Immunization update: What’s changed, what’s on the way

ACIP will attempt to address multiple issues in the next year regarding HPV vaccination: HPV9 use in men and women, including the possibility of catch-up schedules for those who have received HPV4 or HPV2; the possibility of using a 2-dose schedule for all HPV vaccines; and ways to increase uptake of this cancer-preventing vaccine.

Meningococcus type B

With the widespread use of quadrivalent meningococcal vaccines (MCV4), meningococcal meningitis has declined markedly in all age groups. The incidence of disease caused by meningococcal serotype B, which MCV4 does not protect against, has also declined from 0.3 to less than 0.1 cases per 100,000 between 1994 and 2013.¹¹ The highest incidence occurs in infants under the age of 1 year, at 1.5/100,000, with 67% of cases attributable to serotype B. A slight bump in risk is seen with those ages 19 to 22 years (0.2/100,000) compared with other adolescents and adults.

While serotype B accounts for a larger proportion of all meningococcal disease than it did before, it is still relatively rare. In the United States between 2010 and 2012, annual cases totaled 48 to 56.¹¹ Groups that are at higher risk of infection include those with complement deficiencies or asplenia (functional or anatomical), microbiologists and lab personnel who work with the organism, and those who have close contact with infected individuals.

In the past few years, well-publicized outbreaks of meningococcus B have occurred on some university campuses. Princeton had 9 cases, and the University of California at Santa Barbara had 4.¹¹ This led to the use of meningococcal B vaccine as an outbreak control measure, with permission from the FDA before the vaccine was licensed. While these outbreaks created an impression of increased risks on college campuses, college students are actually at lower risk of type B meningococcal disease than others of the same age.¹¹

This year, meningococcal B vaccines Trumenba (a 3-dose series) and Bexsero (a 2-dose series) will be available for individuals ages 10 to 25 years. This year, 2 meningococcal B vaccines will be available in the United States. The first, rLP2086, Trumenba (Pfizer) is a 3-dose series that was licensed in late 2014. The second, 4CMenB, Bexsero (Novartis) is a 2-dose series that received FDA approval in January 2015. Both are licensed for individuals ages 10 to 25 years. Formulating a recommendation for the use of these vaccines will be challenging because of several factors: the multiple dose schedules, the low rate of meningococcal B disease, and the age group for whom the vaccines are licensed.