Meningococcal B vaccination: What it protects against and how it is administered in practice.
- 5 days ago
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Meningococci are bacteria that can cause serious illness, especially in children. They are transmitted from person to person via droplet infection (through sneezing, coughing, kissing, or sharing utensils and pacifiers).
Fortunately, meningococcal infections are very rare in Germany (approximately 1.5 cases per 100,000 children under 5 years of age between 2015 and 2019), but they can have serious consequences and are fatal in 8% of cases.
Meningococcal infections are so feared because they can progress very rapidly and severely. Initially, the symptoms resemble those of the flu. Infected children may have a fever, poor appetite, or restlessness. Within a few hours, the illness can become life-threatening. Two-thirds of all infected individuals develop meningitis (inflammation of the meninges), and one-third of all children with meningococcal B infection develop sepsis (blood poisoning). Rapid diagnosis and immediate treatment are then crucial.
Typical long-term consequences include neurological disorders such as epilepsy or hearing loss, mental health problems, and amputations.
There are different types of meningococcus: A, C, W, Y, and B. The graphic shows the frequency distribution of the individual meningococcal strains. (Source: https://www.meningitis-bewegt.de/content/dam/cf-pharma/meningitis-bewegt/master/assets/erkrankung/verteilung-meningokokken-gruppen.webp)
In Germany, vaccination against meningococcus C is routinely administered starting at age two. Furthermore, vaccination against ACWY is recommended for travel to certain countries. Until now, vaccination against meningococcus B was only recommended for specific patient groups, those at occupational risk, and for travel to certain risk areas. On January 18, 2024, the STIKO (Standing Committee on Vaccination) issued a general recommendation for meningococcus B vaccination for all infants.
The Standing Committee on Vaccination (STIKO) recommends the following procedure:
- Infants should be vaccinated with the meningococcal B vaccine Bexsero according to the 2+1 schedule (two primary immunizations and one booster) at 2, 4, and 12 months.
- Older children who have not yet been vaccinated should receive two doses of the vaccine, at least two months apart, as a catch-up vaccination starting at 12 months of age, followed by a third dose 12-23 months later.
- From the age of 3, only two doses of the vaccine, at least one month apart, are recommended for unvaccinated children.
There is currently no vaccination recommendation for children older than 5 years. This is because very young children under 2 years of age are particularly susceptible to meningococcal B infections, and the incidence (frequency of new cases) decreases sharply with increasing age.
Why should such young children be vaccinated?
... Early vaccination is crucial because the risk of severe meningococcal disease is highest in the first few months of life.
In practice, this means that children should now receive the meningococcal B vaccine at 2 and 4 months of age, in addition to the already recommended 6-in-1 vaccine and the pneumococcal vaccine. These three vaccines are administered intramuscularly. The rotavirus vaccine may also be administered orally. The third dose of the meningococcal B vaccine is given at 12 months of age in combination with the meningococcal C vaccine.
Are three vaccinations at once too many?
The Standing Committee on Vaccination (STIKO) has thoroughly reviewed the safety and efficacy of co-administration (simultaneous administration) of the meningococcal B vaccine with other vaccines. Millions of children worldwide have already been vaccinated with Bexsero in combination with other vaccines. Severe vaccination complications are extremely rare in infants.
However, reactions to the meningococcal B vaccine are relatively common. These include increased crying, pain, redness and swelling at the injection site, fever, and restlessness. Such reactions are normal and indicate that the infant's immune system is responding to the vaccine. From a medical perspective, there is no cause for concern.
Because the symptoms described above occur somewhat more frequently when Bexsero is administered concurrently with other vaccines, parents should be thoroughly informed about this at the pediatrician's office. Furthermore, the Standing Committee on Vaccination (STIKO) recommends administering paracetamol prophylactically to mitigate the severity of the reaction. This does not impair the effectiveness of the vaccines.
The recommendation is to administer three intramuscular vaccinations on the same day. This is intended to minimize the number of necessary vaccination appointments and ensure that important vaccinations are not postponed or forgotten.
... What if three vaccinations on the same day are not possible, or if we as parents object?
The Standing Committee on Vaccination (STIKO) does not prioritize the vaccines against meningococcus B, pneumococcus and tetanus, diphtheria, pertussis, poliomyelitis, Haemophilus influenzae type b, and hepatitis B (hexavalent vaccine).
If co-administration of the three recommended vaccine doses is not possible, medical staff and parents should jointly determine a sensible order that leads to the completion of the vaccination schedule as quickly as possible.
The following prophylaxis is recommended when administering the meningococcus B vaccine with the Bexsero vaccine:
If paracetamol syrup (40mg/ml) is to be given instead of the suppository, children < 4 kg receive 1 ml of syrup (40 mg paracetamol) and children from 4 kg receive 1.5 ml of paracetamol syrup (60 mg paracetamol) at the above-mentioned intervals.
What about children over 5 years old, and how long does the vaccination protection last?
Currently, there is no vaccination recommendation for children over 5 years old because the incidence rate is significantly lower in children between 5 and 19 years of age. However, a pediatrician can still make an individual vaccination recommendation for this age group.
Unfortunately, the reimbursement of costs by statutory health insurance companies is currently very inconsistent.
There is currently insufficient data on the duration of vaccination protection, which is why the Standing Committee on Vaccination (STIKO) cannot make a reliable statement on this.
Sources: Practical tips for implementing the new meningococcal B vaccination recommendation for infants from Kinder- und Jugendarzt No. 02/24.
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