Why Isn’t the MenB Vaccine Recommended for Everyone?

Although not part of routine vaccinations, more young adults and their parents may want to consider a MenB vaccine.

While bacterial meningitis is rare, infections are typically devastating to the people who become infected, and it's best to avoid an infection in the first place.

Bacterial meningitis is a bacterial infection of the central nervous system—more specifically, the membranes that surround the brain and spinal cord, which are called meninges. It most often occurs in infants younger than one year of age and teens and young adults between the ages of 16 and 23.

While bacterial meningitis is rare, infections are typically devastating to the people who become infected. According to the Centers for Disease Control and Prevention (CDC), 70 percent of infections are fatal without treatment. Roughly 1 in 5 people who survive an infection are burdened with permanent aftereffects—brain damage, paralysis, hearing loss, loss of limbs.

When infections are treated early, outcomes tend to be much better, though fatalities and permanent damage still occur even with treatment, especially when there are delays in treatment.

It’s best to avoid infections in the first place. And there are vaccines that can help a person do that.

MenAWCY: The vaccine nearly everyone gets

MenACWY vaccines protect against four strains of bacteria that can cause bacterial meningitis. The CDC recommends MenACWY vaccination for nearly everyone. The MenACWY vaccine is typically given at ages 11 to 12 years, with a booster dose given at age 16 years.

MenB: The vaccine only some people get

There are also MenB vaccines that protect against an additional strain of bacteria that can also cause bacterial meningitis. The CDC guidance states that “teens and young adults (ages 16 through 23 years old) may also get a MenB vaccine.” In other words, for most people this vaccine is optional—though it’s recommended for people who have certain health conditions and those who are at risk due to a local outbreak.

Between 2013 and 2018, there were 10 outbreaks of bacterial meningitis that occurred at colleges and universities in 7 different states. As a result, many colleges and universities require students to get the MenB vaccine.

Why isn’t the MenB vaccine recommended for everyone?

Given the potentially devastating consequences of a bacterial meningitis infection, a person may wonder why MenB vaccination is not more widely recommended. The answer to this question has to do with the difference between public health recommendations and individual health considerations.

Bacterial meningitis infections are rare in the United States—for meningitis B, there are typically fewer than 200 cases each year across all age groups. Most of those cases occur in children younger than age 5 (an age group where there is no approved MenB vaccine). Between 50 to 70 cases occur among people who are 11 to 24 years old each year.

Public health recommendations tend to be based on large data sets, and there are no large data sets available when it comes to meningitis B. With so few cases, evaluating the efficacy of the MenB vaccine is very difficult—it’s difficult to tell how many infections vaccines will prevent when there are so few infections to begin with, and to balance the risk of infection with the risk of side effects (reported side effects listed by the CDC are mild and last 3 to 5 days).

Without this information, it’s difficult for organizations like the CDC and the American Academy of Family Physicians to make recommendations for the entire population.

The factors that decide a recommendation for a population are very different than the factors an individual will consider when making decisions about getting the MenB vaccine. When spread over a population close to 330 million people, 50 or 70 cases of meningitis B are not statistically significant.

When teens, young adults, and their parents decide to get a MenB vaccination, they are considering a completely different set of factors—the physical, emotional, psychological, and financial burdens that typically follow a bacterial meningitis infection that results in brain damage, loss of limbs, or death.

Article sources open article sources

National Organization for Rare Disorders. Meningitis, Bacterial.
UpToDate. Initial therapy and prognosis of bacterial meningitis in adults.
Johns Hopkins Health. Bacterial Meningitis.
Centers for Disease Control and Prevention. Meningococcal Disease: Age as a Risk Factor.
Cleveland Clinic. Bacterial Meningitis.
Centers for Disease Control and Prevention: Laboratory Methods for the Diagnosis of Meningitis. Chapter 2: Epidemiology of Meningitis Caused by Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenza.
Centers for Disease Control and Prevention. Meningococcal Vaccination: What Everyone Should Know.
Centers for Disease Control and Prevention. Meningococcal Vaccination for Preteens and Teens: Information for Parents.
Michael Devitt. ACIP Updates Recommendations for Meningococcal Vaccination. American Academy of Family Physicians. October 7, 2020.
Centers for Disease Control and Prevention. Meningococcal B VIS.
Sara Fludd. Why Your Child Needs the Meningitis B Vaccine Before College. Johns Hopkins All Children's Hospital Newsroom. July 16, 2019.
Heidi M. Soeters, Lucy A. McNamara, et al. University-Based Outbreaks of Meningococcal Disease Caused by Serogroup B, United States, 2013–2018. Emerging Infectious Diseases, 2019. Vol. 25, No. 3.
American Academy of Family Physicians. Meningococcal Disease Vaccine.

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