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Princeton Meningitis Outbreak

By Amesh A. Adalja, MD, FACP, FACEP, November 22, 2013

Since the 1990s, invasive meningococcal disease rates in the US have declined to fewer than 1000 mostly sporadic cases per year.1 Though rare, outbreaks of invasive meningococcal disease do occasionally occur in specific “semi-closed” populations, such as military recruit camps and college campuses.2 A recent 7-person outbreak of invasive meningococcal disease on the campus of Princeton University in New Jersey highlights some of the persistent difficulties with this pathogen. Fortunately, none of the Princeton cases has been fatal.3

Strains and Vaccines

Several strains of Neisseria meningitidis are capable of causing disease, and each has specific characteristic epidemiologic features. The most important disease-causing strains are W-135, A, B, C, and Y, and vaccines have been developed to target them.2

The 2 FDA-approved quadrivalent vaccines, Menactra and Menomune, target the W-135, A, C, and Y strains and are recommended for children at age 11 (with further recommendations available for adults and younger children at higher risk). Because it is protein-conjugated, Menactra has enhanced immunogenicity and is the preferred vaccine.

A vaccine against type B meningococcus has been difficult to develop due to poor immunogenicity. In 2013, the EU and Australia approved a Novartis vaccine directed at type B strains, but the FDA has not approved it for use in the US.3 However, the FDA and CDC have decided to permit use of the EU-approved type B vaccine, as an investigational new drug, for use on the Princeton campus.3

Implications

What is most notable about this outbreak of type B meningococcus is not that it occurred, but the response to it. As happened when the FDA approved use of IV zanamivir during the H1N1 influenza pandemic, the agency has recognized the need to employ a novel, not-yet-approved product to optimize management of this infectious disease emergency. The FDA’s ability and willingness to take such actions are essential to an effective response and will hopefully accelerate the unqualified approval of this vaccine for general use.

References

  1. CDC. Meningococcal disease. http://www.cdc.gov/meningococcal/surveillance-outbreaks.html. Accessed November 19, 2013.

  2. Apicella MA. Neisseria meningitidis. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, PA: Churchill Livingstone; 2010.

  3. CDC. Serogroup B meningococcal vaccine questions and answers. http://www.cdc.gov/meningococcal/vaccine-serogroupB.html. Accessed November 19, 2013.