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meningococcal serogroup B vaccine (Bexsero, Trumenba, 4CMenB)

Indications: - prevention of infection with Neisseria meningitidis serogroup B - persons at high-risk for infection with meningococcal serogroup B infection [3,8] - persistent complement component deficiency - anatomic or functional asplenia - microbiologists routinely exposed to isolates of Neisseria meningitidis - serogroup B meningococcal disease outbreak [5] - ACIP gives weak recommendation for young people at their physician's discretion [6] - patients ages 16-23 may be vaccinated, preferably at age 16-18 - insufficient evidence to recommend vaccinating all adolescents [7] - FDA-approved for patients age 10-25 years [7] Contraindications: - pregnant women should not be vaccinated unless they are at high risk [7] Benefit/risk: - 82% with antibodies that kill 4 N meningitidis serogroup B strains after vaccination (vs 1% without vaccination) - seems to prevent meningitis, but carriage of N meningitidis persists in vaccinated individuals [4] Dosage: - 3 doses for Trumenba, 2 for Bexsero at least one month apart - 2 doses of Trumenba for patients aged 16-23 years not at increased risk [10] - may be given with other vaccines, but should be given at different location [10] Adverse effects: - injection site pain & swelling - headache - diarrhea - myalgia - arthralgia - fatigue - chills Mechanism of action: - multicomponent vaccine - ~2/3 of vaccinated college students show effective bactericidal activity against outbreak strain of serogroup B N meningitidis despite 2 antigens in common [8] Notes: - 2 trials show immunologic response of bivalent meningococcal B vaccine, but do not show that the vaccine protects against clinical meningococcal infection [11]

Related

meningoccal conjugate vaccine ACWY (Menveo) Neisseria meningitidis (meningococcus)

General

meningococcal vaccine

References

  1. FDA News Release. October 29, 2014 First vaccine approved by FDA to prevent serogroup B Meningococcal disease http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm420998.htm
  2. FDA News Release. January 23, 2015 FDA approves a second vaccine to prevent serogroup B meningococcal disease. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm431370.htm
  3. Young K, Sofair A, Chavey WE ACIP Recommends Serogroup B Meningococcal Vaccines in High-Risk People. Physician's First Watch, Feb 27, 2015 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org - Pfizer News Release. Thursday, February 26, 2015 CDC Advisory Committee on Immunization Practices Votes to Recommend Serogroup B Meningococcal Disease Vaccination for Persons at Increased Risk. http://www.pfizer.com/news/press-release/press-release-detail/cdc_advisory_committee_on_immunization_practices_votes_to_recommend_serogroup_b_meningococcal_disease_vaccination_for_persons_at_increased_risk
  4. McNamara LA et al. First use of a serogroup B meningococcal vaccine in the US in response to a university outbreak. Pediatrics 2015 May; 135:798 PMID: 25917990 http://pediatrics.aappublications.org/content/135/5/798
  5. Folaranmi T et al Use of Serogroup B Meningococcal Vaccines in Persons Aged >= 10 Years at Increased Risk for Serogroup B Meningococcal Disease: Recommendations of the Advisory Committee on Immunization Practices, 2015. MMWR Weekly. June 12, 2015 / 64(22);608-612 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6422a3.htm
  6. JWatch editors ACIP Offers Weak Recommendation for Serogroup B Meningococcal Vaccine for Younger People Physician's First Watch, June 26, 2015 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
  7. MacNeil JR, Rubin L, Folaranmi T et al Use of Serogroup B Meningococcal Vaccines in Adolescents and Young Adults: Recommendations of the Advisory Committee on Immunization Practices, 2015. MMWR Weekly. October 23, 2015 / 64(41);1171-6 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6441a3.htm
  8. Basta NE et al Immunogenicity of a Meningococcal B Vaccine during a University Outbreak. N Engl J Med 2016; 375:220-228. July 21, 2016 PMID: 27468058 http://www.nejm.org/doi/full/10.1056/NEJMoa1514866 - Kim JH A Challenge in Vaccine Development - Neisseria meningitidis Serogroup B. N Engl J Med 2016; 375:275-278. July 21, 2016 PMID: 27468064 http://www.nejm.org/doi/full/10.1056/NEJMe1606015
  9. AAP Committee on Infectious Diseases. Recommendations for serogroup B meningococcal vaccine for persons 10 years and older. Pediatrics 2016 Sep; 138:e20161890. PMID: 27573083
  10. Patton ME, Stephens D, Moore K, MacNeil JR. Updated Recommendations for Use of MenB-FHbp Serogroup B Meningococcal Vaccine - Advisory Committee on Immunization Practices, 2016. MMWR Morb Mortal Wkly Rep 2017;66:509=513. https://www.cdc.gov/mmwr/volumes/66/wr/mm6619a6.htm
  11. Ostergaard L et al. A bivalent meningococcal B vaccine in adolescents and young adults. N Engl J Med 2017 Dec 14; 377:2349 PMID: 29236639 http://www.nejm.org/doi/10.1056/NEJMoa1614474
  12. Mbaeyi SA, Bozio CH, Duffy J et al. Meningococcal Vaccination: Recommendations of the Advisory Committee on Immunization Practices, United States, 2020. MMWR Recomm Rep 2020;69(No. RR-9):1-41. Sept 25, 2020 Not indexed in PubMed https://www.cdc.gov/mmwr/volumes/69/rr/rr6909a1.htm
  13. HIGHLIGHTS OF PRESCRIBING INFORMATION BEXSERO (Meningococcal Group B Vaccine) suspension, for intramuscular injection https://gskpro.com/content/dam/global/hcpportal/en_US/Prescribing_Information/Bexsero/pdf/BEXSERO.PDF