Meningococcal B vaccine

Our boy had his 1-year vaccines not long ago and the doc mentioned he should have the vaccine for meningococcal B.

Essentially she said “should have it, it’s expensive, give Panadol”.

Someone obviously skived communication classes in med school.  Thanks for the detailed info.

naat

Neisseria meningitidis is a Gram-negative human nasty. Worldwide there are 13 strains of meningococcal disease, the most common being A, B, C, W135, and Y.

Pretty pics of bacteria follow:

men02
men03
men01

That last pic looks vaguely like the furry testicles that people like to hang in their car. Because why wouldn’t you use a scented pine tree cardboard cutout instead. Crazy.

Back to bacteria.  So pretty.  So deadly.

Here’s what your kid looks like when they’ve got meningococcal disease:

men05rash
men06baby

 

Feel free to have a look at these pictures again if you’re considering withholding vaccines from your child…  That’s if you can spare the time from harping on about how vaccines cause autism…

Highest rates of meningococcal disease occur in children under 5 years of age:

  • Those infected can literally die within 24 hours (despite treatment)
  • Overall case mortality is just under 9% (nearly 1 in 10 children who get meningococcal disease will die) (despite treatment)
  • Highest number of deaths are reported in serogroup B (despite treatment)
  • Case-fatality ratio is highest for serogroup C (despite treatment)
  • Did I mention… despite treatment? Don’t count on being able to get your kid to hospital in time.

Complications from invasive meningococcal disease (happens 1 in 5 of those who survive):

  • Amputations
  • Chronic pain
  • Deafness
  • Blindness
  • Neurological deficits – sensory, motor
  • Seizures, epilepsy
  • So basically it just fries your body. And not in a good-with-chicken-salt kinda way.

I have plenty more pics to put here but honestly unless you’re medically minded they would make you feel ill. Scrap that – I am medically trained and still found them hard-core.

Vaccine

  • Meningococcal C (MenC) vaccine is included as part of the Australian Immunisation Schedule (since 2003)
  • So why has it taken so long for a Meningococcal B (MenB) vaccine to be produced?
  • Up until now, meningitis vaccines have been made from a fragment of the bacterium sugar coat
  • Ordinarily, our immune system recognises this sugar as ‘foreign’ and produces antibodies to destroy the bacterium
  • However, the MenB bacterium is super tricky; its sugar coat looks like developing human cells and therefore does not trigger an immune response. Damn evil sneaky bacterium.

bexsero(R)

 

4cMenB (Bexsero)

  • Is licensed for use as a vaccine in Europe, Canada and Australia
  • Has been used in the States during times of outbreak
  • It consists of different components that:  (1) Stick to and invade human epithelial cells (2) Bind heparin (heparin increases the serum resistance of bacteria) (3) Bind protein H (protein H enables bacteria survival in the blood) (4) Have special proteins that induce bactericidal (bacterial death) responses. Ingenious.

Australia

  • In Australia it has been available since 2013, and costs AUD$125 per dose (and rightly so. Because we don’t shell out enough for our kids as it is. WE SHOULD PAY MORE.)
  • The Pharmaceutical Benefits Advisory Committee estimated that if four million children were vaccinated through a national scheme over 5 years:

– 224 cases of invasive meningococcal disease would be prevented
– 9 lives saved from meningococcal B disease
– 93 children spared lasting sequelae

  • It is not yet included in Australian’s Immunisation Schedule because “the PBAC concluded that the rarity of invasive meningococcal B disease, compared to the large number of vaccinations that are required was the primary driver of the unfavourable incremental cost-effectiveness ratio”.

Effectiveness

  • The effectiveness of vaccine are measured (in part) by how immunogenic they are (how strong an immune response they produce)
  • 4cMenB has high immunogenicity (across a broad age group, and with a variety of vaccine administration schedules)

Side-effects

  • Fever.  Not the “oh he feels a little warm” fever. I’m talking the “fry-an-egg-on-their-forehead” fever. Our boy is a warrior champion (he tried to pull the ears off the petting zoo bunny aged only 6 months, and was recently reprimanded at daycare for beating the other children with a giant plastic asparagus) BUT when he has a fever, he becomes very poor indeed…

– 77% of infants given 4cMen B will develop a fever of 38.5 deg C or higher (argh!)
– This is compared with 45% after routine vaccines, and 47% after MenC vaccine)
– In the trials, 2 of nearly 3,000 infants had febrile convulsions (deemed probably related to 4cMenB)

– It is therefore recommended that paracetamol is given 30 mins before the vaccination (dose 15mg/kg per dose), with a further 2 doses post-vaccine given 6 hours apart

Other side-effects:

  • Local: soreness, redness, swelling, hardness of skin
  • General: fever, crying, loss of appetite, muscle aches, irritability, sleepiness, rash (generally resolve in 2-3 days)

Bottom line: the meningococcal B vaccine is effective and safe in preventing invasive meningococcal B disease, morbidity and mortality, however at present is not considered cost-effective (and therefore does not form part of the national immunisation schedule). You want it? You got it! (Just bust a move*)   *AUD$125

Additional resources

  • Bexsero Consumer Information
  • Your doctor/ nurse/ healthcare professional/ pharmacist
  • Local government immunisation service
  • Maternal and Child Health Line (24 hours) Tel. 132 229
  • NURSE-ON-CALL Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)
  • National Immunisation Information Line Tel. 1800 671 811
  • Emergency department of your nearest hospital
  • EMERGENCIES ONLY: call triple zero (000)
  • VIC-specific:

– Immunisation Program, Department of Health, Victorian Government Tel. 1300 882 008
– SAEFVIC, the Victorian vaccine safety service Tel. 1300 882 924

Have any of you / your children had the meningococcal B vaccine? Feedback please!

NB: I have ordered the vaccine and will give to bub later today… stay tuned.

 

REFERENCES
Medscape Education: Novel Vaccines Against Meningococcal Serogroup B Disease: The Accumulated Evidence.
Australian Government, Department of Health, Immunisation Programme
Meningitis Research Foundation
Panatto D, Amicizia D, Lai PL, Cristina ML, Domnich A, Gasparini R. New versus old meningococcal group B vaccines: how the new ones may benefit infants & toddlers. Indian J Med Res. 2013 Dec;138(6):835-46.
Vesikari T, Esposito S, Prymula R, Ypma E, Kohl I, Toneatto D, Dull P, Kimura A; EU Meningococcal B Infant Vaccine Study group.  Immunogenicity and safety of an investigational multicomponent, recombinant, meningococcal serogroup B vaccine (4CMenB) administered concomitantly with routine infant and child vaccinations: results of two randomised trials.  Lancet. 2013 Mar 9;381(9869):825-35. Erratum in: Lancet. 2013 Mar 9;381(9869):804.

If you have found a spelling or grammatical error, please notify me by highlighting that text and pressing Ctrl+Enter.

Share

5 Comments

  1. My 8month old had his third dose this morning so far so good. He’s currently laughing hysterically at one of his toys. The other two he was a little sleepier than usual and his temperature sat around 37.6 for two days then back to normal. The cost does add up ($155 per shot under , 1s have 3 shots then a booster) but I couldn’t live with myself if he got it and I cheaper out on the vaccine.
    How did you go?

    • Hi Bree – we went surprisingly well! In fact, I wondered if it was working as he had minimal side-effects! For yours a think a low-grade temperature and a bit of sleepiness is not too bad, some bubs have had quite severe reactions. Thanks for reading and keep the comments coming! Regards, Dr Nat.

  2. Hi Dr Nat,

    Just a quick post re-expressing the need for vaccines, I am an ED nurse who has just finished a night shift ending with the unfortunate passing of a 12 year old boy due to meningococcal septacaemia, sparing readers the gory details (and out of respect) this was a happy healthy young man who was simply “under the weather” and within 24 hours is flying free with the Angels.

    I have never seen such a mottled, rashy young man in my life and despite our amazing ED doctors efforts and two rounds of CPR with extensive treatment unfortunately we lost the battle.
    I have come home to research more into the disease and your post came up quite quickly.

    I really appreciate the message you’re sending, sorry if this makes no sense have yet to been able to go to sleep.

    To everyone out there, money for a vaccine is never worth your child’s life, my best to everything and my thoughts to the young man.

    -Casey

    • Dear Casey, thanks so much for sharing and sorry you had to be a part of such an awful event.

      People who have seen kids sick or dead from vaccine-preventable illnesses are very pro-vacc. Nothing is 100% of course but certainly they offer at least the best go at protection.

      Thanks again for your post and also for your service in the ED. I’ve worked there too and parents (and indeed doctors!) don’t always thank nursing staff!

Leave a Reply

Your email address will not be published. Required fields are marked *