Meningococcal group B vaccines (Trumenba and Bexsero) are the first vaccines FDA-approved to prevent invasive disease caused by Neisseria meningitidis serogroup B. The vaccines are composed of antigenic meningococcal surface proteins. Meningococcal group B vaccine (3 strain) is comprised of recombinant proteins Neisserial adhesin A (NadA), Neisserial Heparin Binding Antigen (NHBA), and factor H binding protein (fHBP); it also contains outer membrane vesicles (OMV). Meningococcal group B vaccines were designated as a breakthrough therapy and received expedient review by the FDA because other available vaccines do not prevent infections from N. meningitidis serogroup B; serogroup B is responsible for approximately one-third of all invasive meningococcal disease cases (160 of the 500 reported U.S. meningococcal disease cases in 2012), and because of increased concern due to meningococcal group B outbreaks occurring at U.S. universities. The FDA approved the vaccines based on the results of multicenter, clinical trials involving pediatric and young adult patients (11 to 24 years of age) that demonstrated the immune response, as measured by bactericidal activity against the serogroup B strains representative of the prevalent strains in the U.S. Meningococcal group B vaccines should be routinely administered to those 10 years and older who are considered high risk for meningococcal group B disease. People considered high risk are those with persistent complement component deficiencies or those receiving eculizumab, anatomic or functional asplenia, microbiologists who work with Neisseria meningitidis, and those living in an outbreak area. Additionally, the vaccine may be administered at the discretion of the treating clinician to adolescents and young adults aged 16 to 23 years to provide short-term protection against most strains of meningococcal group B disease; the preferred age for vaccination is 16 to 18 years. Meningococcal group B vaccines are FDA-approved for use in pediatric patients 10 years and older.
General Administration Information
For storage information, see the specific product information within the How Supplied section.
-Inform the patient, parent, guardian, or responsible adult of the benefits and risks of the vaccine. Provide the Vaccine Information Statements from the manufacturer to the patient, parent, or guardian before each immunization. The action is required by the National Childhood Vaccine Injury Act of 1986.
-Record in the patient's permanent record the manufacturer, lot number, administration date, and the name and address of the person administering the vaccine. These actions are required by the National Childhood Vaccine Injury Act of 1986.
Route-Specific Administration
Injectable Administration
-Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit. After vigorous shaking, the meningococcal group B vaccine, recombinant is a homogenous white suspension. If discoloration or visible particulate matter are present, discard the syringe.
Intramuscular Administration
-Do not mix with any other vaccine or product in the same syringe.
-Prior to administration, clean skin over the injection site with a suitable cleansing agent.
-Vigorously shake the prefilled syringe prior to administration to ensure a homogenous white suspension; DO NOT administer if the vaccine cannot be re-suspended.
-The preferred injection site is the deltoid muscle of the upper arm; do NOT inject into the gluteal area or other areas where there may be a major nerve trunk.
The safety of meningococcal group B vaccine (3 strain) was evaluated in pre-marketing trials that included more than 3,000 adolescents and young adults (11 to 24 years). Infants younger than 12 months of age have also been evaluated. In clinical trials, systemic adverse events, particularly increased body temperature, were significantly higher (approximately 2-fold with some vaccines) in infants coadministered meningococcal group B vaccine (3 strain) with routine infant vaccines compared than when these vaccines were given alone.
Injection site reaction was one of the most frequently reported adverse events in patients receiving the intramuscularly administered meningococcal group B vaccine (3 strain). In clinical trials, recipients of the vaccine experienced pain/tenderness (83% to 90%), erythema or redness (45% to 50%), and induration or swelling at the injection site (28% to 32%). Injection site induration unresolved within 7 days was reported in 2% or more of patients in clinical trials. Lymphadenopathy and blisters, at or around the injection site, have been reported in postmarketing surveillance.
Nausea (18% to 19%) and naso-pharyngitis (2% or more) were reported by patients immunized with meningococcal group B vaccine (3 strain) during clinical trials.
Patients receiving meningococcal group B vaccine (3 strain) during clinical trials experienced systemic adverse reactions that are often associated with vaccine administration. Fatigue (35% to 37%), headache (33% to 34%), and myalgia (48% to 49%) were the most common reactions. Arthralgia (13% to 16%) was also relatively common. Fever 38 degrees C or more was less common (1% to 5%), and occurred more frequently after the second dose.
Allergic reactions, including anaphylactoid reactions (anaphylaxis), rash (unspecified), and eye swelling, have been reported with the meningococcal group B vaccine (3 strain) in postmarketing surveillance. One case of anaphylaxis occurred within 30 minutes of vaccine administration. Syncope and vasovagal responses to injection have also been reported.
Prior to administration, inform the parent, guardian, or responsible adult of the benefits and risks of the vaccine, and provide the Vaccine Information Statement, accessible at the Centers for Disease Control and Prevention (CDC) website. These actions are required by the National Childhood Vaccine Injury Act of 1986. If a dose of a vaccine that immunizes against meningococcal disease has been previously given, question the parent or guardian about previous adverse reactions that may preclude further administration. Report all adverse reactions to the Vaccine Adverse Event Reporting System (VAERS), as well as the manufacturer. The toll-free number for VAERS is 1-800-822-7967. Educate the responsible adult(s) to promptly report any adverse reaction after vaccine administration to a health care provider.
Use of a meningococcal group B vaccine (3 strain) is contraindicated in patients with a previous allergic reaction to the vaccine. With any biologic product, the prescriber or health care professional should take precautions to prevent allergic reactions. The health care professional should have immediate availability of epinephrine 1mg/mL injection and other agents used in the treatment of severe anaphylaxis in the event of a serious allergic reaction to the vaccine.
Meningococcal group B vaccine (3 strain) is only indicated for intramuscular (IM) administration. Use caution when administering to patients with an increased risk for bleeding. Patients with thrombocytopenia, vitamin K deficiency, coagulopathy (e.g., hemophilia), or receiving anticoagulant therapy could have bleeding at the IM injection site.
The decision to administer or to delay vaccination with meningococcal group B vaccine (3 strain) because of current or recent febrile illness depends on the severity of symptoms and on the etiology of the disease. The Advisory Committee on Immunization Practices has recommended that vaccinations be delayed during the course of a moderate or severe acute febrile illness. All vaccines can be administered to persons with minor illnesses such as diarrhea, mild upper-respiratory infection with or without low-grade fever, or other low-grade febrile illness. Persons with moderate or severe febrile illness should be vaccinated as soon as they have recovered from the acute phase of the illness.
Patients with significant immunosuppression may not have an adequate antibody response to meningococcal group B vaccine (3 strain). Immunosuppressed persons may include patients with human immunodeficiency virus (HIV) infection; severe combined immunodeficiency (SCID); hypogammaglobulinemia; agammaglobulinemia; altered immune states due to diseases such as generalized neoplastic disease; or an immune system compromised by corticosteroid therapy with greater than physiologic doses, radiation therapy, or chemotherapy, including alkylating drugs and antimetabolites. Short-term (less than 2 weeks) corticosteroid therapy or intra-articular, bursal, or tendon injections with corticosteroids should not be immunosuppressive. Patients vaccinated with meningococcal vaccine within 2 weeks before starting immunosuppressive therapy or while receiving immunosuppressive therapy should be considered unvaccinated and should be revaccinated at least 3 months after therapy is discontinued if immune competence has been restored. According to the Advisory Committee on Immunization Practices (ACIP), individuals with functional/anatomical asplenia, sickle cell disease, or persistent complement deficiencies (i.e., C3, C5 to C9, properdin, factor D, factor H, or eculizumab use) require a 2-dose series with meningococcal group B vaccine (3 strain) administered at least 1 month apart. Patients with certain complement deficiencies and those receiving treatment that inhibits terminal complement activation (i.e., eculizumab) are at increased risk for invasive disease caused by N. meningitidis serogroup B even if they develop antibodies following vaccination.
Syncope or fainting may occur in association with administration of meningococcal group B vaccine (3 strain). Procedures should be in place to avoid injury from fainting.
No adequate and well controlled studies with meningococcal group B vaccine (3 strain) have been conducted in pregnant women and the ability of the vaccine to cause fetal harm or affect the reproductive system is unknown. Two developmental toxicity studies performed in female rabbits administered 0.5 mL meningococcal group B vaccine (3 strain) revealed no evidence of harm to the fetus or offspring. The Advisory Committee on Immunization Practices (ACIP) recommends deferring vaccination in pregnant women unless the woman is at increased risk and the benefits of vaccination are considered to outweigh the potential risks. Instruct women who become pregnant at the time of vaccination to report the pregnancy to their health care professional.
Data are limited regarding use of the meningococcal group B vaccine (3 strain) during breast-feeding, and its excretion in human breast milk is unknown. The Advisory Committee on Immunization Practices (ACIP) recommends deferring vaccination in breast-feeding women unless the woman is at increased risk and the benefits of vaccination are considered to outweigh the potential risks.
General Dosing Information
-Meningococcal group B vaccine (3 strain) should be routinely administered to people 10 years of age and older who are considered high risk for meningococcal group B disease. People considered high risk are those with persistent complement component deficiencies or those receiving a complement inhibitor (e.g., eculizumab, ravulizumab), anatomic or functional asplenia, microbiologists who work with Neisseria meningitidis, and those living in an outbreak area. Additionally, the vaccine may be administered at the discretion of the treating clinician to adolescents and young adults aged 16 to 23 years who are not at increased risk for meningococcal disease to provide short-term protection against most strains of meningococcal group B disease; the preferred age for vaccination is 16 to 18 years.
-The 2 meningococcal group B vaccines are not interchangeable; the same vaccine product must be used for all doses. Meningococcal group B vaccines may be administered concomitantly with other vaccines, but at a different anatomic site, if feasible.
For meningococcal infection prophylaxis due to Neisseria meningitidis serogroup B:
NOTE: The efficacy of meningococcal group B vaccine is based on the demonstration of immune response, as measured by bactericidal activity against 3 serogroup B strains representative of prevalent strains in the U.S. Efficacy of meningococcal group B vaccine against diverse serogroup B strains has not been established.
-for primary immunization:
Intramuscular dosage:
Adults 18 to 25 years: 0.5 mL IM, followed by 0.5 mL IM at least 1 month later.
Children and Adolescents 10 to 17 years: 0.5 mL IM, followed by 0.5 mL IM at least 1 month later.
-for booster dosing or revaccination of patients who remain at increased risk for meningococcal infection*:
Intramuscular dosage:
Adults: 0.5 mL IM. For continued protection of persons at high risk for meningococcal disease, give booster dose 1 year after primary immunization and repeat every 2 to 3 years thereafter.
Children and Adolescents 10 to 17 years: 0.5 mL IM. For continued protection of persons at high risk for meningococcal disease, give booster dose 1 year after primary immunization and repeat every 2 to 3 years thereafter.
Maximum Dosage Limits:
-Adults
26 years and older: Safety and efficacy not established.
18 to 25 years: 0.5 mL/dose IM.
-Geriatric
Safety and efficacy not established.
-Adolescents
0.5 mL/dose IM.
-Children
10 to 12 years: 0.5 mL/dose IM.
9 years and younger: Safety and efficacy not established.
-Infants
Safety and efficacy not established.
-Neonates
Safety and efficacy not established.
Patients with Hepatic Impairment Dosing
Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed.
Patients with Renal Impairment Dosing
Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed.
*non-FDA-approved indication
Albuterol; Budesonide: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Betamethasone: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Bimekizumab: (Moderate) Patients receiving immunosuppressant medications may have a diminished response to vaccines. When feasible, administer indicated vaccines at least two weeks prior to initiating immunosuppressant medications. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving immunosuppressant medications about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Budesonide: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Budesonide; Formoterol: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Budesonide; Glycopyrrolate; Formoterol: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Corticosteroids (systemic): (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Corticotropin, ACTH: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Cortisone: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Deflazacort: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Deucravacitinib: (Moderate) Patients receiving immunosuppressant medications may have a diminished vaccine response. When feasible, administer indicated vaccines at least two weeks prior to initiating immunosuppressant medications. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving immunosuppressant medications about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Dexamethasone: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Elivaldogene Autotemcel: (Moderate) Patients receiving immunosuppressant medications may have a diminished response to non-live vaccines. When feasible, administer indicated vaccines at least six weeks prior to initiating immunosuppressant medications. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving immunosuppressant medications about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Hydrocortisone: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Methylprednisolone: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Ocrelizumab: (Moderate) Administer all non-live vaccines at least 2 weeks before ocrelizumab initiation, whenever possible. Ocrelizumab may interfere with the effectiveness of non-live virus vaccines. Attenuated antibody responses to tetanus toxoid-containing vaccine, pneumococcal polysaccharide and pneumococcal conjugate vaccines, and seasonal influenza vaccine were observed in patients exposed to ocrelizumab at the time of vaccination during an open-label study. Infants born to mothers exposed to ocrelizumab during pregnancy may receive non-live vaccines as indicated before B-cell recovery; however, consider assessing the immune response to the vaccine. ACIP recommends that patients receiving any vaccination during immunosuppressive therapy or in the 2 weeks prior to starting therapy should be considered unimmunized and should be revaccinated a minimum of 3 months after discontinuation of therapy. Passive immunoprophylaxis with immune globulins may be indicated for immunocompromised persons instead of, or in addition to, vaccination.
Ofatumumab: (Major) Administer all needed non-live vaccines according to immunization guidelines at least 2 weeks before initiation of ofatumumab. Ofatumumab may interfere with the effectiveness of inactivated vaccines due to its actions, which cause B-cell depletion.
Prednisolone: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Prednisone: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Satralizumab: (Major) Administer all non-live vaccines according to immunization guidelines at least 2 weeks before initiation of satralizumab.
Siponimod: (Moderate) Administer all non-live vaccines at least 2 weeks before siponimod initiation, whenever possible. Vaccines may be less effective if given during siponimod treatment. Patients should be considered unimmunized if vaccinated within a 14-day period before starting immunosuppresive therapy or during immunosuppressive therapy, and should they be revaccinated at least 3 months after therapy is discontinued if immune competence is restored.
Triamcinolone: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Ublituximab: (Moderate) Patients receiving immunosuppressant medications may have a diminished response to non-live vaccines. When feasible, administer indicated vaccines at least two weeks prior to initiating immunosuppressant medications. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving immunosuppressant medications about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Vamorolone: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Meningococcal disease is a result of an invasive infection by Neisseria meningitis; the five main N. meningitis serogroups responsible for meningococcal disease are A, B, C, Y, and W. Vaccination with meningococcal group B vaccine provides protection against invasive meningococcal disease caused by serogroup B. The meningococcal group B vaccine (3 strain) is composed of the recombinant proteins Neisserial adhesin A (NadA), Neisserial Heparin Binding Antigen (NHBA), factor H binding protein (fHBP), and PorA P1.4 (present in outer membrane vesicles [OMV]). These meningococcal surface proteins contribute to the ability of the bacterium to cause disease. Immunization with meningococcal group B vaccine (3 strain) leads to the production of antibodies directed against NadA, NHBA, fHBP, and PorA, which leads to complement-mediated antibody-dependent killing of N. meningitides serogroup B. The vaccine's efficacy depends on the antigenic similarity of the bacterial and vaccine antigens, as well as the amount of antigen expressed on the surface of the invading meningococci.
Meningococcal group B vaccine (3 strain) is administered intramuscularly. Vaccination does not ensure immunity. Distribution, metabolism, and excretion of the vaccine have not been defined.
Efficacy of the 2-dose vaccination series was evaluated during clinical trials involving pediatric and young adult patients, ages 11 to 24 years. Serum bactericidal antibodies were measured with hSBA assays using 3 strains selected to measure responses to 1 of 3 vaccine antigens, either fHBP, NadA, or PorA P1.4, prevalent among strains in the U.S. The primary endpoints were the percentage of subjects with at least a 4-fold rise in hSBA titers for each of the 3 test strains, and the percentage of subjects who achieved titers greater than or equal to the lower limit of quantitation (LLOQ) for all 3 strains (composite response). At one month after the second dose, at least a 4-fold rise in hSBA titers was observed in 78% to 98% for strain fHBP, 94% to 99% for strain NadA, and 39% to 67% for strain PorA P1.4; 63% to 88% of vaccine recipients achieved the composite response of titers greater than or equal to LLOQ for all 3 strains.