FEBRUARY 9, 2016
Sometimes the story comes to you.
One of the three students sickened in last week’s meningococcal disease outbreak at Santa Clara University is the son of Penny Nelson, who works with me at KQED News. What’s especially interesting about his case is that he had received a new vaccine against the illness, yet still got sick.
‘We don’t know if it impacts herd immunity. We don’t know how long immunity lasts. Is it a few years? Five years? Ten years?’
Dr. Cody Meissner, Tufts Univ. School of Medicine
Backing up a bit, the outbreak was caused by Neisseria meningitidis serogroup B, an especially serious infection. All three students now have been discharged from the hospital in good condition. Two of them, including Nelson’s son, Misha Hindery, were treated for meningitis, an infection of the lining of the brain and spinal cord. A third student had septicemia, a bloodstream infection.
The disease is fatal in 10-15 percent of cases, and many others lose a limb or suffer brain damage.
Nelson knew how serious a disease it could be. A few years ago, a friend’s daughter contracted a serogroup B infection at college and died within days, despite aggressive medical treatment.
When Nelson found out her son was in the hospital, she says she got there as fast as she could. “I was so frightened. I just couldn’t believe it. … I sat there and read about it, and that frightened me even more.”
The chief symptoms are sudden onset of fever, headache and stiff neck.
After Misha was released, Nelson contacted his primary care doctor, who confirmed that Misha had received both doses of Bexsero. The vaccine was approved by the Food and Drug Administration (FDA) a year ago, under an accelerated process, says Dr. Cody Meissner, a pediatrics professor at Tufts University School of Medicine and consultant to the Advisory Committee on Immunization Practice, which recommends vaccine guidelines to the Centers for Disease Control and Prevention (CDC). It is intended for people ages 10 to 25.
The vaccine was developed in a new way, a “terrific accomplishment” technologically, Meissner said. But because of the shortened approval process, much is not known about it. “We don’t know if it impacts herd immunity,” he says, in reference to vaccinating enough of a population to keep a disease that crops up from spreading. “We don’t know how long immunity lasts. Is it a few years? Five years? Ten years?”
Bexsero and a second vaccine, Trumenba, cover most — but not all — strains of bacteria within the serogroup B. It’s possible Misha was infected with a strain that is not included in the vaccine. Meissner said there is no scientific evidence to support the idea that the vaccine makes the course of the disease less severe, if someone does become infected.
And while meningococcal group B infections are rare — just160 cases in 2012 — they can be devastating, often striking young, healthy people. Nelson’s son rows crew and was a member of an eight-man boat that won a national title last year.
Public health officials are now watching to see how the vaccine performs, says Dr. James Watt with the California Department of Public Health.
“These vaccines have been used in outbreaks,” he said. “They have appeared to have an impact, so that’s good news.” Together with the Santa Clara County Public Health Department, Santa Clara University ran four vaccine clinics, ending Monday. Nearly 5,000 of the university’s 8,000 undergraduate and graduate students received the first dose.
Penny Nelson with her son, Misha. He is recovering from bacterial meningitis. (Courtesy: Penny Nelson)
The California Department of Public Health will provide 5,000 doses next month, when students will need the final shot in the two-dose series.
The vaccine is not part of the routine immunization schedule for adolescents. Instead, it received a “permissive” recommendation, meaning that doctors can administer it if they feel it is in the best interest of the adolescent. Some people at high risk should be immunized, according to the Centers for Disease Control and Prevention, including anyone with a damaged or removed spleen, sickle cell anemia or who has a rare immune system condition known as “complement deficiency.”
California follows CDC guidelines, so does not require the vaccine for school-age children. Watt says California colleges and universities set their own vaccine guidelines.
Meanwhile, cases are dropping. In the late 1990s, there were 1-2 cases per 100,000 people. Now it’s 0.1 per 100,000. “Meningococcal disease is disappearing in the U.S.,” Meissner says. “No one knows why.”
On top of everything else, this vaccine is expensive, more than $300 for the series. Meissner published an analysis in Monday’s JAMA spotlighting the challenges of providing such an expensive vaccine for such a rare disease. As many as 350,000 adolescents would need to be vaccinated to prevent one case of disease, he wrote.
“This vaccine is 25 times higher [in cost] than any other vaccine,” he told me.
“Is this the way we want to be spending scarce funds for public health?”