In the Journals: Providers and the Category B Recommendation for Meningococcal B Vaccine

In 2015, the ACIP recommended that 16- to 23-year-olds may be vaccinated with the serogroup B meningococcal (MenB) vaccine (either Bexsero® or Trumenba®) on the basis of individual decision-making (Category B recommendation). The hesitancy by the ACIP to give MenB vaccines a routine (Category A) recommendation centered on questions about duration of immunity, effectiveness, and breadth of strain protection.

To determine the likelihood that pediatricians and family physicians recommended MenB vaccines following the ACIP recommendation, Alison Kempe and co-workers surveyed 660 practitioners by email and internet (Kempe A, Allison MA, MacNeil JR, et. al. “Adoption of Serogroup B Meningococcal Vaccine Recommendations," Pediatrics. 2018 Sep 142(3):e20180344. DOI: 10.1542/peds.2018-0344). They found that 73 percent of pediatricians and 41 percent of family physicians currently administered the vaccine. Not surprisingly, practitioners who lived in states with outbreaks of meningococcal disease were more likely to recommend the vaccine. Many providers, however, reported not knowing about the factors that led to the ACIP decision and were negatively influenced to recommend the vaccine because of the Category B recommendation. The authors concluded that, “Primary care physicians have significant gaps in knowledge about MenB disease and the MenB vaccine, and this appears to be a major driver of the decision not to discuss the vaccines.”

In an accompanying editorial, titled “Strength and Clarity of Vaccine Recommendations Influences Providers’ Practice,” Dr. Michael Brady stated that, “Recommendations that require clinical decision-making need to provide clear guidance that informs providers so that they can determine what needs to be discussed with their patients and families and determine how strongly to recommend the vaccine. Without this guidance, providers will continue to be challenged with Category B or permissive recommendations as suggested in the survey.”