Meningitis is an infection of the fluid and tissues surrounding the brain which can be caused by viruses or bacteria. While most cases of viral meningitis are fairly mild, bacterial meningitis can be a severe, life threatening infection, and is greatly feared. Meningitis caused by the meningococcal bacteria is particularly serious as it can strike very quickly and progress rapidly, often leading to death in several hours. Some studies have shown that college students are at increased risk of being infected by the meningococcal bacteria, particularly first year students living in dormitories. For this reason, most colleges including Tufts require that incoming first year students receive a dose of the quadravalent meningococcal vaccine (two brand names are Menveo and Menactra) at age 16 or after.
The quadravalent meningococcal vaccine protects against four different strains of the bacteria: A, C, W, and Y, and has been available since 2005. However, there is a fifth strain, meningococcus type B (called MenB), that also causes meningitis in college students. It is the strain that most commonly causes bacterial meningitis in college students at this time. Developing an effective vaccine against MenB has been difficult, and an effective product for use in adolescents and young adults has only been approved in the past year and a half.
The CDC Advisory Committee on Immunization Practices (ACIP) has recommended MenB vaccination for people 10 years of age or older who have medical conditions that compromise their immune system and make them more susceptible to bacterial infection. But MenB is not required or routinely recommended for adolescents or young adults without medical indications. ACIP advises a discussion between the patient and primary care provider when deciding whether to get vaccinated with MenB. It is framed as a personal choice. On the one hand, Meningococcal meningitis is rare, but devastating when it occurs. On the other hand, because the vaccine is not routinely recommended, health insurances may not cover it for healthy students. Meningitis vaccines in general have a history of being well tolerated. Side effects of Men B noted to date are mild; pain at injection site, possible fatigue, headache or low grade fever. Severe reactions have not been described, but the vaccine has not been widely used yet. So cost and individual concern about risk of infection and risk of vaccines all play a role in thinking about this vaccine. If cases of meningitis were to occur among Tufts students, the recommendation for vaccination would change significantly; in that situation, vaccination would be strongly recommended for all.
Based on my review of the literature, I believe the MenB immunization is an important addition to our tool kit in preventing meningitis. I believe it is a health option that families should consider as they send their students off to college, and I recommend you discussing it with your child’s pediatrician.
Margaret Higham MD
Tufts University Health Service