A ‘new turning point’: Patients could soon have a new shot to protect them from deadly meningitis
Patti Wukovits still thinks about how she had to bury her daughter in her prom dress.
In June 2012, 17-year-old Kimberly Coffey had a fever and body aches. She told her mom it felt like her ankles were bleeding. When Wukovits looked, she noticed a purple rash.
Wukovits, a nurse from Long Island, rushed Kimberly to the emergency room where doctors diagnosed her with meningitis. Her kidneys and heart were failing. They could do little to help her.
Kimberly died days before her high school graduation.
“Our whole world changed,” Wukovits said. “There’s not one day, one hour that goes by that I really don’t think about her. She’s always on top of my mind.”
Wukovits was confused about how Kimberly could have meningitis. She had followed the US Centers for Disease Control and Prevention’s recommendations and made sure her daughter had been vaccinated.
Doctors explained that while Kimberly had protection with the MenACWY vaccine, a shot that the CDC recommends adolescents get when they turn 11 or 12, the vaccine only protected against four groups of meningococcal bacteria. The meningitis Kimberly’s doctors diagnosed her with, meningitis B, belonged to a group not covered in the shot. At the time, there was no vaccine to protect her against meningitis B.
On Wednesday, the CDC’s independent vaccine advisors recommended a new vaccine that could potentially prevent someone like Kimberly from getting sick.
Pfizer’s new pentavalent meningococcal vaccine, Penbraya, protects against five kinds of bacteria and could soon be an option that offers people broad protection from meningococcal disease with fewer shots.
Meningococcal disease, including meningitis, is an uncommon illness caused by the bacteria neisseria meningitidis, that can include infection in the lining of the brain and spinal cord that can be deadly or leave someone with a lifetime of medical problems including problems with memory and concentration, seizures, balance problems, hearing loss, and blindness. The disease can also lead to a serious blood infection called septicemia or blood poisoning. Research shows an estimated one in 10 cases of bacterial meningitis is fatal.
Antibiotics can fight the bacteria, but the infection has to be caught extremely early for that medicine to work. However, diagnosis is often delayed because the symptoms can mimic other infectious diseases like Covid-19 or the flu. Symptoms include fever, headache, nausea or vomiting, trouble waking, stiff neck, a skin rash, sensitivity to light and brain fog.
Wukovits did not delay in getting Kimberly diagnosed. She says she got her daughter to the doctor within 18 hours of her first symptom, but the infection spread rapidly.
It’s not clear how Kimberly caught the highly contagious disease. She could have been near someone who had it, who coughed or sneezed, or shared a drink with her, since the disease spreads through contact with bodily fluids. Outbreaks are rare, the CDC says only about 1 in 20 cases is related to an outbreak, but when they happen they can be devastating and tend to happen where people operate in close quarters like in schools or dorms. From 2013 to 2019, meningococcal cases were reported on more than 50 college campuses in the US, according to the National Meningitis Association.
Currently, the CDC recommends meningococcal vaccines for all preteens and teens and for some younger children and adults under specific circumstances.
There are two types of meningococcal vaccines currently used in the United States. The meningococcal conjugate vaccine, also known as the MenACWY vaccine, protects against four variations of the bacteria that are in wide circulation: A, C, W, and Y. There are three makers of that vaccine: Menactra, Menveo, and MenQuadfi.
There is also a separate vaccine, the serogroup B meningococcal or MenB vaccine, the type of bacteria that killed Kimberly. The MedB vaccine is made by two companies, Bexsero and Trumenba.
Not everyone gets both kinds of meningococcal vaccine. If a doctor determines that a patient should need both versions, the patient would currently get four or five shots. Two of the MenACWY–one when they turn 11 or 12–and a booster when they turn 16. The preferred age to get the MenB shot is between ages 16 and 18 years, which is also a two or three-dose series.
As another option, the committee voted Wednesday to recommend Pfizer’s pentavalent meningococcal vaccine, which was approved by the US Food and Drug Administration this month. The vaccine protects against the serogroups A, B, C, W and Y that cause the majority of meningococcal disease in young people. It would be for people ages 16 through 23 who are healthy, or for individuals aged 10 years and older who were at an increased risk for meningococcal disease. These individuals would get a two-dose shot instead of the others–-one on the first visit, and another six months later.
The vote was 10 to 4. The specific question was: “Pfizer’s MenABCWY vaccine may be used when both MenACWY and MenB are indicated at the same visit.” The committee had a second vote to then update the Vaccines for Children administration plan, to reflect this meningococcal vaccine recommendation. The committee voted unanimously.
As the Executive Director of the Kimberly Coffey foundation, an organization that educates people about meningitis, Wukovits testified during the public comments portion of the CDC’s independent vaccine advisers meeting.
“Today is a major turning point,” Wukovits said.
But she told committee members they had to make access to Pfizer’s new meningococcal vaccine as easy as possible.
“The availability of the pentavalent vaccine has the potential to completely change the landscape of meningitis vaccinations,” she said.
In a company statement, Pfizer said the vaccine could help improve vaccination rates.
“Penbraya, the first FDA approved 5-in-1 meningococcal vaccine, provides adolescents and young adults in the US with the most comprehensive protection available against the leading causes of meningococcal disease,” Dr. Luis Jodar, Pfizer’s chief medical affairs officer for vaccines, antivirals and evidence generation, said in a company statement. “Penbraya helps simplify a complex meningococcal disease vaccination schedule and has the potential to increase vaccine coverage by providing the broadest protection in the fewest number of shots to help prevent this deadly disease.”
Committee members said anything that could simplify how many shots someone needs to be fully vaccinated could be helpful.
“Complexity has negative side effects,” said committee member Dr. Matt Daley, senior investigator, Institute for Health Research, Kaiser Permanente Colorado.
Currently, only 30% of 17-year-olds are getting even one dose, according to a CDC presentation to the committee.
Committee member Dr. Pablo Sanchez, professor of pediatrics, division of neonatal-perinatal medicine, Ohio State University said that the existing meningococcal immunization recommendations have always been confusing to him. He thought the decision to add this simpler option was a “reasonable option in certain circumstances.”
Committee member Dr. Kathy Poehling, a professor of pediatrics and epidemiology and prevention at the Wake Forest School of Medicine, said she voted “no” on the resolution but it wasn’t because she lacked faith in the new vaccine or the current schedule of vaccines.
“We know that there’s been tremendous benefit from the vaccines that are being administered. And there’s a lot more to learn,” Poehling said. “My vote no was because I wanted to vote for a little bit of a broader recommendation. I respect that of my colleagues and believe there are going to be many more conversations to come about meningococcal vaccines.”
The CDC will still need to accept the committee’s recommendation to make it official.
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