2015-09-03

The new meningitis B vaccines

The new meningitis B vaccines-
Not yet recommended for routine use

As you have recently read in our postings, bacterial meningitis is a particularly horrible and deadly infection, and there are immunizations that can prevent it.

A very new immunization for meningitis is now available, and being heavily marketed to the public and to doctors.  The immunization is for a very specific subset of meningitis, the bacterial meningitis caused by one of the five types of the meningococcal germ, Type B meningococcus.

The meningococcal type B immunization is being marketed under two brand names, Bexsero and Trumendba.  (These names once again remind me of my wonder at how drug names are created, these, like most drug brand names, are so odd and unusual).  Our office has received very expensive promotional materials, including audio materials, very compelling photography, multi-color layouts.
Of course, as with all promotional materials, we do not accept or keep, or refer to them, but instead we try to get the information directly from trustworthy scientists.

With that in mind, I recently asked Dr. Walter Orenstein his thoughts on this new immunization.
Dr. Orenstein headed the National Immunization Program for many years, and currently heads the vaccine program of research and study at Emory University, down the street from his old office at the CDC.

It turns out that Dr. Orenstein attended the meeting of the ACIP this summer that weighed the case for and against use of the meningococcal type B immunizations.   The ACIP is the nation's group of experts that weighs all data concerning immunizations and crafts the best recommendations on their use.  ACIP stands for Advisory Committee on Immunization Practices.

The ACIP met this summer and reviewed these new vaccines.  After careful review of the new meningococcal Type B vaccines, their recommended that these vaccines not be given routinely, but that patients and their doctors can discuss its use.  They also recommended this vaccine be given to those few individuals with immune system deficiencies that make getting meningococcal infections more likely.

The ACIP decided against recommending routine use for two key reasons:  they had concerns about safety, and they had concerns about how well it would help.

Safety concerns from the ACIP
The safety concerns had to do with reports that adolescents who got this immunization had some serious problems, including a painful condition called rhabdomyolysis in which muscle can become inflamed severely, and seven other serious events.   It is not clear if the adverse events were due to the vaccine, but until that is settled, routine use is not recommended.

Does it really help?
The ACIP, according to its report, and what Dr. Orenstein told us, raised concerns that trends showing meningococcal Type B infections are becoming less common even before this vaccine was created.   It is also not clear how long this vaccine remains effective.  These and other concerns made the ACIP wonder if use of this vaccine would offer enough benefit to recommend it.  At this time, the ACIP concluded it did not, but awaited further information to see if it might be someday.

BOTTOM LINES
1.  The meningococcus is a nasty bacteria that causes very dangerous infections, including meningitis.
2.   The Menactra immunization protects against 4 types of meningococcus- the A, C, Y, and W-135 types.  We use this routinely and it works well and safely.
3.   There is a tremendous amount of publicity and marketing heralding the arrival of an immunization for the 5th of the 5 types of meningococcus, the B Type.  And it is sold under two brand names, Bexsero and Trumenba.
4.   We consulted one of the country's top authorities on immunizations, Dr. Walter Orenstein, who reviewed the nation's top agency's (ACIP) thoughts on the pros and cons of use of the meningococcal Type B vaccine.
5.    The ACIP has concluded that concerns about the safety of this vaccine, and of how limited its benefits may be lead them to recommend that it not be used for routine use.
6.    At the same time, the ACIP did recommend that patients and doctors discuss its use.
7.    We at Advanced Pediatrics have concluded that we will keep the meningococcal Type B vaccine in stock, and available.   It is to be given to those with specific defects of their immune system.  But also, for families that have a strong concern about the risk of any meningococcal infections, the vaccine can be given with the understanding that its safety and ability to protect are not yet fully established.  Finally, families should know that it is not yet known if insurers will pay for it.

To your health,
Dr. Arthur Lavin



*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

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