Vaccines for Meningitis B: Why it took so long

This blog originally appeared on Emily Monosson's blog and is reposted here with permission.

Yesterday I read of a meningitis B outbreak at Oregon State University. Today, it’s the University of Massachusetts in Amherst, MA. MenB is a potentially lethal and easily spread infection particularly in settings where young adults gather together. As the university races to vaccinate tens of thousands of students, my thoughts turn to our daughter, a senior in college. A few years ago after writing a book chapter that included the history of meningitis B and the recent development of a vaccine, I had asked my daughter’s pediatrician (ironically in Amherst, MA) if she could receive the vaccination as she headed off for her sophomore year. They would not, stating that it was available only for those who had other health indications. Perhaps if it were more easily available, colleges would not have to react, and students would already be protected.

Below is an excerpt from that chapter about meningitis and the vaccine:

My father had just returned from the Navy, an apple-cheeked mischievous twenty year-old looking forward to his junior year in college when meningitis struck. It was 1946 and the last thing he recalled was brushing his teeth at home in the bathroom. For the next ten days he lay unconscious in a hospital bed his body fighting off an invisible army of bacterial invaders. Aided by the new miracle drug, penicillin, he survived, but not entirely unscathed. Shortly after recovery my father was jolted by brain seizures – his brain permanently damaged by the infection. For the remainder of his life he managed the condition with a combination of powerful antiepileptic drugs (while baffling his doctors by referring to the electronic brainstorms as a “free high.”)

Meningitis is a catch-all term for swelling of the tissues surrounding the brain and spinal cord. Specific viruses, fungi, and injury can all cause the potentially fatal condition but one of the most frightening and lethal causes is bacterial infection. Bacterial meningitis, caused by a handful of bacteria (Haemophilis influenza type b (Hib) or Streptococcus pneumonia and Neisseria meningitides) can kill in within a day, is often incurable, and may leave survivors with amputated limbs, hearing loss or brain seizures. My father was relatively lucky. One of the more intractable causes of meningitis is Neisseria, a bacterium adept at spreading through populations gathering together for the first time: freshmen dorms, summer camps, day care, the military barracks. Some five to twenty percent of us carry Neisseria in our nose and throat and unwittingly spread it around to those we share a meal, or a drink or a kiss. Most of us won’t get sick. A few of us may die from the infection, even today.

My kids were born in the 1990s. By the time they toddled off to school, they had received a slew of vaccines: measles, tetanus, mumps, polio, smallpox, chicken pox and even Haemophilus influenza and Streptococcus pneumonia (two other important causes of meningitis). But an effective vaccine against Neisseria meningitidis had not yet made it on to the recommended vaccine schedule. Then in 2005, just as they were heading off to the middle school milieu of new students, sweaty locker rooms, team sports and shared drinking bottles, a vaccine against a collection of N. meningitidis serotypes become available. Though the disease is rare here in the U.S.,compared to sub-Saharan Africa, in the so-called meningitis belt, I felt relieved. One more disease they wouldn’t get. Except.

Except for the escape artist, a serotype called meningitis B or MenB. Though rare, the infection that can take a turn for the worse within hours, has frustrated vaccine makers for decades. And it seems to pop up out of nowhere. In 2013 an outbreak at the University of California caused a freshman lacrosse player to undergo amputation of both feet. Four other students were infected, and the university was forced to provide prophylactic antibiotics to five hundred students. The next year an outbreak at that began at Princeton University caused the death of a Drexel student. In the first months of 2016, MenB hit three different colleges and killed one employee. Even in our “golden age of disease prevention,” and vaccine development, MenB has remained intractable through its ability to evade immunity.

It does this by wrapping itself in a sugary polysaccharide sheath that is identical to human polysaccharide molecules. Immune cells recognizing this molecule would have been naturally eliminated or deactivated as a protection against autoimmunity. By sequencing the pathogen’s genome vaccine makers have been able to discover antigenic proteins that would otherwise be hidden; four different antigens found on the majority of circulating Men B (a single pathogen may have several different circulating strains.) The discovery was a breakthrough for vaccine development. When Mariagrazia Pizza and co-workers reported their findings in the journal Science, they wrote: “In addition to proving the potential of the genomic approach, by identifying highly conserved proteins that induce bactericidal antibodies, we have provided candidates that will be the basis for clinical development of a vaccine against an important pathogen.” A few years ago when meningitis broke out at Princeton and UCSB campuses, the vaccine, licensed in Europe in 2013 but not yet here in the U.S., was offered to students on both campuses. One headline blared “California students to receive unlicensed meningitis vaccine.”

Sold as Bexsero by Novartis the vaccine (along with another new vaccine called Trumenba) was finally licensed in the U.S. in 2015. Hopefully it will become more widely available.

For more from CDC see here