Immunization for meningococcal serogroup B - What does the practitioner need to know?

Question 1

How many serogroups of Neisseria meningitidis are there?

Answer 1

12 determined by the polysaccharide capsule

Question 2

Which serogroups cause most invasive meningococcal disease?

Answer 2

A, B, C, Y, and W

Question 3

Which serogroups are routinely immunized in infancy?

Answer 3

All provinces C

Alberta, Saskatchewan, Ontario, NB, PEI, Nfld quadrivalent (A,C,Y,W) conjugate vaccine

Question 4

What is the most prevalent serogroup in Canada?

Answer 4

B (>50% of cases)

Question 5

What are the four components in 4CMenB?

Answer 5

1. Neisserial heparin-binding antigen (NHBA)
2. Factor H-binding protein (fHbp)
3. Neisserial adhesion A (NadA)
4. PorA (the most immunogenic protein from the outer membrane vesicles)

Question 6

What percentage of Canadian meningitis B strains would be covered by 4CMenB?

Answer 6

66% of strains

Question 7

What is the effectiveness of 4CMenB?

Answer 7

Estimates of effectiveness are still very tentative

Question 8

How many does are required?

Answer 8

2m, 4m,, and 6m

Likely will require boosters

Question 9

What adverse effects are associated with 4CMenB?

Answer 9

1. Fever in 65% of infants, may result in FSWU in children at 2m

Question 10

What is the NNT for 4CMenB?

Answer 10

As infants younger than 6m will remain unprotected 1 in 141 000
10-20 times that number to prevent one death

Question 11

Who should receive 4CMenB?

Answer 11

1. Asplenia
2. Hyposplenism
3. Congenital complement deficiency
4. Properdin deficiency
5. Factor D deficiency
6. Primary antibody deficiency
7. > 1 episode of invasive meningococcal disease
8. Laboratory personnel working with the organism
9. Consider with eculizumab >2wks prior to the first dose or within 1 week post-eculizumab as risk of hemolysis