The Meningococcal B Vaccination Gap - Check Your Teens

For teenagers and young adults in the UK, starting university or moving into shared accommodation is a major milestone. However, it also marks a period of increased risk for invasive meningococcal disease (IMD).

IMD is a bacterial infection with the Neisseria meningitidis (aka Meningococcus) bacteria, in which the bacteria passes into the bloodstream. 

While many people carry this and other bacteria harmlessly in their nose and throat, it becomes invasive & serious when it breaks through the body’s barrier into the bloodstream. It then has the potential to cause sepsis (inflammation of the blood and vital organs), and/or meningitis (inflammation of the brain lining), which are serious inflammatory conditions needing urgent medical care.

There are several strains of the bacteria. While most teens receive the MenACWY vaccine at school (covering strains A, C, W & Y of the bacteria), many parents are unaware that this does not protect against Meningococcal strain B, which has become the most common strain affecting this age group. 

The Vaccination - and Information - Gap: ACWY vs. MenB

In the UK, the vaccination schedule has evolved recently, leaving current teenagers in a specific protection gap:

• The Routine School Invite: Teenagers are offered a free MenACWY vaccine in Year 9 or 10. This is highly effective against four bacterial strains (A, C, W, and Y) but provides zero protection against the B strain.

• The Newborn Programme: The vaccine for Meningitis B (Bexsero) was introduced to the NHS schedule in 2015. While it is a vital part of routine childhood immunisation, it was only offered to infants born after that date.

• The Result: Most people born before 2015 have never been offered the MenB vaccine on the NHS. Unless they have been vaccinated privately or overseas, they remain vulnerable.

Why the Risk Increases in Teens?

The bacteria causing IMD live harmlessly in around 1 in 10 people in the UK. A number of factors elevate the risk of it becoming invasive for teens & young people, and of serious consequences: 

• Increased bacteria pool & elevated transmission risk: the bacteria spread through close respiratory contact - coughing, sneezing, sharing food/drink/cigarettes/vapes, talking at close quarters & kissing. Living in student halls, attending festivals, or shared housing significantly increases transmission risk. It’s thought 25% of teens and young people carry the bacteria, so there’s a bigger pool and the right conditions for sharing. 

• Opportunity for it to take hold: research is ongoing as to how/why some otherwise-healthy people become unwell with IMD, but cases often increase after cold and flu outbreaks, whereby weakening of throat & nasal membranes can allow the bacteria to become invasive. Research has shown an elevated risk from smoking, and early studies indicate vaping may have a similar impact. 

• Rapid progression:  Bacterial meningococcal is notoriously fast-acting, in part because this particular bacteria can evade the immune system. A young person can go from feeling "under the weather" to a life-threatening emergency in just 4 to 24 hours. While many symptoms are recognisable, they can be mistaken for a more general illness, with many inclined to wait/’sleep it off’. 

• The Reality of the Risk: While relatively rare in actual case numbers, IMD can be fatal. Approximately 1 in 10 cases of bacterial meningitis results in death. For those who survive, around 25% are left with life-altering complications such as brain damage, hearing loss, or limb loss.

Recognising the Symptoms of Invasive Meningitis B

IMD often starts with symptoms that can look like ‘freshers' flu’ or a bad hangover, but symptoms will rapidly become those of sepsis and/or meningitis, and knowing what to look for and taking action quickly is critical. Treatment is most effective when started early. If suspected, it should be treated as a medical emergency.

• General early signs: Fever, vomiting, severe headache, muscle/joint pain.

• Signs of sepsis: Cold hands and feet, where the body pulls blood away from the limbs to protect the organs; muscle pain, often in the legs causing difficulty standing; mottled or blue/off-colour skin; a red/purple pinprick rash or blotches that do not fade when a glass is pressed firmly against them (the Tumbler Test) 

  • Important: Do not wait for a rash to appear. It’s often a late sign of serious illness. 

• Signs of meningitis: A stiff neck, severe headache, vomiting, a strong dislike of bright lights (photophobia), drowsiness, confusion, sometimes seizure.

Addressing the Source: Is Men B the only risk?

No. It helps to think about the pattern of this health risk. The risk in this situation isn't Meningococcal B per se - the bacteria can live harmlessly in noses & throats. It's the entry of it into the blood stream - ie it becoming invasive. There are many bacteria, viruses and other threats that become a particular problem if they get into the bloodstream.

An invasive Men B infection triggers an immune response in the body which can lead to life-threatening conditions including meningitis, septicaemia and (less commonly) pneumonia. These are all inflammatory conditions. There are however many other causes of these conditions:

• Invasive bacterial infections: There are a number of bacteria that pose a threat. MenB and MenACWY are primary bacterial threats, as are Pneumococcus and Hib. Bacterial infections are considered the most serious and high-risk, and the UK childhood vaccination programme includes protection against a number of these threats (which is why it’s important to remain up to date and check status for young people as they transition to adulthood).

• Viral infections: Viral infections are common but can lead to more serious inflammatory responses when the immune system fails to fight them off. They include but are not limited to 'winter bugs' such as Covid-19 and influenza, through to viruses such as polio, all of which have the potential to create serious illness even in otherwise-well individuals. 

• A number of bacterial and viral infections are more ‘opportunistic’ in nature, such as bacterial Staph and the herpes virus, which for instance can become a risk in a surgery or trauma situation. Here, the exposure risk occurs as a result of surgery or trauma, rather than the bacteria posing an everyday risk to otherwise healthy people. 

Reducing the risk:  

• There is a safe and effective vaccine for MenB - but currently, most teens and young people in the UK need to access it privately. 

• Know the signs: even if vaccinated, there are a number of causes of meningitis, septicaemia and pneumonia that are not vaccine-preventable, and not everyone is vaccinated, so knowing what to look for and taking quick action are potentially-life-saving steps. 

• Keep up-to-date: It remains essential that people follow the routine NHS vaccination schedule. Many of these vaccines provide the foundational ‘firewall’ against various forms of bacterial & viral meningitis, septicaemia and other diseases.

• Remain current: new vaccines are released with frequency, and many are available on a self-pay basis before they are adopted by the NHS. Just because it’s not funded doesn’t mean it’s not safe & effective. 

The Men B Vaccine: Practical FAQs

1. What is the vaccine and how many doses are needed?

The vaccine available in the UK is called Bexsero (for people checking their records, Trumenba is also a Men B vaccine but not typically used in the UK). For teenagers, the Bexsero course consists of two doses, administered at least 4 to 8 weeks apart, and ideally within 6 months.

2. How effective is it?

Real world UK data suggests it's 83-94% effective at preventing serious illness as a result of an IMD infection with the major Men B strains. As with many vaccines - it isn't a 100% guarantee, in this case because the bacteria can present in many ways and a small number of those can evade the vaccine. But it is very effective when dealing with the vast majority of bacteria falling under the Men B umbrella.

It’s considered highly-effective at providing individual protection (protecting the person receiving the vaccine), but less so at preventing transmission of the bacteria between people.

3. Who should NOT have the vaccine?

Bexsero is a ‘non-live’ (inactivated) vaccine, meaning it cannot cause the disease itself. It’s suitable for most people, with the following exceptions:

• Severe Allergic Reaction: Anyone who has had a confirmed anaphylactic reaction to a previous dose of Bexsero or any of its ingredients should not have it.

• Latex Sensitivity: The tip cap of the pre-filled syringe contains natural rubber latex. While the risk is low, those with a severe latex allergy should consult their clinician first.

• Hypersensitivity to Kanamycin: The manufacturing process uses the antibiotic kanamycin. If you have a known severe allergy to this specific antibiotic, you must inform the provider.

• Current Illness: If the teen has a high fever or is acutely unwell, the vaccination should be postponed until they have recovered.

  
  

4. How long does vaccination protection last?

This varies depending on when the vaccine is taken.

For infants, 2 doses particularly with a further booster are considered suitable to protect in the higher-risk early years window. Protection does wane however, and it's likely that revaccination or boosting would be required for a vaccinated infant to maintain adequate protection during the higher-risk teenage window. As it’s a relatively new vaccine, that data is building. 

Fully-vaccinated teens are considered to have protection for at least five years. Those at higher risk of complications (for instance with health conditions that elevate their risk of an IMD infection, such as those without a spleen) are often recommended to take boosters, at times to be worked out in conjunction with healthcare providers.

5. Does the Men B vaccine protect against anything else?

Yes - research indicates the Men B vaccine also offers protection against gonorrhea, which is the second most common sexually transmitted infection (STI) in the world. The meningococcal bacteria and gonorrhea bacteria are closely related, and studies show the vaccine offers 30-40% protection against the infection.