© UNIVERSITY OF CINCINNATISarah Ely, of Milford, Ohio, a first-year student at the University of Cincinnati, receives a meningitis B vaccination from Randi Smith, a staff member with UC's University Health Services.
As the fall semester gets under way, some U.S. colleges and universities are offering students new vaccines against a bug responsible for recent campus outbreaks of a rare but life-threatening form of meningitis.
Academic institutions are taking a range of approaches, from simply making the shots available at student health centers to anyone who is interested, to holding vaccine clinics on campus that students are required to attend.
Providence College, where two students contracted meningitis last winter, held vaccination clinics the past two weekends. The school required first-year students to attend, though students could opt out of receiving the shots.
"We wanted to immunize students as soon as possible," partly because of the risk that some students may still be carrying the bug, says Kristine Goodwin, vice president of student affairs at the Rhode Island college.
Two new vaccines, Trumenba and Bexsero, protect against a category of strains of Neisseria meningitidis known as serogroup B. The bacteria, which are spread by contact with saliva or mucus, can cause meningitis, an inflammation of membranes around the brain and spinal cord that can be fatal or cause disabilities. Symptoms include fever, headache and stiff neck. Meningitis is more commonly diagnosed in adolescents and young adults than other age groups.
Older meningitis vaccines that have been routinely given to adolescents in the U.S. for the past decade don't protect patients from the B strains. Those older vaccines, which include Menactra, protect against four other serogroups. Many states require university students to receive them. Until 2014, there were no meningitis B vaccines approved for sale in the U.S.
But the U.S. Food and Drug Administration approved Pfizer's Trumenba and GlaxoSmithKline's Bexsero for use in adolescents and young adults. Clinical studies showed the shots triggered immune responses believed to protect against meningitis B in a majority of recipients, as measured by blood tests. But because the rate of meningitis B is low, studies haven't yet determined whether the shots reduced the rate of infections versus a placebo.
In June, a U.S. Centers for Disease Control and Prevention advisory committee said the new MenB vaccines, as they're known, may be given to provide short-term protection to people ages 16 to 23, and that decisions to vaccinate should be left up to families and doctors.
The CDC committee stopped short of its strongest recommendation—routine vaccination of adolescents, which some experts and patient advocates support—because it wanted more data about the long-term safety and efficacy of the shots. The committee may revisit its recommendation in the future.
The CDC committee also has recommended that high-risk groups get the shots, including those with certain genetic deficiencies or impaired spleen function, as well as people close to an outbreak.
The vaccines aren't cheap, costing $320 to $345 for complete dosing regimens. (Bexsero is given in two doses at least one month apart, Trumenba in three doses over several months). But most insurers are either already paying for the vaccines or are expected to begin covering them soon, according to the vaccines' manufacturers and the trade group America's Health Insurance Plans.
Serogroup B infections have caused more than 20 cases of meningitis at institutions including Providence, the University of Oregon, Princeton University and the University of California, Santa Barbara since 2013, according to the National Foundation for Infectious Diseases. Some of the infected students died.
The prevalence of bacterial meningitis, however, is relatively low, affecting about 500 to 600 Americans a year. About one-third of those cases are caused by serogroup B strains, says Jessica MacNeil, a CDC epidemiologist. The incidence of meningitis has declined since the 1990s.
Providence launched a mass vaccination campaign for students and certain staff after two students were hospitalized with meningitis B in February. More than 90% received the first shot of the three-dose Trumenba series. Neither student died, and no additional cases associated with Providence have been reported.
But throat cultures from a sample of students found that at least one was a carrier of the bug—though not infected. The college decided to vaccinate all first-year students and held a clinic Aug. 30, the day before classes started.
About 750 of 1,040 eligible students were vaccinated, says Kathy Kelleher, director of the student health center. Some didn't receive the shot because they weren't sure if they had already gotten one, she says. Most of these students were expected to get the shot at subsequent clinics.
Michael Foss, a Providence freshman from Charlton, Mass., showed up at the Aug. 30 clinic. He initially thought he didn't need the shot because he had received the older meningitis vaccine. But after texting his mother, he learned he hadn't gotten the MenB shot and she recommended he get it, he says.
His only complaint: upper-arm soreness. "It hurt to put pressure on it" the night after he got the shot, he says. The shots are associated with more intense soreness than other common vaccines, but studies show that overall side effects are considered tolerable.
The University of Cincinnati didn't require incoming students to be vaccinated, but it held a series of mobile vaccination clinics around campus in late August. Glenn Egelman, executive director of the university's health services, says he promoted the vaccine after a handful of meningitis B cases surfaced near campus in the past year.
More than 200 students got vaccinated, a small portion of the overall student body of 44,000. Dr. Egelman says one limitation was students' mistaken assumption that the older vaccine protected against MenB. Still, the health service used up its initial supply of shots, and plans on holding more clinics in the future.
Some universities cite the CDC recommendations for taking more limited approaches. The student health center at the University of Missouri at Columbia doesn't have the MenB shots in stock, but its doctors will write prescriptions for students that can be filled at a nearby pharmacy, says Susan Even, executive director of the center.
If the CDC had given its strongest recommendation for routine vaccination of adolescents, "it would be much more likely" that universities would be stocking up on the shots, says Dr. Even, who is also chairwoman of a vaccine committee of the American College Health Association.
The University of Pennsylvania's student health service is making it available to those who are interested, says Giang Nguyen, executive director of the service. He cited the CDC guidelines and noted the risk of meningitis is "quite low."
Some advocates would like to see wider use of the shots, not just on campuses but for other adolescents and young adults, too. "Why not protect everyone, so that if there is an upturn in disease incidence, we've already gotten people protected, we don't have to do it after the fact?" asks Lynn Bozof, president of the National Meningitis Association, an advocacy group. Ms. Bozof's 20-year-old son died from meningitis in 1998.
Mark Schleiss, a pediatric infectious disease specialist at the University of Minnesota, says: "I can tell you as a parent, for me it would be a no-brainer to want to get my children immunized against MenB. Because you never know if your child is going to be that one that's at risk."
Reader Comments
to our Newsletter