Group B Streptococcus Vaccines
Infections with group B streptococcus are responsible for around 150,000 infant deaths each year, more than half a million preterm births and are a significant cause of long-term disability. It has ten different serotypes, with 1a, 1b, II, III, IV and V causing the most disease.
Several vaccine candidates are in development for both mothers and babies but none are yet available.
Meningococcal Conjugate Or Menacwy Vaccines
Sanofi Pasteur formulates each 0.5-milliliter dose of Menactra® in sodium phosphate buffered isotonic sodium chloride solution. Each dose contains 4 micrograms each of meningococcal A, C, W, and Y polysaccharides conjugated to approximately 48 µg of diphtheria toxoid protein carrier. It does not contain a preservative or an adjuvant. The manufacturer supplies it as a liquid in a single-dose vial.
GlaxoSmithKline formulates each 0.5-mL dose of Menveo® to consist of 2 portions:
- 10 µg of lyophilized meningococcal serogroup A capsular polysaccharide conjugated to CRM197
- 5 g each of capsular polysaccharide of serogroup C, W, and Y conjugated to CRM197 in 0.5 mL of phosphate buffered saline
Vaccine providers reconstitute the lyophilized MenA component with the MenCWY liquid component before injection. It does not contain a preservative or an adjuvant.
Sanofi Pasteur formulates each 0.5-milliliter dose of MenQuadfi® to contain 10 µg each of meningococcal A, C, W, and Y polysaccharides conjugated to approximately 55 µg of tetanus toxoid protein carrier. It does not contain a preservative or an adjuvant. The manufacturer supplies it as a liquid in a single-dose vial.
Persons With Chronic Diseases
Asplenia
Two doses of Men-C-ACYW vaccine are recommended for persons with anatomic or functional asplenia, including sickle cell disease. When elective splenectomy is planned, all recommended vaccines should ideally be completed at least 2 weeks before surgery if only one dose can be given before surgery, the second dose should be given 8 weeks after the first dose, with a minimum interval of 4 weeks. In the case of an emergency splenectomy, two doses of vaccine should ideally be given beginning 2 weeks after surgery but can be given earlier, before discharge, if the person might not return for vaccination after discharge. Persons one year of age and older with asplenia who have not received Men-C-ACYW vaccine should receive two doses administered 8 weeks apart, with a minimum interval of 4 weeks. In addition, 4CMenB or MenB-fHBP vaccine should be offered. Periodic booster doses with Men-C-ACYW vaccine are also recommended.
Refer to Table 1 for vaccination recommendations of high risk individuals due to underlying conditions. Refer to Booster doses and re-immunization for additional information and Immunization of Persons with Chronic Diseases in Part 3 for additional general information.
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H Influenzae Type B Vaccine
This vaccine protects against H. influenzae type b bacteria, which can cause a range of mild to severe illnesses. These include throat swelling, blood infections and pneumonia.
Before the vaccine, Hib was a leading cause of bacterial meningitis in children under age 5.
- Hib vaccine is to infants in three to four doses, starting at 2 months old. In rare cases, it may be recommended for older children and young adults with HIV. The vaccine can be given with other vaccines.
Simultaneous Administration With Other Vaccines
Men-C-C and 4CMenB vaccine may be administered concomitantly with routine childhood vaccines, and Men-C-ACYW vaccine may be administered concomitantly with adolescent and adult age appropriate vaccines. MenB-fHBP can be given concomitantly with quadrivalent human papillomavirus vaccine meningococcal serogroup A, C, Y, W conjugate vaccine and tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine adsorbed. The concomitant administration of MenB-fHBP has not been studied with other vaccines.
Men-C-ACYW-CRM can be administered with routine paediatric vaccines however, further studies are needed with regard to concomitant administration with pneumococcal 13-valent conjugate vaccine. Co-administration of Men-C-ACYW-CRM and combined tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine may result in a lower immune response to the pertussis antigens than when Tdap vaccine is given alone however, the clinical significance of this is unknown. Tdap vaccine given one month after Men-C-ACYW-CRM induces the strongest immunologic response to pertussis antigens.
If vaccines are to be administered concomitantly with another vaccine, a separate injection site and a different syringe must be used for each injection.
Refer to Timing of Vaccine Administration in Part 1 for additional general information.
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Isnt My Child Already Protected
Your child may have already received a meningitis vaccine when they were younger. But that doesnt mean they are protected against meningitis B.
The meningitis vaccine most people have received covers meningitis groups ACWY, not meningitis B. Since a meningitis B vaccine was not available until 2014, most teenagers have not yet received the vaccine suggested for 16- to 23-year-olds.
Where Can I Find These Vaccines
Your doctor is usually the best place to receive recommended vaccines for you or your child. These vaccines are part of the routine childhood immunization schedule. Therefore, vaccines for children and teens are regularly available at
- Pediatric and family practice offices
- Community health clinics
If your doctor does not have these vaccines for adults, ask for a referral.
Vaccines may also be available at
- Pharmacies
- Health departments
- Other community locations, such as schools and religious centers
You can also contact your state health department to learn more about where to get vaccines in your community.
When receiving any vaccine, ask the provider to record the vaccine in the state or local vaccine registry, if available. This helps providers at future visits know what vaccines you or your child have already received.
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Persons With Inadequate Immunization Records
Children and adults lacking adequate documentation of immunization should be considered unimmunized and started on an immunization schedule appropriate for their age and risk factors. Conjugate meningococcal vaccine, as appropriate for age, may be given regardless of possible previous receipt of the vaccine, as adverse events associated with repeated immunization have not been demonstrated. Refer to Immunization of persons with inadequate immunization records in Part 3 for additional general information.
From Harmless To Harmful
While these bacteria usually lead a relatively harmless existence in our bodies, the problem comes if they break through our defences, pass into the bloodstream, and infect the meninges triggering inflammation that puts pressure on the brain. Some of them may also trigger sepsis an overwhelming immune response to disseminated infection that can lead to tissue damage, organ failure, and death while S. pneumoniae is also the leading cause of pneumonia, which kills more children each year than any other disease.
Bacterial meningitis can affect anyone, living anywhere in the world, but it is more common in babies and young children, whose immune systems arent fully developed, and in teenagers and young people. People living in a region of sub-Saharan Africa known as the African Meningitis Belt, are at particularly high risk of meningococcal meningitis, due to persistently high levels of bacteria carriage and infection and hot, dry, and dusty conditions between December and June. This can irritate the lining of peoples airways and make it easier for those bacteria to break into the bloodstream and travel to the meninges.
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Are Students Required To Get Meningococcal Vaccine Before College
Yes. Massachusetts law requires the following students receive quadrivalent meningococcal conjugate vaccine :
- Secondary School : newly enrolled full-time students who will be living in a dormitory or other congregate housing licensed or approved by the secondary school must provide documentation of having received a dose of meningococcal conjugate vaccine at any time in the past.
- Postsecondary Institutions : newly enrolled full-time students 21 years of age and younger must provide documentation of having received a dose of quadrivalent meningococcal conjugate vaccine on or after their 16th birthday, regardless of housing status.
Immunizations should be obtained prior to enrollment or registration however, students may be enrolled or registered provided that the required immunizations are obtained within 30 days of registration. There is no requirement for meningococcal B vaccination. However, adolescents and young adults may also be vaccinated with a serogroup B meningococcal vaccine, preferably at 16 through 18 years of age, to provide short term protection for most strains of serogroup B meningococcal disease.
More information about requirements and exemptions may be found in the MDPH document Information about Meningococcal Disease, Meningococcal Vaccines, Vaccination Requirements and the Waiver for Students at Colleges and Residential Schools.
Why Are Meningococcal Vaccines Recommended
Meningococcal disease is caused by a type of bacteria. It can lead to an infection of the bloodstream or meningitis, or both, and can be life-threatening if not quickly treated. The MenACWY vaccine is very effective at protecting against four strains of the bacteria, while the MenB vaccine protects against a fifth strain.
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What Are Neisseria Meningitidis
Neisseria meningitidis are bacteria that may be found normally in peoples throats and noses. About 5 to 15% of people carry these bacteria and do not get sick from them. These people may be referred to as colonized. Colonized people only have bacteria for a short time. Usually, the bacteria go away and these people may have increased resistance to infection in the future. In rare cases, the bacteria may get into the blood and go to the tissue surrounding the spinal cord and brain, causing severe illness. It is not known why this occurs in certain people and not in others. A recent upper respiratory illness may be a contributing factor.
Immunogenicity And Vaccine Effectiveness
- Conjugate: A type of vaccine that joins a protein to an antigen in order to improve the protection the vaccine provides
- Recombinant protein: A type of vaccine that contains protein antigens
Incidence of meningococcal disease has declined in the United States since the 1990s and remains low today. Much of the decline occurred prior to routine use of MenACWY vaccines. In addition, serogroup B meningococcal disease declined even though MenB vaccines were not available until the end of 2014.
CDC first recommended adolescents get a MenACWY vaccine in 2005. Since then, the incidence of meningococcal disease in adolescents caused by serogroups C, Y, and W decreased by over 90% . Other age groups that CDC does not recommend routine MenACWY vaccination for did not see this large of a percent decline. These data suggest MenACWY vaccines have provided protection to those vaccinated, but not to the larger, unvaccinated community through population or herd immunity. Experts also believe MenB vaccines do not provide protection to unvaccinated people through population immunity. As part of the licensure process, both MenACWY and MenB vaccines demonstrated that they produce an immune response. This immune response suggests the vaccines are protective , but effectiveness data are limited. Since meningococcal disease is uncommon, many people need to get these vaccines in order to measure their effectiveness.
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Symptoms And Causative Agent
Neisseria meningitidis bacteria, also called meningococcus , are an important cause of bacterial meningitis and sepsis in the United States. Meningococci can also cause pneumonia, otitis media , arthritis, and other infections, although these are less common. Collectively, the different illnesses caused by N. meningitidis are referred to as meningococcal disease.
Meningococcal meningitis symptoms include fever, headache, confusion and stiff neck, which may also be accompanied by nausea, vomiting, and sensitivity to light. Meningococcal bacteremia symptoms include sudden fever onset and rash. Other forms of meningococcal disease have symptoms related to the organ affected: otitis media has ear pain arthritis has joint pain and swelling.
Invasive meningococcal disease can be fatal survivors may have permanent injury, including brain damage, hearing loss, or loss of a limb.
There Are Three Types Of Meningococcal Vaccines:
- The meningococcal C vaccine that protects against infection from one of the most common types of meningococcal bacteria, type C.
- The meningococcal quadrivalent vaccine that protects against 4 types of meningococcal bacteria: types A, C, Y and W-135.
- The meningococcal B vaccine that protects against infection by one of the most common types of meningococcal bacteria, type B.
The type of vaccine recommended depends on a person’s age and risk factors.
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Guidance On Reporting Adverse Events Following Immunization
To ensure the ongoing safety of vaccines in Canada, reporting of AEFIs by vaccine providers and other clinicians is critical, and in some jurisdictions, reporting is mandatory under the law.
Vaccine providers are asked to report AEFIs, through local public health officials, and to check for specific AEFI reporting requirements in their province or territory. In general, any serious or unexpected adverse event felt to be temporally related to vaccination should be reported.
For additional information about AEFI reporting, please refer to Adverse events following immunization. For general vaccine safety information, refer to Vaccine safety and pharmacovigilance in Part 2.
Global Public Health Response Elimination Of Meningococcal A Meningitis Epidemics In The African Meningitis Belt
In the African meningitis belt, meningococcus serogroup A accounted for 8085% of meningitis epidemics before the introduction of a meningococcal A conjugate vaccine through mass preventive campaigns and into routine immunization programmes . As of April 2021, 24 of the 26 countries in the meningitis belt have conducted mass preventive campaigns targeting 1-29 year olds , and half of them have introduced this vaccine into their national routine immunization schedules. Among vaccinated populations, incidence of serogroup A meningitis has declined by more than 99% – no serogroup A case has been confirmed since 2017. Continuing introduction into routine immunization programmes and maintaining high coverage is critical to avoid the resurgence of epidemics.
Cases of meningitis and outbreaks due to other meningococcal serogroups, apart from serogroup B, continue to strike. The roll out of multivalent meningococcal conjugate vaccines is a public health priority to eliminate bacterial meningitis epidemics in the African Meningitis Belt.
Pneumococcus
The pneumococcus has over 97 serotypes, 23 causing most disease.
Haemophilus influenzae
Haemophilus influenzae has 6 serotypes, serotype b causing most meningitis.
- Conjugate vaccines protect specifically against Haemophilus influenzae serotype b . They are highly effective in preventing Hib disease and are recommended for routine use in infant vaccine schedules.
Group B streptococcus
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You Are Pregnant Or Breastfeeding
- Pregnant women who are at increased risk for serogroup A, C, W, or Y meningococcal disease may get MenACWY vaccines.
- Pregnant or breastfeeding women who are at increased risk for serogroup B meningococcal disease may get MenB vaccines. However, they should talk with a doctor to decide if the benefits of getting the vaccine outweigh the risks.
What Is Meningitis
The meninges are a membrane that covers and protects the brain and spinal cord. When that membrane gets inflamed, its called meningitis. One of the ways this inflammation can happen is from infection. Common symptoms of an infection of the meninges are fever, headache, and a stiff neck.
There are many different germs that can infect the meninges. Viruses cause most cases, and while this can be serious, most people with viral meningitis get better without treatment. Some may not even realize theyve had meningitis.
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Are Free Or Low
Yes, if you dont have insurance or your insurance does not cover the cost of the meningococcal vaccines, you may be able to find free or low-cost meningococcal shots.
- Talk to your doctor or clinic to see if they participate in the Minnesota Vaccines for Children Program. If the person in need of vaccination is 18 years old or younger, they may be eligible for no-cost vaccines. However, there may be an administration fee of up to $21.22 per shot.
- Talk to your city or county health department. They may be able to provide low-cost meningococcal shots.
Why The Meningitis B Vaccine Is Used
There are many reasons that the meningitis B vaccine was developed and why you would want to protect yourself and those you love against it.
Meningitis B is a serious disease that progresses quickly and can lead to death. The mortality rate from meningitis B in the United States is about 10 to 15 percent when treated and up to 50 percent when untreated. Its also possible to develop long-term conditions such as hearing loss or even brain damage after recovering from meningitis B.
The MenB bacterial infection is passed between people through saliva and respiratory fluids. Activities like sharing drinks, kissing, or coughing can spread the bacterium. The meningitis B vaccine can help reduce transmission between people and prevent or manage outbreaks.
Unlike many diseases, meningitis B is most common in young people. Infants and young children are at the highest risk. Adolescents and young adults are at the next highest risk of infection.
Between 2013 and 2018, meningococcal disease outbreaks occurred at 10 universities and led to two deaths. All 10 universities implemented MenB vaccination to prevent further spread.
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History And Status Of Meningitis Vaccines
Hib, pneumococcus, meningococcus, and GBS are encapsulated bacteria that cause sepsis, meningitis, and other invasive and mucosal diseases . Capsular polysaccharides are important virulence factors and have become the major vaccine target for all four pathogens. HibCVs, PCVs, and NmCVs are highly successful at preventing meningitis and other disease manifestations caused by these organisms. Conjugate vaccines against these bacteria not only protect against disease in multiple age groups, but also confer herd protection via reductions in pharyngeal carriage . GBS is amenable to conjugate vaccine development but development thus far has targeted maternal immunization, given that the greatest disease burden occurs in the first three months of life .
What Are The Different Types Of Vaccines For Meningitis B
In the United States, two types of meningitis B vaccines are Food and Drug Administration -approved Bexsero and Trumenba.
To receive FDA approval, both vaccines had to undergo clinical trials showing their safety and effectiveness. Both vaccines work in a similar way but use different proteins to stimulate your immune response.
Bexsero is produced by GlaxoSmithKline. Its administered in two 0.5 milligram doses, 1 month apart.
Before approval, safety data was reviewed from 3,139 subjects in clinical trials in the United States, Canada, Australia, Chile, the United Kingdom, Poland, Switzerland, Germany, and Italy. Additional safety information was collected from 15,351 people who received Centers for Disease Control and Prevention sponsored vaccines at universities.
Trumenba is produced by Pfizer and is administered in two to three doses. For the three-dose schedule, the second dose is administered 1 to 2 months after the first, and the third vaccine is given 6 months after the first dose. For the two dose schedule, the second dose is given at 6 months after the first.
Before the FDA approved Tremenba, reviewers examined
People who have the highest chance of getting meningitis B include:
In the U.S. meningitis B vaccine isnt available yet for infants younger than 1 year old but is administered in the United Kingdom as part of the National Health Service vaccination schedule.
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