WSJ on meningococcal vaccine for adolescents

Today's Wall Street Journal has a story about meningococcal vaccine -- the cause of many cases of bacterial meningitis -- and the obstacles faced by efforts at vaccinating adolescents. The story, "Quelling a Killer: The Case For the Meningococcal Vaccine," uses the stories of a few victims of bacterial meningitis to illustrate the rapid and severe course of the rather rare disease in the U.S. Estimates vary, but the WSJ story says that 1,400 to 2,800 cases occur annually, roughly 10% of which are fatal.

Routine vaccination (with SanofiPasteur's Menactra) is recommended for all 11-12 year olds, many colleges and universities require vaccination for students living in dormitories (a high-risk group), and now states such as New Jersey are adding the vaccine to those required for school entrance. Despite these efforts, vaccination rates among recommended populations have ample room for improvement.

As these types of stories tend to do, the article includes back-to-back quotes from Paul Offit and Barbara Loe Fisher on the merits and possible concerns, respectively, associated with routine vaccination of adolescents.

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Speaking of the Wall Street Journal, a lengthy story appeared in July -- "Get Your Shots: Adults Need Vaccines, Too" -- detailing the growing number of vaccines recommended for another population, adults, for which awareness of vaccination efforts lags in comparison to pediatric vaccination programs.

Caplan on college meningococcus vaccine requirements

Last week, MSNBC.com published a story titled, "Killer at college: Meningitis threatens students; Mandatory vaccine for deadly bacterial disease sparks debate." The story provides a detailed account of the threat posed by bacterial meningitis on college campuses and efforts by many states to require vaccination for college freshmen (or a signed waiver declining the vaccine). More information about meningococcal vaccination is available from this CDC website, and details about SanofiPasteur's Menactra (the vaccine recommended for adolescents) is available here.

In response to this story, Penn's Art Caplan wrote a commentary for MSNBC.com that was posted last Thursday: "Students' meningitis shots should be required." He writes, in part,

"Americans do love choice. But they also hate to lose a child, a sister or a granddaughter. Sometimes choice ought to yield to common sense and evidence. We ought [to] be doing all we can to get young people vaccinated against meningitis and to make sure that the costs of doing so are covered."

The importance of this issue was illustrated by tragic news on our own campus Sunday of the death of a Penn sophomore from bacterial meningitis. Here is coverage from The Daily Pennsylvanian and The Philadelphia Inquirer.

At Penn, all students living in on-campus dormitories are required to be vaccinated with Menactra or sign this waiver citing medical contraindications or religious objections to the vaccine. (This policy is in accordance with a 2002 Pennsylvania law.)

News reports note that the victim lived off-campus during the current school year, but nearly all Penn students live on-campus during their freshman year, making it likely that the vaccination requirement applied to the student one year ago. No information has been made public regarding her vaccination status.

From MMWR: childhood & 65+ vaccination rates, 2006-07 adult schedule, and Menactra safety update

A great deal of news on vaccines and vaccination efforts has appeared in recent issues of the CDC's Morbidity and Mortality Weekly Report. Here are some items of note:

• "Childhood Influenza Vaccination Coverage -- United States, 2004-05 Influenza Season" and "Influenza and Pneumococcal Vaccination Coverage Among Persons >65 Years -- United States, 2004-05." With flu cases starting (very slowly) to appear, these two pieces offer some data on the effectiveness of efforts to vaccinate two populations at higher risk of influenza-related complications. For children, the headline is that young children (19-35 months) had a substantially higher vaccination rate in the 04-05 season than for the previous year -- likely attributable to stronger ACIP recommendations. However, the overall percentage of fully vaccinated children in this age group was still very low (17.8%). For 65+ adults, the reverse phenomenon is true: both flu and pneumococcal vaccination rates are over 60%, but flu vaccination rates in 2005 were 4% lower than a year earlier. (The MMWR story notes that all of these numbers are well below the goal of 90% included in Healthy People 2010.)

• Better news can be found in this report, "Vaccination Coverage Among Children Entering School, 2005-2006 School Year." Compiling the latest data available, a editorial note accompanying the report explains, "More than half of reporting states indicate that they have already reached the Healthy People 2010 goal of >95% coverage for each of the vaccines recommended by the Advisory Committee on Immunization Practices (ACIP); the remaining states are making progress toward this goal."

• The 2006-2007 Recommended Adult Immunization Schedule, approved by the ACIP at their June meeting, has been published. Particularly because of efforts made at simplifying the schedule's design, the document is a great source for a general overview of recommended vaccinations in the 18+ population.

• One final item provides an update on reports of cases of Guillain-Barre Syndrome (GBS) among recipients of Menactra, Sanofi Pasteur's meningococcal vaccine. (We've written previously about this story in April.) A total of 17 cases have been reported with a suspected link to Menactra vaccination. As the report explains, analysis of these cases suggests a slightly increased risk of GBS among Menactra recipients, but the risk of meningococcus itself is among the reasons why no change in the current recommendation is being made at this time.
  

CDC update on possible link between meningitis vaccine and Guillain-Barre Syndrome

Today's issue of the Morbidity and Mortality Weekly Report (MMWR -- the widely-read CDC infectious disease publication) includes an update on a series of cases of Guillain-Barre Syndrome among college-age students shortly after receiving meningococcal vaccine. Below are excerpts from the CDC summary of the report. The bottom line: It's unclear whether the vaccine is responsible for the GBS cases, further study is needed, and no changes for the time being regarding the recommendation status of the vaccine.

"In October 2005, a possible association between Guillain-Barré Syndrome (GBS) and receipt of meningococcal conjugate vaccine (MCV4)...was reported. GBS is a serious neurologic disorder involving inflammatory demyelination of the peripheral nerves. At the time of the first report, five confirmed cases of GBS after receipt of MCV4 had been reported to the Vaccine Adverse Events Reporting System (VAERS). During the 4 months since, three additional confirmed cases of GBS have been reported...

Because available evidence neither proves nor disproves a causal relation between MCV4 and GBS, further monitoring and studies are ongoing within VAERS and the Vaccine Safety Datalink (VSD). CDC continues to recommend use of MCV4 for persons for whom vaccination is indicated; the additional reported cases have not resulted in any change to that recommendation."