Pondering the New Meningococcal B Vaccine: Do B or Do Not Do B?

“To be or not to be?” Hamlet asked himself this question as he contemplated suicide in Shakespeare’s eponymous drama. Parents will soon be asking themselves a similar question, “To give the meningococcal B vaccine or not to give, etc . . .”

The FDA in January 2015 approved a second vaccine against the B serogroup of meninogoccus, Bexsero, made by Novartis. The first meningococcal B vaccine, Trumemba (Pfizer), was approved in October 2014. Bexsero has been in use in Europe since January 2013 and was the meningococcal B vaccine granted emergency use in the Princeton University meningitis outbreak last year (9 students stricken, 1 death) before a vaccine against this strain had been approved for use in the United States. This begs the question: why was Trumemba approved before Bexsero?

Perhaps the simplest answer is that Pfizer submitted its application to the FDA for Trumemba before Novartis submitted the one for Bexseso. A cynic might suggest that the FDA wanted to introduce a little competition to Bexsero in an attempt to keep the price of the vaccines down, since the federal government buys a lot of vaccines every year.

The current quadravalent meningococcal vaccines (against strains A, C, Y, and W-135) are recommended for universal use in children aged 11 to 12 years, with a booster at age 16. The Advisory Committee on Immunization Practices (ACIP) voted its recommendations for menigococcal B vaccine use. Let’s see how you do on a little quiz. Here is a hint (or not): serogroup B is responsible for close to 40% of disease in college-aged adolescents.