ratio is high

References:

CDC Meningococcal Disease

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Nigeria Centre for Disease Control and Prevention April 27, 2023

Africa Acts to Stop Meningitis Outbreaks

Donald Hackett — Wed, 21 Sep 2022 19:23:30 +0000

Reviewer:

WHO meningitis outbreak action plan

With the COVID-19 pandemic delaying meningitis vaccination campaigns for more than 50 million children in Africa, the World Health Organization (WHO) region is at a heightened risk of outbreaks of meningitis type A, which has nearly been eliminated on the continent.

In a race against time, the WHO and partners recently launched a roadmap to stop bacterial meningitis outbreaks by 2030.

Based on reports from countries, the WHO found that meningitis control activities were reduced by 50% in 2020 compared with 2019, with a slight improvement in 2021.

On September 6, 2022, the WHO stated it is 'urging countries to implement it rapidly before the start of the meningitis season beginning in January thru June 2023.'

Moreover, the African region accounts for the highest number of new meningitis cases globally and is the only region to experience outbreaks still.

The pandemic severely disrupted meningitis prevention and control services.

The African countries of Benin, Guinea, Guinea Bissau, Nigeria, and Togo delayed campaigns with the MenAfriVac vaccine.

"The defeat of meningitis type A is one of Africa's biggest success stories in health, but the fallout from COVID-19 hampers our drive to eliminate this bacterial infection as a public health threat once and for all and could lead to catastrophic resurgences," said Dr. Matshidiso Moeti, WHO Regional Director for Africa, in a related media statement.

While no meningitis type A case has been reported in Africa during the past five years, outbreaks still occur and are caused by other types of meningococcal bacteria.

Major outbreaks caused by meningitis type C have been recorded in seven meningitis belt countries since 2013.

In 2019, 140,552 people in the African region died from all types of meningitis.

In 2021, a four-month outbreak in the Democratic Republic of the Congo claimed 205 lives.

Historically, meningitis type A was Africa's highest cause of meningitis outbreaks.

"More than 400 million Africans are still at risk of seasonal meningitis outbreaks, but the disease has remained off the radar for too long," added Dr. Moeti.

"Aside from the toll on human life, outbreaks negatively impact health systems, our fragile economies, and impoverish entire populations forced to contend with multiple health and socio-economic challenges."

Meningitis is caused by inflammation of the membranes surrounding the brain and spinal cord and is transmitted via a sneeze, saliva, or phlegm from the nose and throat of infected persons.

Acute bacterial meningitis is one of the deadliest and most disabling forms of illness. It can cause death within 24 hours and leaves one in five infected people with lifelong disability after infection, says the WHO.

In the USA, there are two types of meningococcal vaccines licensed by the U.S. FDA.

Meningococcal conjugate (MenACWY) vaccines
Serogroup B meningococcal (MenB) vaccines

The U.S. CDC suggests speaking with a travel vaccine expert before visiting Africa's meningitis belt.

Travelers who spend much time in the meningitis belt, especially during the outbreak season, are more likely to get this disease.

'Getting a meningococcal vaccine is the best way to protect against meningococcal disease,' says the CDC.

Additional meningitis vaccine information is posted at PrecisionVaccinations.com/Meningococcal.

Vax-Before-Travel publishes fact-checked research-based travel vaccine news.

Sub Title:

Meningitis prevention vaccines are licensed in the USA

References:

CDC meningitis vaccine options

Meningococcal Vaccines

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CDC African meningitis outbreak belt

Meningococcal Disease Outbreak Reported in the Republic of Benin

Danielle Reiter RN — Wed, 29 Jan 2020 14:41:35 +0000

Reviewer:

CDC: Meningococcal Disease in Benin

An outbreak of meningococcal disease has been reported in the Banikora District of the Republic of Benin.

The US Centers for Disease Control and Prevention (CDC) issued a Level 1 Travel Alert on January 28, 2020, notifying visitors to the northwest border with Burkina Faso, which is located in west-central Africa.

This ‘Practice Usual Precaution’ Alert is important since illnesses related to the meningococcal disease are often severe and can be fatal.

Meningococcal disease includes infections of the lining of the brain and spinal cord (meningitis) and bloodstream infections. The bacteria that cause meningococcal disease is spread through respiratory secretions, such as saliva, says the CDC.

Most cases of meningococcal disease in this outbreak have been caused by Neisseria meningitidis serogroup C.

There is a vaccine available to travelers that can help prevent infection against meningococcal disease caused by Neisseria meningitidis serogroup C.

The CDC says health officials are reporting that a smaller number of cases in this outbreak have been caused by Neisseria meningitidis serogroup X.

Unfortunately, there are no vaccines available today that prevent infection against meningococcal disease caused by Neisseria meningitidis serogroup X.

Approximately 7–10 days before departure to Benin, the CDC suggests all travelers aged 2 months or older should be vaccinated with a single vaccine dose against Neisseria meningitidis serogroups A, C, W, and Y.

And, children younger than 2 years of age are recommended to receive 2–4 doses of serogroup A, C, W, Y vaccine before traveling, depending on age.

Since 2005, most adolescents in the United States receive vaccination against serogroups A, C, W, and Y. Protection from the serogroup A, C, W, Y vaccine only lasts for a few years.

Therefore, people who were vaccinated more than 3–5 years ago are recommended to receive an additional vaccine dose before traveling.

Vaccination against Neisseria meningitidis serogroup B (Bexsero or Trumenba) is not indicated for the outbreak in Benin.

There are 2 meningococcal vaccines available in the USA that protect against infection from serogroups A, C, W, and Y; Menactra and Menveo.

From a security perspective, the US Department of State issued a Level 1 Travel Advisory for Benin on May 23, 2019.

This ‘Exercise Normal Precautions’ Advisory includes specific security notices for ‘urban areas’ and for Park Pendjari, Park W and adjacent hunting zones, and other areas near Benin’s northern border with Burkina Faso, due to terrorism and kidnapping.

The CDC suggests international travelers who have vaccination questions to speak with a certified healthcare professional prior to departure.

Travel vaccine news published by Vax-Before-Travel.

Sub Title:

Vaccination against Neisseria meningitidis serogroups A, C, W, and Y suggested before visiting Benin Africa

References:

CDC: Meningococcal

US Department of State: Benin Travel Advisory

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CDC Watch - Level 1, Practice Usual Precautions

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menactra

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MenB Vaccines Can Be More Target-Specific and Effective

Don Hackett — Sat, 21 Dec 2019 14:16:15 +0000

Reviewer:

Variant Signal Peptides of Vaccine Antigen, FHbp, Impair Processing Affecting Surface Localization and Antibody-Mediated Killing

United Kingdom-based vaccine experts at the University of Nottingham say their new study ‘could have major implications for the meningococcal group B (menB) vaccines Trumenba and Bexsero.’

And, this new study highlights the importance of multivalent vaccine approaches.

According to these researchers, this new study’s findings could lead to an improved vaccine to protect people against the bacterium, Neisseria meningitides, that causes sepsis and meningitis, and may help to protect against mutated strains.

This is potentially important news published on December 19, 2019, since meningococcal infections are the most common cause of bacterial meningitis, and is a life-threatening disease that poses a continuing threat worldwide.

The new study, led by Dr. Ruth Griffin, Assistant Professor in Microbial Pathogenesis from the School of Life Sciences at the University of Nottingham, found that over 88 percent of invasive strains express the precursor version of FHbp- i.e. a larger, uncleaved protein that is not lipidated.

Therefore the antigen in the Trumenba vaccine is presented in a different manner to the native antigen produced by most strains.

This study said ‘it is unclear at the moment whether the altered presentation affects the ability of vaccine-elicited antibodies to kill these strains.’

“We analyzed the FHbp sequence of almost 2,000 isolates and experimentally tested 20 and saw a 100 percent correlation between mutations in the signal peptide sequence and inability to convert the precursor protein to the cleaved lipidated antigen, “said Dr. Griffin, in a related press release.

The test currently used to predict which meningococcal isolates will be targeted by Trumenba measures the abundance of FHbp on the cell surface since a critical amount is needed for antibodies to bind the cell and aid killing.

Dr. Griffin continued saying, “The data reported from these tests show that some strains with sufficient FHbp levels are surprisingly not susceptible to killing by Trumenba vaccine antibodies.”

“With our discovery that key mutations affect FHbp structure and abundance on the cell surface, this data can be re-evaluated and the MEASURE assay refined to include appropriate reference strains that express the precursor so that isolates can be benchmarked against typical strains.”

“Knowledge of the signal peptide sequence, (as well as “promoter” sequences which affect the amount of the protein made), can now be used to make predictions on FHbp structure and abundance and recognition by Trumenba.”

“Importantly, including the precursor form of FHbp in formulations, will no doubt increase the breadth of isolates that can be targeted.”

‘Our findings also bear relevance for Bexsero, although this vaccine is multivalent and thus less heavily reliant on the successful targeting of FHbp.’

“So, not only is improving target recognition of individual antigens important but increasing the number of antigens in a formulation is vital to overcome problems encountered by mutation,” concluded Dr. Ruth.

The US Centers for Disease Control and Prevention (CDC) says on its website as of April 15, 2019, the case-fatality ratio of meningococcal disease is up to 15 percent, even with appropriate antibiotic therapy.

And, the case-fatality ratio of meningococcemia is up to 40 percent.

As many as 20 percent of survivors have permanent injuries, such as hearing loss, neurologic damage, or loss of a limb.

Meningococcal disease is typically diagnosed by isolation of N. meningitidis from a normally sterile site. However, the sensitivity of bacterial culture may be low, particularly when performed after initiation of antibiotic therapy.

Meningococcal vaccination is recommended for persons at increased risk for meningococcal disease.

The CDC recommends routine vaccination with either MenACWY vaccine at 11 or 12 years of age, with a booster dose at 16 years of age.

The CDC says ‘first monovalent (serogroup C) polysaccharide vaccine was licensed in the United States in 1974.

A quadrivalent polysaccharide vaccine was licensed in 1981.

Monovalent serogroup C meningococcal conjugate vaccine has been licensed in the United Kingdom since 1999 and has had a major impact on the incidence of serogroup C meningococcal disease.

Quadrivalent conjugate vaccines were first licensed in the United States in 2005.

A bivalent conjugate combination vaccine (with Hib) was licensed in the United States in 2012, and two serogroup B recombinant vaccines were licensed in early 2015.

Both MenACWY and MPSV4 vaccines are recommended by the CDC for use in the control of meningococcal outbreaks caused by vaccine-preventable serogroups (A, C, W, Y).

Hib-MenCY-TT may be used for age-appropriate persons in outbreaks specifically caused by vaccine-preventable serogroups C and Y.

Furthermore, the CDC vaccine committee said people in an outbreak setting whom public health officials deem to be at risk should receive a 1-time booster at least a year after the primary series.

And, public health officials should consider a vaccination interval as short as 6-months. depending on the outbreak conditions, such as a college campus.

A study published in January 2019 found that students who were aged 18 to 24 were 3.5 times more likely to contract MenB than their peers who were not attending college classes.

Ten university-based MenB outbreaks occurred during 2013–2018, causing a total of 39 cases and 2 deaths, reports the CDC.

In 5 of these outbreaks, additional cases occurred 6–259 days following MenB vaccination initiation.

Moreover, the additional MenB cases occurred mainly among unvaccinated students.

Although it is difficult to predict outbreak trajectories and evaluate the effects of public health response measures, achieving high MenB vaccination coverage is crucial to help protect at-risk persons during outbreaks of meningococcal disease caused by this serogroup, says the CDC.

Both Bexsero® and Trumenba® have been licensed by the US Food and Drug Administration.

The University of Nottingham located in the UK is a research-intensive university with a proud heritage, consistently ranked among the world's top 100.

MenB vaccine news published by Precision Vaccinations

Sub Title:

University of Nottingham study could have implications for the meningococcal group B vaccines Trumenba and Bexsero

References:

New research uncovers improvements in vaccines against meningitis

CDC: Meningococcal Disease

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Hexavalent Group B Streptococcus Vaccine Candidate Found Protective

Don Hackett — Fri, 20 Sep 2019 16:47:59 +0000

Reviewer:

Trial To Evaluate The Safety, Tolerability, And Immunogenicity Of A Multivalent Group B Streptococcus Vaccine In Healthy

Kelley Lu, PharmD

The results from a First-in-Human clinical study of a Hexavalent Group B Streptococcus (GBS6) conjugate vaccine were found to be positive.

This Phase 1/2 clinical study reported on September 17, 2019, the Multivalent Group B streptococcus vaccine candidate from Pfizer met the study’s end-points.

The GBS6 vaccine was reported well-tolerated in healthy adults and elicited robust immune responses for all at all dose levels and formulations that persisted through 6 months post-vaccination in healthy adults between the ages of 18-49 years.

This Phase 1/2 study is a placebo-controlled, observer-blinded dose-escalation trial, subjects (364) were randomized to receive a single dose of GBS6, formulated with or without AlPO 4, or saline placebo.

The primary objective of this study was to describe the safety of GBS6, assessed by prompted local and systemic reactogenicity for 14 days after vaccination and unprompted adverse events (AEs) for up to 6 months depending on the severity of the adverse event.

For the 312 GBS6 recipients, the most common injection site reaction was pain and the most common systemic reactions were fatigue and headache. Adverse events were reported by 21% to 48.1% of GBS6 recipients across groups, compared to 38.5% of placebo recipients.

Few recipients had serious adverse events during the 6 months of the study.

The secondary objective was to describe the immunogenicity as measured by GBS6 serotype-specific IgG geometric mean concentrations (GMCs) before and after vaccination.

GBS6 was reported to elicit robust immune responses for all recipients at all dose levels and formulations that persisted through 6 months after vaccination.

These researchers concluded saying ‘ this study supports the evaluation of GBS6 in pregnant women’ in future studies.

Currently, there is a larger ongoing Phase 2 study for a Multivalent Group B streptococcus vaccine sponsored by Pfizer.

Group B streptococcus (GBS) is an important cause of invasive disease in young infants. In the United States, GBS bacteria are a leading cause of meningitis and bloodstream infections in a newborn’s first 3 months of life, says the Centers for Disease Control and Prevention (CDC).

Infants born to women with sufficient pre-existing anti-GBS capsular IgG antibodies are at reduced risk of GBS disease.

But, newborns are at increased risk for GBS disease if their mother tests positive for the bacteria during pregnancy.

In newborns, GBS manifests as sepsis, pneumonia, and meningitis, with potentially fatal outcomes for some, and long-lasting neurological damage in about 46 percent of those infected.

And, case fatality rates are higher globally, 6-14% in high-income countries and 6-47% in low and middle-income countries.

Which means maternal immunization is an attractive disease prevention strategy for infants.

This study’s results are available via a PDF upon request.

These researchers work for Pfizer, Inc. Kimberly J. Center, M.D., Senior Director, Vaccine Clinical Research and Development, Pfizer, lead this study.

Published by Precision Vaccinations

Sub Title:

Pfizer GBS6 conjugate vaccine is targeted for the prevention of infant GBS invasive disease by maternal immunization

References:

A Novel Hexavalent Capsular Polysaccharide Conjugate Vaccine (GBS6) for the Prevention of Neonatal Group B Streptococcal

PFIZER BEGINS PHASE 1 CLINICAL TRIAL TO EVALUATE INVESTIGATIONAL GROUP B STREPTOCOCCUS VACCINE

CDC: Active Bacterial Core Surveillance (ABCs) Report Emerging Infections Program Network group B Streptococcus, 2016

FDA: Group B Streptococcus Maternal Immunization Program

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Kansas Expands School Vaccine Requirements

Don Hackett — Sat, 20 Jul 2019 16:03:44 +0000

Reviewer:

Kansas Department of Health and Environment: Hep A and Meningococcal Vaccines to be required for 2019-20 School Year

Two new vaccines will be required for school-age children to attend class in Kansas for the 2019-20 school year.

In a letter dated July 18, 2019, the Kansas Department of Health and Environment (KDHE) announced the following vaccine requirements for this academic year:

Vaccinations are required by August 2, 2019,
Students entering Kindergarten and Grade 1 now need two doses of the hepatitis A vaccine,
Students entering Grade 7 need one dose of the meningococcal ACWY vaccine,
Students entering Grade 11 need one dose of the meningococcal ACWY vaccine if not vaccinated prior to their 16th birthday. They will need two doses if their first dose was before their 16th birthday.

These vaccine requirements are in addition to the 2018-2019 Kansas school year schedule.

“We received many comments and input from all viewpoints,” KDHE Secretary Lee Norman said in a press release.

“We looked at the evidence. Both Meningitis and Hepatitis A illnesses are severe and preventable, and the safety profile of the vaccines is well-recognized. As an agency charged to establish policies that protect and improve the lives of Kansans, we felt the addition of the two vaccines was essential for the health and safety of our state.”

About these vaccines

Meningococcal ACWY Vaccine: The meningococcal ACWY vaccine protects against meningococcal disease, which has two common outcomes: meningitis (infection of the lining of the brain and spinal cord) and bloodstream infections. The bacteria that cause meningococcal disease spread through the exchange of nose and throat droplets, such as when coughing, sneezing, or kissing. Symptoms include sudden onset of fever, headache, and stiff neck. With bloodstream infection, symptoms also include a dark purple rash. About one of every 10 people who get the disease dies from it. Survivors of meningococcal disease may lose their arms or legs, become deaf, have problems with their nervous systems, become developmentally disabled, or suffer seizures or strokes. The Menactra vaccine is indicated for active immunization to prevent invasive meningococcal disease caused by Neisseria meningitidis serogroups A, C, Y, and W-135.
Hepatitis A Vaccine: The hepatitis A vaccine protects against the hepatitis A virus. The virus is spread primarily person to person through the fecal-oral route. In other words, the virus is taken in by mouth from contact with objects, food, or drinks contaminated by the feces (stool) of an infected person. Symptoms can include fever, tiredness, poor appetite, vomiting, stomach pain and sometimes jaundice (when skin and eyes turn yellow). An infected person may have no symptoms, may have a mild illness for a week or two, may have a severe illness for several months, or may rarely develop liver failure and die from the infection. There are 3 HAV vaccines approved in the USA, Vaqta, Havrix, and Twinrix, which are available at pharmacies in most states.

Furthermore, in accordance with KSA 72-6262, legal alternatives to vaccination requirements include medical contraindications and religious beliefs. The medical exemptions signed by a medical clinician must be submitted on an annual basis by the family/guardian of the student.

Additionally, there could also be instances in which a person has a religious belief that prevents them from receiving a particular vaccination. The parent/guardian of the student must submit a written statement indicating they are adherent of a religious denomination whose religious teachings are opposed to such vaccination.

Local school boards or governing body for nonpublic schools are responsible for ensuring compliance with these vaccination regulations and statutes in Kansas.

Regarding the cost of these vaccines, the Vaccines For Children program is a federally funded program that provides vaccines at no cost to children who might not otherwise be vaccinated because of inability to pay.

And, for those who do not qualify for the Vaccines-For-Children program, financial support programs can be found at Vaccine Discounts.

Vaccines can cause side effects, which should be reported to a healthcare provider, or the CDC.

Sub Title:

Meningococcal and hepatitis A vaccinations now required for Kansas students

References:

State of Kansas: KANSAS SCHOOL IMMUNIZATION REQUIREMENT (Kindergarten-12 th Grade) 2018-2019 SCHOOL YEAR

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Meningococcal Vaccination Schedule Changes Pending

Don Hackett — Mon, 01 Jul 2019 13:12:05 +0000

Reviewer:

Meningococcal Vaccine Recommendations

A Centers for Disease Control and Prevention (CDC) vaccine committee unanimously voted to recommend certain people at high-risk of serogroup B meningococcal disease get a ‘booster’ dose of the vaccine.

The CDC’s Advisory Committee on Immunization Practices (ACIP) says people with certain health conditions and those in an outbreak setting are at increased risk of serogroup B meningococcal disease (MenB).

Meningococcal disease is a serious illness caused by a type of bacteria called Neisseria meningitidis. It can lead to meningitis and infections of the blood, says the CDC.

The ACIP currently recommends MenB vaccinations for people 10 years of age and older with complement deficiency, complement inhibitor use or asplenia; microbiologists; and people exposed during an outbreak are vaccinated.

The ACIP recommendations suggest that individuals age 10 years or older at an elevated risk for serogroup B meningococcal disease get a MenB primary series and that teens and young adults ages 16 to 23 years may be vaccinated with a MenB primary series as determined by the physician through clinical decision making.

Since there is evidence that the MenB vaccine’s immunity protection wanes after 2 years, the ACIP approved a booster dose for people with the health issues listed above, reported the AAP.

These individuals should receive the MenB vaccine booster a year after the primary series and additional booster doses every 2 to 3 years, while the health risk is ongoing.

Furthermore, the ACIP committee said people in an outbreak setting whom public health officials deem to be at risk should receive a 1-time booster at least a year after the primary series.

And, public health officials should consider a vaccination interval as short as 6-months. depending on the outbreak conditions, such as a college campus.

A study published in January 2019 found that students who were aged 18 to 24 were 3.5 times more likely to contract MenB than their peers who were not attending college classes.

Ten university-based MenB outbreaks occurred in 7 states during 2013–2018, causing a total of 39 cases and 2 deaths, reports the CDC.

In 5 outbreaks, additional cases occurred 6–259 days following MenB vaccination initiation.

Moreover, the additional MenB cases occurred mainly among unvaccinated students.

All 10 universities implemented MenB vaccinations: 3 primarily used MenB-FHbp and 7 used MenB-4C.

Recent MenB news:

Regarding the CDC’s Vaccine-For-Children program’s meningococcal vaccines, the ACIP unanimously voted in favor of removing the conjugate vaccine HibMenCY from the list of currently available vaccines, and for new guidelines regarding serogroup B meningococcal vaccine booster doses.

Two serogroup B meningococcal vaccines — Bexsero® and Trumenba® — have been licensed by the US Food and Drug Administration.

MenB vaccines can help prevent meningococcal disease caused by serogroup B. Other meningococcal vaccines are recommended to help protect against serogroups A, C, W, and Y.

These vaccines are recommended routinely for people 10 years or older who are at increased risk for serogroup B meningococcal infections.

In conclusion, the ACIP said the same MenB vaccine should be used for all vaccination doses.

The ACIP provides advice and guidance to the Director of the CDC regarding the use of vaccines. Recommendations made by the ACIP are reviewed by the CDC Director and, if adopted, are published as official recommendations in the Morbidity and Mortality Weekly Report.

Sub Title:

MenB vaccines Bexsero and Trumenba can help prevent meningococcal disease caused by serogroup B

References:

Effectiveness and Duration of Protection of One Dose of a Meningococcal Conjugate Vaccine

Serogroup B Meningococcal (MenB) VIS

Vaccines for Children Program (VFC)

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Meningococcal Vaccine Elicited Higher Protective Antibody Responses

Don Hackett — Fri, 28 Jun 2019 20:14:00 +0000

Reviewer:

A Meningococcal Outer Membrane Vesicle Vaccine with Overexpressed Mutant FHbp Elicits Higher Protective Antibody Responses

Researchers have developed a Native Outer Membrane Vesicle (NOMV) vaccine, for meningitis and bloodstream infections caused by "meningococcal group B" bacteria.

"We developed the improved version of the vaccine by making several genetic changes to the strain of bacteria used to produce the vaccine, resulting in a broadly protective vaccine rather than a strain-specific vaccine," said Peter Beernink, Ph.D., Scientist at the Center for Immunobiology and Vaccine Development, Benioff Children's Hospital Oakland.

"The experimental NOMV vaccine extends the approach of using outer membrane vesicle vaccines, which previously have been given to millions of persons during meningitis B epidemics in Norway, Cuba and New Zealand," said Dr. Beernink in a press release.

Both vaccines contain a bacterial protein known as Factor H binding protein (FHbp), which can bind to a host protein known as Factor H (FH).

The researchers immunized infant rhesus monkeys with the NOMV-FHbp vaccine, which induced higher levels of protective serum antibodies than a licensed vaccine against five of six bacterial strains tested.

Two macaques immunized with the licensed vaccine, which contains FHbp that binds macaque FH, developed antibodies to the host FH protein whereas none of the animals given the NOMV-FHbp vaccine or a negative control vaccine developed such antibodies.

Thus, in a relevant infant non-human primate model, the NOMV-FHbp vaccine elicited higher levels of protective antibodies than the licensed vaccine and anti-FH antibodies in fewer animals.

"This shows that the vaccine has the potential to be developed into a more broadly protective vaccine for humans, to extend coverage to infants and toddlers, which are the age groups among the highest risk of developing meningococcal disease, and to increase vaccine safety," said Dr. Beernink.

This is good news because the approved vaccines are licensed for people age 10 years and older.

Furthermore, these licensed vaccines lack some effectiveness against some bacterial strains and low immune responses of infant humans.

Meningococcal disease refers to any illness caused by bacteria called Neisseria meningitidis, also known as meningococcus. These illnesses are often severe and can be deadly.

They include infections of the lining of the brain and spinal cord (meningitis) and bloodstream infections (bacteremia or septicemia).

These bacteria spread through the exchange of respiratory and throat secretions like spit.

Doctors treat meningococcal disease with antibiotics, but quick medical attention is extremely important. Keeping up to date with recommended vaccines is the best defense against meningococcal disease.

The work was performed by Peter Beernink, Dan Granoff and colleagues at UCSF Benioff Children's Hospital Oakland (California). The work was funded by a research grant from the National Institute of Allergy and Infectious Diseases, National Institutes of Health.

Sub Title:

NOMV vaccine candidate elicited higher levels of protective antibodies in monkeys than licensed vaccine

References:

An improved vaccine for bacterial meningitis and bloodstream infections

A Meningococcal NOMV-FHbp Vaccine for Africa Elicits Broader Serum Bactericidal Antibody Responses Against Serogroup B and non-B

Meningococcal Disease

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California College Freshman Now Required to Prove MenB Vaccination

Don Hackett — Fri, 31 May 2019 15:22:12 +0000

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SDSU to Require menB Vaccine for all Incoming Students Effective Fall 2019

San Diego State University (SDSU) announced that incoming freshman students are now required to present proof of meningococcal B (menB) vaccination within the first 10 days of Fall 2019 classes.

A class registration ‘hold’ will be placed on SDSU freshman unable to prove menB vaccination, SDSU said in a statement on May 30, 2019.

This new vaccination policy is related to 3 confirmed cases of meningococcal serogroup B at SDSU during 2018.

Since the Fall 2018 semester, the university has continued to strongly urge all SDSU undergraduate students 23 years of age or younger, who have not yet been fully vaccinated for serogroup B meningococcal disease, to receive one of the menB vaccines, Bexsero or Trumenba.

Since that 2018 outbreak, nearly 9,000 SDSU students have been vaccinated against meningococcal serogroup B.

SDSU’s decision supersedes the new California State University (CSU) immunization policy by rolling out expanded immunization requirements 1 year earlier and making menB a required vaccine, as opposed to a recommended one.

On March 25, 2019, Executive Order 803 was revised expanding the CSU immunization requirements. In accordance with CSU policy, each campus president has the responsibility for implementing executive orders.

Executive Order 803, says all new, incoming students will be required to receive the Measles, Mumps, and Rubella, Hepatitis B (HepB), Varicella, Tetanus-Diphtheria-Pertussis, meningococcal disease (Serogroups A, C, Y, W-135) vaccines, and the Tuberculosis Screening.

“As we became aware of the immunization conversations occurring at the CSU level, it was important for us to make the menB vaccine a required immunization given our ongoing meningococcal serogroup B outbreak, but more importantly, for the overall health and safety of our campus community,” said Andrea Dooley, associate vice president for Student Affairs.

New, incoming SDSU students were made aware of the immunization requirements through university communications which began mid-May 2019 when receiving confirmation of their admission to SDSU.

The new immunization requirements are also posted to SDSU Student Health Services.

Vaccination is the best defense against meningococcal meningitis, yet according to the Centers for Disease Control and Prevention (CDC), more than 50 percent of U.S. teens have not received the recommended 2nd dose of a meningococcal meningitis vaccine.

Meningococcal disease is caused by infection with bacteria called Neisseria meningitidis.

These illnesses are often severe and can be deadly. They include infections of the lining of the brain and spinal cord, meningitis and bloodstream infections, bacteremia or septicemia.

Meningococcal disease is treated with antibiotics, however quick medical attention is extremely important since 10-15 percent of people may die despite receiving antibiotic treatment.

Keeping up to date with recommended vaccines is the best defense against meningococcal disease.

Most pharmacies in the USA offer vaccination services, including menB vaccines.

Vaccine prices vary and can be researched at this CDC site. To research vaccine financial support programs, please visit this page.

Vaccines, like any medicine, can have side effects, says the CDC. You are encouraged to report negative side effects of vaccines to the FDA or CDC.

Sub Title:

Meningococcal B vaccines include Bexsero and Trumenba

References:

Immunization Requirements - Executive Order 803

Immunization Requirements & Recommendations

California State Universities May Require MenB Vaccination

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UK Decreases Prevnar 13 Vaccinations From 3 to 2 Doses for Infants

Don Hackett — Wed, 17 Apr 2019 12:49:25 +0000

Reviewer:

John Paul Sanchez, PharmD

The United Kingdom (UK) announced it will become the first country in the world to reduce the pneumococcal conjugate vaccine (PCV) from 3 to 2 doses for children.

The PCV vaccine, Prevnar 13, which protects children from 13 types of pneumococcal bacteria and against diseases such as pneumonia, sepsis, and some types of meningitis, is currently given to infants at 2 and 4 months of age, followed by a booster at 13 months.

This decision is based upon the July 2018 Joint Committee on Vaccination and Immunisation (JCVI) recommendation after a study published in the Lancet showed that the PCV vaccine was just as effective and safe in children when given in 2 shots, reported The Telegraph on April 16, 2019.

A UK Department of Health and Social Care spokesperson said it was estimated that the vaccine had prevented more than 5,000 deaths and 40,000 cases of the serious disease since it was first introduced.

"The program has been so effective in creating population-wide immunity in the UK that independent experts have advised we can sustain the excellent results we have seen already by moving from three doses of the vaccine to two," the UK spokesperson added.

Experts believe that the change could eventually pave the way for similar policies in lower and middle-income countries, saving them significant amounts of money.

The UK does not disclose how much it pays for Prevnar 13, which is manufactured by the US drug firm Pfizer. But it is one of the most expensive vaccinations in the routine childhood schedule and in the US it costs $130 for every shot.

David Goldblatt, professor of vaccinology and immunology at University College, London, who led the research that helped inform the JCVI's decision, said that the UK's decision would give confidence to other countries.

"If you're a country which has only recently introduced the Prevnar 13 vaccine you couldn't go straight to the [new dosing] schedule. But there are some countries in Africa - South Africa is one example - which could move to it relatively quickly," he said.

Recent Prevnar 13 news articles:

In the USA, the Centers for Disease Control and Prevention (CDC) recommends the pneumococcal conjugate vaccine for all children younger than 2 years old, all adults 65 years or older, and people 2 through 64 years old with certain medical conditions.

The CDC recommends pneumococcal polysaccharide vaccine for all adults 65 years or older, people 2 through 64 years old with certain medical conditions, and adults 19 through 64 years old who smoke cigarettes.

Talk with your child’s healthcare professional if you have questions about vaccines.

Relevant Links: CDC vaccination schedules, CDC vaccine price list, international travel alerts, and report vaccine side effects.

Sub Title:

CDC recommends pneumococcal conjugate vaccine (PCV) for all children younger than 2 years old

References:

World watches as UK announces it will drop key childhood vaccine to two doses

JOINT COMMITTEE ON VACCINATION AND IMMUNISATION PNEUMOCOCCAL SUB-COMMITTEE

Pneumococcal conjugate vaccine 13 delivered as one primary and one booster dose compared with two primary doses and a booster

Pneumococcal Vaccination

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Niger Discovers ‘Fake’ Meningitis Vaccine Given to Children

Don Hackett — Fri, 15 Mar 2019 23:46:11 +0000

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Niger's Health Minister warns of possible circulation of fake meningitis medications

Niger health authorities said today ‘they had found a fake version of a meningitis vaccine after launching a vaccination campaign to inoculate 5 million children against the disease.

The Ministry of Public Health Dr. Idi Illiassou Mainassara said on March 15, 2019, the bogus vaccine, Mencevax ACWY, had been discovered during a "routine inspection" in the Niger capital city of Niamey.

An investigation is underway to try to ascertain how many of the fake vaccines have been used, the spokesman said. The fake vaccine is marked as having been manufactured in December 2016, with an end-date for use by November 2021.

In a statement, Dr. Mainassara asked doctors to be vigilant over this "counterfeit" vaccine.

Niger is a country that lies in the so-called "meningitis belt" stretching from Senegal in West Africa to Ethiopia in the east.

The Meningitis Belt is where outbreaks of the disease are a regular occurrence, says the World Health Organization (WHO).

In December 2010, a new meningococcal A conjugate vaccine was introduced in Africa through mass campaigns targeting persons 1 to 29 years of age.

As of November 2017, more than 280 million persons have been vaccinated in 21 African belt countries.

The vaccine is remarkably safe and cheap. In addition, its thermostability allows its use under Controlled Temperature Chain (CTC) conditions.

Its impact on carriage and the reduction in disease and epidemics is significant: a 58% decline in meningitis incidence and a 60% decline in the risk of epidemics were described.

It is now introduced into routine infant immunization.

Maintaining high coverage is expected to eliminate meningococcal A epidemics from this region of Africa.

However, other meningococcal serogroups such as W, X, and C still cause epidemics and around 30 000 cases are reported each year in the meningitis belt.

WHO is committed to eliminating the meningococcal disease as a public health problem.

Meningococcal meningitis is a bacterial form of meningitis, a serious infection of the thin lining that surrounds the brain and spinal cord.

Meningococcal meningitis is associated with high fatality (up to 50% when untreated) and high frequency (more than 10%) of severe sequelae.

Early antibiotic treatment is the most important measure to save lives and reduce complications.

Previously, the US Centers for Disease Control and Prevention (CDC) had issued Travel Alerts for Polio in Niger on December 14, 2018. The CDC recommends that all travelers to Niger be fully vaccinated against the polio virus.

The CDC recommends vaccination with a meningococcal conjugate vaccine for all preteens and teens at 11 to 12 years old, with a booster dose at 16 years old. Teens and young adults (16 through 23-year-olds) also may be vaccinated with a serogroup B meningococcal vaccine.

Separately, on February 15, 2019, the US Department of State issued a Level 3 Travel Advisory, Reconsider Travel, regarding safety and security risks in Niger.

Sub Title:

Mencevax ACWY has been reported in Niger as a fake meningitis vaccine

References:

WHO Update on the health situation in Niger

Meningococcal meningitis

Health Information for Travelers to Niger Traveler View

Reconsider travel to Niger due to crime and terrorism

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Are Colleges Prepared for a Meningococcal Disease Outbreak?

Don Hackett — Thu, 14 Mar 2019 18:26:20 +0000

Reviewer:

John Paul Sanchez, PharmD

Kelley Lu, PharmD

University-Based Outbreaks of Meningococcal Disease Caused by Serogroup B, United States, 2013–2018

New research says ‘achieving high MenB vaccination coverage is crucial to help protect at-risk persons during outbreaks of meningococcal disease caused by this serogroup.’

Moreover, 10 to 15 percent of meningitis B patients ultimately die from an infection, says the CDC.

This new study was published by the Centers for Disease Control and Prevention (CDC) in March 2019, it says ‘Although the incidence of meningococcal disease is low, university students are at increased risk of meningococcal disease caused by serogroup B outbreaks.’

This study reviewed outbreaks between 2013 and 2018 that included 39 cases and 2 deaths.

In some outbreaks, cases occurred over a prolonged period of time, as in a 2008–2010 Ohio outbreak, and the 2013–2014 New Jersey outbreak.

Half of the 10 studied outbreaks ended following implementation of MenB vaccination efforts, but additional cases occurred at the other 5 universities, mainly among unvaccinated students or close contacts.

College students are at risk for this disease since the MenB vaccine is not integrated into standard vaccination schedules, said this study.

A recent survey demonstrated that only 2 percent of universities require MenB vaccination for students prior to matriculation.

During 2013–2018, between 1 to 4 university-based MenB outbreaks occurred annually.

These outbreaks varied in size and duration and affected both small and large universities. All the outbreaks occurred at residential 4-year degree-granting universities.

Similar university-based disease outbreaks were reported in Canada in 2015, and the United Kingdom in 2017.

In 2017, partly on the basis of the experiences of these university outbreaks, the CDC revised its guidance for the evaluation and public health management of suspected outbreaks of meningococcal disease.

In the revised guidance, the outbreak threshold for vaccine decision-making in an organization-based outbreak, such as at a university, is defined as 2–3 outbreak-associated cases within an organization during a 3-month period.

“In most situations, 2 cases within an organization constitute an outbreak. However, in some situations, such as an outbreak within a large university where no identifiable subgroup at risk within the population can be identified, it may be reasonable to declare an outbreak after 3 cases,” said these researchers in a CDC statement.

The CDC says ‘decisions about whether, when, and how to offer MenB vaccine during an outbreak remain challenging and should be tailored to the unique epidemiology of each outbreak.’

Although the exact MenB vaccination coverage among young adults in the USA is unknown, the coverage of 1 dose of MenB vaccine among persons 17 years of age was estimated to be 14.5 percent in 2017.

Recently, on December 3rd, 2018, a New Jersey State committee approved Assembly Bill 1991 requiring residential students at 4-year colleges receive vaccinations that provide protection from meningitis serogroup B.

Currently, New Jersey is one of 37 states requiring college students to be vaccinated with the meningococcal conjugate vaccine, which delivers protection for meningitis serogroups A, C, W, and Y.

But, on December 19th, 2018, Johns Hopkins Medicine researchers said ‘that providing universal vaccination against the meningitis B infection to college students may be too costly to justify.’

Two serogroup B meningococcal vaccines — Bexsero® and Trumenba® — have been licensed by the US Food and Drug Administration.

These vaccines are recommended routinely for people 10 years or older who are at increased risk for serogroup B meningococcal infections.

Other meningococcal vaccines are recommended to help protect against serogroups A, C, W, and Y.

Meningococcal meningitis is a rare but serious bacterial infection. It causes the membranes that cover the brain and spinal cord to become inflamed.

Each year, approximately 1,000 people in the U.S. get meningococcal disease, which includes meningitis and septicemia, says the CDC.

Recent MenB vaccine news:

Dr. Soeters lead this new CDC study and is an epidemiologist in the Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC.

The members of the Serogroup B Meningococcal Disease University Outbreak Group are: Kathleen Harriman and Kathleen Winter (California); Susan Lett, Ann Becker, and Kerry-Beth Garvey (Massachusetts); Barbara Montana and Elizabeth F. Zaremski (New Jersey); Tasha Poissant (Oregon); Perrianne Lurie and Elizabeth A. Negrón (Pennsylvania); Utpala Bandy (Rhode Island); and Susann Ahrabi-Fard (Wisconsin).

Sub Title:

Bexsero and Trumenba are serogroup B meningococcal vaccines licensed by the FDA

References:

Meningococcal Disease

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MenB May Linger on Campus After an Outbreak

Don Hackett — Fri, 15 Feb 2019 19:03:00 +0000

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