Meningococcal disease and vaccination in college students

Estimating the cost of university-based outbreaks of serogroup B meningococcal disease with different pre-matriculation vaccination policies in the United States

Objective: We developed an Excel-based cost calculator to assess the economic burden of university-based Neisseria meningitidis serogroup B (MenB) outbreaks. Participants: Hypothetical university with 6,354 students. Methods: Total societal costs of outbreak were estimated for three MenB pre-matriculation immunization policies-vaccination required, vaccination recommended, and no vaccine policy-under three different cost assumptions (low/mid-range/high cost). Results: Mid-range cost estimates of an outbreak under "no policy" were $2.60 and $2.70 million (of which 35% were incurred by the university) if targeting all undergraduates for mass vaccination with a two-/three-dose vaccine, respectively. The "required" and "recommended" policies lowered the burden to $2.17-$2.18 million and $2.34-$2.39 million, respectively. For a larger university with 40,000 students, costs were almost $9 million for a two-dose vaccine with "no policy" in place. Conclusions: The economic burden of a university MenB outbreak is substantial, but could be mitigated by a pre-matriculation MenB vaccination requirement or recommendation.

Invasive Neisseria meningitidis subtype C in gay, bisexual and other men who have sex with men: a systematic review

INTRODUCTION

Outbreaks of invasive Neisseria meningitidis subtype C in networks of gay, bisexual and other men who have sex with men (MSM) have been reported. We aimed to explore any factors seen in MSM with invasive N.meningitidis subtype C.

METHOD

We searched three bibliographical databases for manuscripts written in English exploring at least one factor seen in MSM with invasive N. meningitidis subtype C published up to May 2024. Following an initial search, removal of duplicates and abstract review, two authors independently reviewed full-text manuscripts and performed a risk of bias assessment using the Joanna Briggs Institute toolkit. Narrative data were synthesised to generate themes.

RESULTS

16 manuscripts were included in this review from the USA (n=10), Germany (n=2), France (n=2), Canada (n=1) and Italy (n=1) and consisted of nine case series, four cross-sectional studies, two case reports and one case-control study published between 2003 and 2024 involving 236 MSM with invasive N. meningitidis subtype C, of which at least 64 died. We have highlighted some demographic (African-American or Hispanic identity in the USA, living with HIV), behavioural (kissing, sharing drinks, visiting sex-on-premises venues, visiting gay-oriented venues, using websites/mobile phone apps to meet sexual partners, recreational drug use, multiple and non-regular sexual partners) and infection (previous Chlamydia trachomatis, Treponema pallidum, Neisseria gonorrhoeae, Mpox) factors in MSM with invasive N. meningitidis subtype C.

CONCLUSION

These data serve as an important resource to inform and target future public health strategies and outbreak control measures for the prevention of invasive N. meningitidis subtype C in MSM.

PROSPERO REGISTRATION NUMBER

CRD42024543551.

College health administrator's perceptions of the impacts of COVID-19 on college immunization programs

College immunization policies vary. To evaluate the landscape of college immunization programs, we distributed a 45-item survey to college health administrators between July and September 2021. Items measured perceptions of institutionally recommended and required vaccines, enforcement strategies, barriers to vaccine uptake, and the impact of the COVID-19 pandemic. Of 566 invitations sent, only 66 college health administrators completed the survey (11.7% response rate). The majority of participating institutions (89%) required at least one vaccine, with measles-mumps-rubella (MMR) being the most commonly required (83%). Geographic region, school type, or size was not significantly correlated with immunization policies but state-level political leanings were. Common barriers to vaccine program implementation identified by respondents included student-based and institutional concerns. The COVID-19 pandemic was described as both exacerbating existing immunization program barriers and providing opportunities to strengthen programs. Future work will evaluate identified themes in a larger study population and monitor change in perceptions over time.

Understanding the Factors Influencing Health Care Provider Recommendations about Adolescent Vaccines: A Proposed Framework

Health care provider recommendations are among the most important factors influencing parents' decisions to vaccinate their adolescents. However, delivery of high-quality health care provider recommendations for vaccination is not universal. There is wide variation in the strength, timeliness and consistency of the delivery of recommendations for all adolescent vaccines. The factors that influence health care providers' recommendations are multi-level and can be conceptualized in much the same way as vaccine acceptance among parents. Health care providers are influenced by their own attitudes and beliefs about a vaccine and also by the patient they are treating and by the community in which they practice as well as state and national level vaccine policy. We propose a multi-level framework for understanding the factors that influence health care providers' recommendations at the individual, interpersonal and community level to both develop and adapt interventions to improve providers' recommendations.

CLINICAL AND EPIDEMIOLOGICAL FEATURES OF MENINGOCOCCAL INFECTION AND ITS EARLY DIAGNOSIS IN RESIDENTS OF THE TRANSCARPATHIAN REGION

OBJECTIVE

The aim: To identify clinical and epidemiological features of meningococcal infection on the initial day of a patient's medical consultation, as well as the efficacy of laboratory examinations.

PATIENTS AND METHODS

Materials and methods: A retrospective analysis of 76 patients' histories diagnosed with meningococcal disease was carried out.

RESULTSResults: Children were more susceptible to meningococcal disease (p < 0.001). The majority of children were of preschool age, with the minority being adolescents and children under the age of one year. Among children disease incidence did not depend on gender. Among adults, the majority were women (p=0.002). All patients had a family history of a disease, close relatives tested positive for meningococcal diseases (p=0.039). The main symptom discovered during the primary examination on the day of admission to the hospital was a hemorrhagic rash (p<0.001). Most cases were of moderate severity (p<0.001) and cases of children having meningococcemia (p<0.001). A typical rash was found in 40% of patients with generalized meningococcal disease. A complete blood count showed leukocytosis in 47.8% of all cases. The most effective method of confirming the diagnosis was a thick blood smear and microscopic examination of cerebrospinal fluid (p<0.001).

CONCLUSION

Conclusions: Patients in the Transcarpathian region mainly develop an atypical form of meningococcal disease. Only half of all patients diagnosed with meningococcemia had a classical hemorrhagic rash. Generalized forms of meningococcal disease may proceed with normal or subfebrile temperature and without severe leukocytosis. We doubt the use of bacteriological methods of laboratory diagnosis due to their low effectiveness. The most sensitive method of laboratory diagnosis is a microscopic examination of blood smear, and cerebrospinal fluid.