Vaccine Is Highly Effective But The Disease Is Too Rare To Justify The Cost Of Universal Vaccinations
A computer-generated model developed by Johns Hopkins Medicine researchers adds to evidence that providing universal vaccination against meningitis B infection to students entering college may be too costly to justify the absolute number of cases it would prevent. The study also suggests that if vaccine developers could significantly lower the price, universal vaccination might be worth requiring on college campuses.
In a report on the cost/benefit estimate published in the American Journal of Preventive Medicine, researchers determined the cost per quality-adjusted life year, or QALYstandard measure of the public policy value of medical interventionsto be $13.9 million if every student entering college in the United States were vaccinated. Historic expenditures and previous research, the investigators say, assume that society is willing to pay $150,000 per QALY.
Put another way, the new study suggests that universal vaccination of the college student population would be considered cost-effective only if a vaccine series cost less than $65 the average current price is $324, according to study authors.
“Vaccines have become widely available within the past few years,” Leeds says, “but there’s very little evidence to suggest that they’re going to do much good given their high cost in a generally healthy population.”
Meningitis: Why College Students Are So Vulnerable
Marissa Villasenor
University campuses across the country are seeing an outbreak of meningitis. Health officials most recently confirmed three cases of Meningococcal Disease at University of California, Santa Barbara. This comes after six Princeton University students and one campus visitor were hospitalized with the disease. Another New Jersey student from Monmouth University was also diagnosed with Meningitis in November.
Common Questions About Meningitis B
IS MENINGITIS B LIFE-THREATENING?
It can be. Meningitis B is an uncommon but serious disease that is caused by the bacterium Neisseria meningitidis. It can lead to an infection of the lining of the brain and spinal cord or an infection of the blood . Meningitis B can strike without warning and progress quickly.
IS IT TRUE THAT MENINGITIS B CAN BE FATAL WITHIN 24 HOURS?
Potentially. Symptoms such as sudden fever, severe headache, and neck stiffness can progress rapidly and can become serious and possibly fatal. While most people recover from meningitis B, some may end up permanently disabled and suffer from disabilities including hearing loss, brain damage and nervous system problems, kidney damage, loss of limbs, and skin scarring. Although meningococcal disease is uncommon, about 1 in 10 people infected with the disease will die, sometimes within 24 hours.
HAVE THERE BEEN OUTBREAKS OF MENINGITIS B?
Although outbreaks of meningitis B are rare, they can be very serious. Several outbreaks and isolated cases of meningitis B have occurred on U.S. college campuses in the last five years.
WHY DO TEENAGERS AND YOUNG ADULTS HAVE HIGHER RATES OF MENINGITIS B?
HOW DOES MENINGITIS B SPREAD?
The bacteria that causes the disease can spread when a carrier or infected person comes in close contact with another person .
DO I NEED TO GET VACCINATED IF I ALREADY RECEIVED A MENINGITIS VACCINE WHEN I WAS YOUNGER?
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What Are Meningitis And Meningococcal Disease
Meningitis is an inflammation of the linings around the brain and spinal cord. Meningitis can be caused by viruses or bacteria. Often, the symptoms of viral meningitis and bacterial meningitis are the same. Diagnosis of both viral and bacterial meningitis is confirmed by a lumbar puncture .
Viral meningitis is serious but rarely fatal in persons with normal immune systems. Usually, symptoms last 7-10 days and the person recovers completely. Many different viruses can cause meningitis. About 90% of cases of viral meningitis are caused by members of a group of viruses known as enteroviruses, such as coxsackieviruses and echoviruses. Herpes viruses and the mumps virus can also cause viral meningitis. There is no vaccination or treatment for viral meningitis .
Bacterial meningitis is of greater concern than viral meningitis, because it is associated with a significant risk of brain damage and death. Meningococcal meningitis, one type of bacterial meningitis, is of particular concern because while uncommon, it does affect college-age students and the disease may progress rapidly if untreated.
Do College Students Need Mmr
In the U.S., almost everyone receives the CDC-recommended two doses of MMR, the vaccine against measles, mumps, and rubella, as young children. The MMR affords good protection against these diseases, and routine vaccination with a third dose of MMR isnt necessary for all students.
Still, there are some circumstances in which youll want your student to get a dose of MMR before he or she arrives on campus. If for some reason your child didnt receive MMR vaccination at a young age, they should have two doses, separated by 28 days.
Heres why: Although most recent measles outbreaks havent been on college campuses, they are considered high-risk settings. Mumps is sometimes a concern for college students as well. Between 2015 and 2017, two large outbreaks at universities in Iowa and Illinois caused several hundred students to get sick.
The CDC usually recommends that people in communities with an active mumps outbreak receive an additional dose of MMR. A 2017 study in the New England Journal of Medicine found that a mumps booster in an outbreak significantly reduced the risk of infection. For measles outbreaks, the CDC recommends people who arent adequately vaccinated catch up, but people generally dont need an extra dose of MMR if they’re already immune to measles.
Editor’s Note: Catherine Roberts contributed reporting to this story.
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What Is Meningitis B
While its not very common, if you get meningococcal B, it is a nasty disease, Litjen Tan, MD, chief strategy officer at the Immunization Action Coalition , tells Health. The IAC is a national nonprofit authority on vaccination policies that aims to increase immunization rates.
Meningitis B is more prevalent among 18 to 24-year-old college students than kids and adults in other age groups that’s because it’s easier for infections to spread among young adults living in cramped living quarters, such as dorms. Symptoms of the disease include sudden high fever, stiff neck, severe headache, nausea, and vomiting, as well as convulsions, rapid breathing, and confusion. A dark purple rash will usually appear on the arms, legs, or torso, too.
Part of what makes meningitis B so deadly is that many students and parents dont know about it, and many symptoms mimic those of more common illnesses, such as the flu. It wouldnt be unreasonable for a college student to assume they had the flu and then try to sleep off some of the symptoms. But if they actually have meningitis B and try that approach, theres a good chance the illness will overcome them and turn fatal.
Kimberly was perfectly healthy. Sitting in her classroom. Next day shes in the ICU fighting for her life, Wukovits recalls.
Stillman echos her heartbreak. People think so rare. But when its your child, 100% of that child just died. It doesnt matter what the statistics are, she says.
Is Giving All College Students Meningitis Vaccines Worth It
You are free to share this article under the Attribution 4.0 International license.
Vaccinating all new college students against meningitis B may cost too much right now to justify preventing relatively few cases of the sometimes-deadly disease, according to a new study.
But a computer model researchers have developed also suggests that if vaccine developers could significantly lower the price, universal vaccination on college campuses might be worthwhile.
Despite the poor prognosis of meningitis B infection and the fairly reasonable cost of meningitis B vaccination, the extreme rarity of this infection even amongst its peak in college-age individuals makes universal vaccination cost-ineffective, says lead researcher Ira Leeds, a postdoctoral research fellow in surgery at the Johns Hopkins University School of Medicine.
Vaccinating 100,000 college students, for example, would prevent less than five cases of MenB, says Leeds. Health care systems and public health programs do not have unlimited funds and such a small benefit makes support of universal vaccination economically untenable, even when accounting for individual, payer, and community outbreak costs, and productivity lost by society.
The MenB vaccine is safe and effective and should remain available, Leeds and his fellow researchers say. Those at high risk because of compromised immune systems or other conditions should consider vaccination.
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Vaccines Dont Kill People
For her part, Munoz argued that anti-vaccine protesters are a small part of the population, but that their loud protests may exaggerate their influence. In fact, she said, most people support vaccination because it saves lives, and theres no evidence that its unsafe, as claimed by opponents.
Widespread vaccination will prevent the spread of meningitis as well as the return of diseases like polio, which affected her father, Munoz said.
We protect people who are less likely to be able to protect themselves through their own immune system, she said. Anti-vaccinators are doing a great disservice to the public. Vaccines dont kill people, the diseases do.
What Shots Do College Students Need
Influenza
Influenza, or the flu, is caused by a virus and can make a college student miserable from aches, chills, headache and high fever. Lost productivity, missed class time and related medical issues can arise from catching the flu while living on a campus. Studies have shown that productivity is increased and symptoms are minimized when students are vaccinated for the flu when the vaccine becomes available in early September. Encouraging your college student to head to the campus health center for a yearly flu shot not only protects your kid but also the rest of the campus community.
Tetanus, Diphtheria and Pertussis
Tetanus is a bacterial infection that cause by a tetanus spore that makes its way into an open wound or cut somewhere on the body. Your college student could be exposed to tetanus by scraping up against a rusty fence or accidentally stepping on a loose nail on a run. Diphtheria is much less common but its a serious bacterial infection that will affect the lining of the lungs if contracted.
In order to protect your teen against Tetanus, Diphtheria and Pertussis, the CDC recommends a booster of the Tdap vaccine between the ages of 11 and 12. And adults should receive a Tdap every 10 years. Check with your doctor about where your teen falls on this schedule.
Bacterial Meningitis
Many serious diseases are preventable with a simple, safe vaccine and parents should make sure their teen is up to date on all vaccines before sending them off to college.
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What Are The Different Types Of Vaccines For Meningitis B
In the United States, two types of meningitis B vaccines are Food and Drug Administration -approved Bexsero and Trumenba.
To receive FDA approval, both vaccines had to undergo clinical trials showing their safety and effectiveness. Both vaccines work in a similar way but use different proteins to stimulate your immune response.
Bexsero is produced by GlaxoSmithKline. Its administered in two 0.5 milligram doses, 1 month apart.
Before approval, safety data was reviewed from 3,139 subjects in clinical trials in the United States, Canada, Australia, Chile, the United Kingdom, Poland, Switzerland, Germany, and Italy. Additional safety information was collected from 15,351 people who received Centers for Disease Control and Prevention sponsored vaccines at universities.
Trumenba is produced by Pfizer and is administered in two to three doses. For the three-dose schedule, the second dose is administered 1 to 2 months after the first, and the third vaccine is given 6 months after the first dose. For the two dose schedule, the second dose is given at 6 months after the first.
Before the FDA approved Tremenba, reviewers examined
People who have the highest chance of getting meningitis B include:
In the U.S. meningitis B vaccine isnt available yet for infants younger than 1 year old but is administered in the United Kingdom as part of the National Health Service vaccination schedule.
Cdc Does Not Routinely Recommend Menb Vaccination For All Adolescents
Vaccine providers may choose to administer a MenB vaccine to adolescents and young adults 16 through 23 years of age. The preferred age at which to administer the vaccine is 16 through 18 years old.
Together, clinicians and patients or their parents can determine if MenB vaccination is appropriate for them. Clinicians, parents, teens, and young adults may want to consider the following when making this decision:
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Meningococcal Vaccine And College Students
On September 30, 1997, the American College Health Association ,which represents about half of colleges that have student health services, released astatement recommending that “college health services a more proactive role inalerting students and their parents about the dangers of meningococcal disease,” that”college students consider vaccination against potentially fatal meningococcaldisease,” and that “colleges and universities ensure all students have access to avaccination program for those who want to be vaccinated” . Parent andcollege student advocates have also encouraged more widespread use ofmeningococcal vaccine in college students. In a joint study by ACHA and CDC, surveys were sentto 1,200 ACHA-member schools of 691 responding schools, 57 reported thatpre-exposure meningococcal vaccination campaigns had been conducted on theircampus since September 1997. A median of 32 students were vaccinated at each school . During the 1998–1999 school year,3%–5% of 148 students enrolled in a case-control study reported receiving prophylacticmeningococcal vaccination . Before the 1999 fall semester, many schools mailedinformation packets to incoming freshmen data are not yet available regarding theproportion of students who have been vaccinated.
Cost-effectiveness of meningococcal vaccine incollege students
Common Questions About Meningitis
Meningococcal disease is a potentially life-threatening bacterial infection caused by Neisseria meningitidis, a common bacterium. Sometimes these bacteria invade the body to infect the lining of the brain or the bloodstream .
This invasive disease is sometimes fatal unless recognized and treated promptly. Brain damage, hearing loss, loss of limbs, or kidney failure can also occur. Meningococcal disease is relatively rare, occurring at a rate of less than 1 in 100,000 people in the United States.
Everyone is potentially at risk, but college freshmen living in dormitories have an increased risk of developing meningococcal disease compared with other college students. For this reason, it is important for students to become familiar with meningococcal disease and get vaccinated against it before they come to college.
Meningococcal bacteria are spread from person-to-person by direct contact with an infected persons oral or nasal secretions.
While the bacteria may be spread through close and direct contact with an infected persons saliva, such as by sharing cups or eating utensils, this disease is not spread through the air, in food or water, or by casual contact in bathrooms, classrooms, restaurants, bars, or other social settings.
Meningococcal disease can cause an individual to become very ill, very quickly. Symptoms may include:
- High fever
- Sensitivity to light
- Vomiting or rashes may also occur
Additional Resources
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Healthy Infants And Children
One dose of Men-C-C vaccine is recommended in unimmunized children less than 5 years of age. One dose of Men-C-C vaccine may be considered for children 5 to 11 years of age if they have not previously been immunized as infants or toddlers. Immunization with 4CMenB vaccine or MenB-fHBP may be considered on an individual basis, depending on individual preferences, regional serogroup B epidemiology and strain susceptibility.
Persons With Chronic Diseases
Asplenia
Two doses of Men-C-ACYW vaccine are recommended for persons with anatomic or functional asplenia, including sickle cell disease. When elective splenectomy is planned, all recommended vaccines should ideally be completed at least 2 weeks before surgery if only one dose can be given before surgery, the second dose should be given 8 weeks after the first dose, with a minimum interval of 4 weeks. In the case of an emergency splenectomy, two doses of vaccine should ideally be given beginning 2 weeks after surgery but can be given earlier, before discharge, if the person might not return for vaccination after discharge. Persons one year of age and older with asplenia who have not received Men-C-ACYW vaccine should receive two doses administered 8 weeks apart, with a minimum interval of 4 weeks. In addition, 4CMenB or MenB-fHBP vaccine should be offered. Periodic booster doses with Men-C-ACYW vaccine are also recommended.
Refer to Table 1 for vaccination recommendations of high risk individuals due to underlying conditions. Refer to Booster doses and re-immunization for additional information and Immunization of Persons with Chronic Diseases in Part 3 for additional general information.
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Are Students Required To Get Meningococcal Vaccine Before College
Yes. Massachusetts law requires the following students receive quadrivalent meningococcal conjugate vaccine :
- Secondary School : newly enrolled full-time students who will be living in a dormitory or other congregate housing licensed or approved by the secondary school must provide documentation of having received a dose of meningococcal conjugate vaccine at any time in the past.
- Postsecondary Institutions : newly enrolled full-time students 21 years of age and younger must provide documentation of having received a dose of quadrivalent meningococcal conjugate vaccine on or after their 16th birthday, regardless of housing status.
Immunizations should be obtained prior to enrollment or registration however, students may be enrolled or registered provided that the required immunizations are obtained within 30 days of registration. There is no requirement for meningococcal B vaccination. However, adolescents and young adults may also be vaccinated with a serogroup B meningococcal vaccine, preferably at 16 through 18 years of age, to provide short term protection for most strains of serogroup B meningococcal disease.
More information about requirements and exemptions may be found in the MDPH document Information about Meningococcal Disease, Meningococcal Vaccines, Vaccination Requirements and the Waiver for Students at Colleges and Residential Schools.
Risk Of Meningococcal Infection
For any individual, IMD risk is associated with the probability of exposure to a virulent strain of Neisseria meningitidis, and exposure is determined by the frequency, duration and closeness of interpersonal contacts, and by the prevalence of asymptomatic carriers among contacts . Bringing together groups of young adults in a university setting is a recipe for the transmission of meningococci. In a longitudinal study of asymptomatic carriage of meningococci among students in their first year at the University of Nottingham in the United Kingdom, the prevalence rate increased from 6.9% on day 1 to 23.1% on day 4 in the first week of term in October, and was up to 34.2% in some groups in December . Independent risk factors for acquisition were frequency of visits to bar halls, active smoking, visits to night clubs and intimate kissing.
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