What is the recommended vaccination strategy for meningococcal B in Western Australia?

Meningococcal B Vaccination Recommendations in Western Australia

For Western Australia, meningococcal B vaccination is recommended routinely for high-risk individuals, while for healthy adolescents and young adults aged 16-23 years, vaccination may be administered based on shared clinical decision-making between healthcare providers and patients/families.

High-Risk Groups (Category A Recommendation)

Meningococcal B vaccination is routinely recommended for persons aged ≥10 years at increased risk of meningococcal disease, including:

• Persons with persistent complement component deficiencies (inherited or chronic deficiencies in C3, C5-C9, properdin, factor D, factor H) or those receiving complement inhibitor therapy such as eculizumab 1
• Persons with anatomic or functional asplenia, including sickle cell disease 1
• Microbiologists routinely exposed to isolates of Neisseria meningitidis 1
• Persons at risk during meningococcal B disease outbreaks 1

Healthy Adolescents and Young Adults (Category B Recommendation)

• Meningococcal B vaccination is not routinely recommended for all adolescents but may be administered to adolescents and young adults aged 16-23 years (preferred age 16-18 years) based on shared clinical decision-making 1
• This recommendation is based on the very low incidence of serogroup B meningococcal disease in persons who are not at high risk 1
• The decision should consider the serious nature of meningococcal infections, the low number of serogroup B cases, and the increased risk among college students 1

Vaccine Options and Administration

Two MenB vaccines are available:

• MenB-4C (Bexsero): 2-dose series administered at 0 and ≥1 month 1
• MenB-FHbp (Trumenba): 2-dose series (0,6 months) for healthy adolescents; 3-dose series (0,1-2,6 months) for high-risk individuals 1

Important administration considerations:

• The same vaccine product must be used for all doses in a series; the vaccines are not interchangeable 1
• If the second dose of MenB-FHbp is administered earlier than 6 months after the first dose, a third dose should be given at least 4 months after the second dose 1
• MenB vaccines can be administered simultaneously with other age-appropriate vaccines but at different anatomic sites 1

Epidemiology and Effectiveness

• South Australia has implemented a state-funded MenB vaccination program due to high disease burden (82% of IMD cases were serogroup B in 2016, compared to 29% in Western Australia) 2
• Vaccine effectiveness against MenB disease is high: 98.5% (95% CI 81.9% to 99.9%) for three-dose schedule in children and 92.3% (95% CI 34.3% to 99.1%) for two-dose vaccination in adolescents 3
• However, MenB vaccination has shown no discernible effect on meningococcal carriage, suggesting that herd protection is unlikely 4

Cost-Effectiveness Considerations

• A routine adolescent MenB vaccine recommendation would prevent an estimated 15-29 cases and 2-5 deaths per year nationally, assuming all eligible persons were immunized 1
• The number needed to vaccinate (NNV) to prevent one case ranges from 102,000-203,000 depending on age of vaccination 1
• Cost per quality-adjusted life-year (QALY) ranges from $3.7-8.7 million depending on vaccination strategy 1

Practical Guidance for Western Australia

• Given Western Australia's relatively lower proportion of serogroup B disease (29%) compared to some other states 2, routine vaccination of all adolescents is not recommended
• Focus vaccination efforts on high-risk individuals (complement deficiencies, asplenia) 1
• For healthy adolescents aged 16-23 years, discuss the following factors during shared clinical decision-making:
  • The serious nature of meningococcal disease with high rates of death and sequelae 1
  • The low number of serogroup B cases in Western Australia 2
  • The increased risk for college students, especially freshmen in residence halls 1
  • The relatively short duration of protection (antibody waning within 1-2 years) 1, 5

Common Side Effects and Safety

• Common side effects of MenB vaccines include injection site pain (≥85%), fatigue (≥40%), headache (≥35%), muscle pain (≥30%), and chills (≥15%) 6
• MenB-4C is associated with higher rates of severe pain at injection site (20-29%) compared to MenB-FHbp (5-8%) 1
• No significant increased risk for serious adverse events has been identified 1