One more vaccine for teens, college students

Cedarburg pediatrician Dan Hagerman hasn't personally treated meningococcal disease, but one of his daughters was a student at the University of Wisconsin-Madison when a fellow Badger died three years ago from the fast-moving bacterial disease that begins with flu-like symptoms.

"It is rare; something like one in a million," Hagerman said. "But when they do get this, they get severely ill; 10 to 20% die and upwards of 20% have serious, long-term neurologic injury or limb loss. Most of us will never see it, but all it takes is that one case."

So Hagerman will readily recommend to his adolescent and college-bound patients a new two-dose vaccine in the fight against the disease transmitted through close contact with respiratory and throat secretions, such as kissing and sharing drinks. The disease, which can be treated with antibiotics if quickly diagnosed, is most often seen among young people who spend a lot of time in close quarters and engage in behaviors conducive to transmitting the bacteria that lives in the nasal cavity.

The new vaccine — which two different companies make — potentially could have saved the life of UW-Madison senior Henry Mackaman of St. Paul, Minn., in 2013, had it been available, though there is no guarantee someone given the vaccine will develop an immune response. The new vaccine was licensed by the Food and Drug Administration early last year, but has not been widely available locally until this summer.

Mackaman had received the recommended two doses of a routinely given vaccine that's been available since 2005 to protect against four of the major strains of meningococcal disease, A, C, W and Y. But he died from an unprotected-at-the-time B strain, which accounts for about one out of every three cases of meningococcal disease in the U.S.

The new two-dose vaccine protects against the B strain. It does not replace the two-dose vaccine that college students already routinely receive starting at age 11 or 12, but is offered in addition to that vaccine for those ages 16 to 23.

Wisconsin has had a total of 65 cases of meningococcal disease reported in the last five years, from 2011-2015. Thirty of those cases (46%) were linked to the B strain, as was the only death during that time, according to the state Department of Health Services. Meningococcal disease linked to the other bacteria strains has decreased in frequency in Wisconsin, due to the quadrivalent vaccine that has been given since 2005, a spokeswoman said.

Hagerman and other physicians in the Columbia St. Mary's Cedar Mills Medical Group just received a batch of the new B vaccine on Friday. Physicians in Aurora Healthcare practices also are recommending the new B vaccine, though not all area doctors agree it's necessary for all young people, and neither does the U.S. Centers for Disease Control and Prevention.

The CDC made a "permissive" recommendation for the new vaccine, so most insurance companies required to cover preventative care under the Affordable Care Act should pay for it. But it is not included in the official adolescent immunization schedule at this time.

The CDC's advice to parents is to discuss it with their child's physician.

The B strain of meningococcal disease has been linked to outbreaks on at least six college campuses across the country since 2013.

Sarah Van Orman, a physician and executive director of University Health Services at UW-Madison, said she recommends students talk with their physician about the new B vaccine, but notes it may not be as effective as the routinely given vaccine against the four other major bacteria strains.

In a study of 499 Princeton University students who received the new B vaccine during an outbreak there, up to a third did not show a good immune response eight weeks after the second dose, Van Orman said.

Some research suggests the vaccine also may only provide immunity for six to 12 months, she said.

"So the focus is on getting it to people at increased risk, and during outbreaks," she said. Among those at increased risk are those with weakened immune systems or spleen issues.

Last fall, 91% of first-year students reported they got the first dose of the other vaccine against meningococcal disease, which is commonly given at age 11 or 12, Van Orman said. Only 60% said they got the second, pre-college booster.

UW-Madison's health services does have the new B strain vaccine and will administer it to students who request it for $141 per dose.

Mark Obermyer, an internist at Springdale Health Clinic in Brookfield, said he sees no need for the majority of his young patients to get the vaccine at this time unless they have high-risk medical issues, or there is an outbreak on their college campus.

Several universities with outbreaks of B strain meningococcal disease have held emergency clinics to administer the new vaccine since it was licensed by the Food and Drug Administration in early 2015. Princeton received special permission from the federal government during its 2013 outbreak to offer the vaccine before it was licensed for use in the U.S.

The most recent B strain outbreak occurred at Rutgers University last spring; two students contracted the disease and recovered. Seven cases were reported last year at University of Oregon, and one student died. A Drexel University student who came into contact with an infected student during the Princeton University outbreak also died.

Other outbreaks occurred at Santa Clara University, Providence College and University of California, Santa Barbara. A male lacrosse player — one of seven students at UC-Santa Barbara to contract the disease in late 2013 — had both feet amputated

Meningococcal disease most often leads to severe swelling of the tissues surrounding the brain and spinal cord (meningitis) or infection of the bloodstream. Even with antibiotic treatment, 10 to 15 out of 100 people infected with meningococcal disease will die; about 11 to 19 out of every 100 survivors will have long-term disabilities, such as loss of limbs, deafness, nervous system problems, or brain damage, according to the National Foundation for Infectious Diseases.

Sudden onset of symptoms such as headache, fever and stiff neck is common with the disease. Other symptoms, such as rash, nausea and vomiting, light sensitivity and confusion may appear, typically within three to seven days of exposure to the bacteria. The symptoms often get mistaken for the flu, which can make diagnosis difficult.

Mackaman, the UW-Madison student who died in April 2013, had gone to a hospital emergency department in Madison not far from his off-campus home with a 104-degree fever on a Saturday night. He was sent home after a chest X-ray ruled out pneumonia. He felt better the next day, but walked back to Meriter Hospital that Monday because he had a headache, trouble speaking and his right hand "felt funny."

Two days later, he was brain-dead.

Mackaman's shocking death still reverberates in Wisconsin, as college-bound students prepare for a new academic year.

Oak Creek pediatrician Gregg Tetting said he believes the new vaccine represents an important advancement against a potentially deadly disease.

Tetting began recommending it to his patients at the Aurora Health Center/Lakeshore Medical Clinic over the past month "because the disease is so devastating."

One of Tetting's 18-year-old patients, Stephanie Kluczykowski of South Milwaukee, said she doesn't like shots. But she knows that living in a college residence hall could put her at risk for meningococcal disease.

So the young woman who is about to start her freshman year at UW-Platteville got her first dose of the new B strain vaccine on Friday. She already has had two doses of the vaccine that protects against four other strains of meningococcal disease.

“I heard about meningitis and know it can be a dangerous disease, and wanted to protect myself from it," Kluczykowski said. "I had to get the shot."