A 17-year-old female came to clinic for her health maintenance visit. She was a senior in high school and was planning on living in the dormitories when she starts college the following year. There were no health concerns. The pertinent physical exam revealed a healthy female with normal vital signs and normal physical examination.
The diagnosis of a healthy female was made. “I recommend that you get the Meningitis B vaccine today. It helps to protect against a meningitis which is a bad brain infection. It can occur in group settings like dorms so we recommend it for college-bound students. You’ll need one now and one again after at least 6 months,” the pediatrician recommended. “Didn’t I already get the meningitis vaccine last year?” she asked. “Right. You did but that is a different vaccine. That one is for meningitis groups A,C, W and Y. Meningitis B is different, and was developed differently, so we do it separately. There is a combination vaccine with all 5 types in it, but I don’t have that one. There’s been some problems with insurances paying for the combination. Your insurance will pay for the separate Meningitis B vaccine. What questions do you have about it or meningitis?” he went on. After discussion with her and her parent, she agreed to all recommended routine health surveillance including HIV screening and all vaccines.
Discussion
Neisseria meningitidis is a major cause of morbidity and mortality including pneumonia, septicemia and meningitis. There are high case fatality and serious life-long complications for those that survive. There are 12 serotypes but A, B, C, W, X and Y cause almost all of the invasive meningococcal disease (IMD). The others are C, H, I, K, L, and Z. The epidemiology of which serotypes cause IMD is different geographically and changes over time. Most IMD cases are in children < 2 years of age, but in some countries there is also a small peak in late adolescence/early adulthood.
Crowded conditions especially when first exposed have a high risk of IMD including first year students in dormitories, military recruits and those exposed for events such as Hajj and Umrah pilgrimages. The Kingdom of Saudi Arabia requires vaccination against A,C,W,Y for these pilgrimages. Some health care providers will also recommend it for other global events such as the Olympics or World Cup Soccer because of crowded conditions. The 73rd World Health Assembly has approved a public health path to defeat meningitis by 2030.
Vaccines against A, C, W, and Y that are mainly used today are polysaccharide-conjugate vaccines.
Learning Point
Meningitis B vaccines “have been difficult to develop due to structural similarities of its capsular polysaccharide with human foetal neural cell adhesions modules, rendering it poorly immunogenic.” There was also the concern for inducing antoimmunity. It has taken more than 40 years to develop these effective vaccines.
In 2013, 4CMenB (Bexsero® from GSK) was approved again serotype B and started being used as part of the routine immunization schedule in the United Kingdom in 2015. It is a 4 component, recombinant, protein-based vaccine. In 2015, it was approved for use in the United states for 10-25 year olds. Since that time more countries are using it and another approved vaccine against serotype B, MenB-FHbp (Trumenba®, from Pfizer). PENMENVY® (from GSK) has serotypes A,B,C,W,Y antigens and was approved in February 2025 in the US.
The vaccines have been very effective including >80% effectiveness in infancy and protection lasting up to 3 years. They have been shown to be potentially effective against other serotypes, and in some studies to also be effective against nasal carriage. Protection is thought to be longer lasting in people > 5 years who receive the vaccine than those < 5 year olds. There is some data supporting additional protection against Neisseria gonorrhea as both organisms share some antigens.
Questions for Further Discussion
1. What meningococcal meningitis vaccines to you recommend and have available in your practice?
2. Where can you find vaccine schedules for other countries?
3. What are the different cerebrospinal fluid findings in different causes of meningitis? A review can be found here.
4. What causes encephalitis? A review can be found here.
Related Cases
- Disease: Meningitis | Childhood Immunization
- Symptom/Presentation: Health Maintenance and Disease Prevention
- Age: Teenager
To view pediatric review articles on this topic from the past year check PubMed.
Evidence-based medicine information on this topic can be found at SearchingPediatrics.com and the Cochrane Database of Systematic Reviews. Information prescriptions for patients can be found at MedlinePlus for these topics: Meningitis and Vaccine.
To view current news articles on this topic check Google News.
To view images related to this topic check Google Images.
To view videos related to this topic check YouTube Videos.
Rappuoli R, Pizza M, Masignani V, Vadivelu K. Meningococcal B vaccine (4CMenB): the journey from research to real world experience. Expert Review of Vaccines. 2018;17(12):1111-1121. doi:10.1080/14760584.2018.1547637
Garland JM. An Update on Meningococcal Vaccination. Rhode Island Medical Journal. Published online 2020.
Isitt C, Cosgrove CA, Ramsey ME, Ladhani SN, Success of 4CMenB in preventing meningococcal disease: evidence from real-world experience. Arch Dis Child 2020:105; 784-790.
Parikh SR, Campbell H, Bettinger JA, et al. The everchanging epidemiology of meningococcal disease worldwide and the potential for prevention through vaccination. Journal of Infection. 2020;81(4):483-498. doi:10.1016/j.jinf.2020.05.079
Meningitis. Accessed September 23, 2025. https://www.who.int/teams/immunization-vaccines-and-biologicals/diseases/meningitis
Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa