The majority of students, when they enter college, have been vaccinated against meningitis, a potentially deadly bacterial infection of the membranes covering the brain and spinal cord.
In fact, 37 states mandate meningitis vaccination or education before entering college, according to the Immunization Action Coalition, which is financially supported by the Centers for Disease Control and Prevention.
The problem? The vaccines available and routinely used in the U.S. only protect against meningitis strains C and Y—not meningitis B, which sickened eight Princeton students and four University of California, Santa Barbara students in 2013.
In an unprecedented effort, both schools are working with the CDC to give students Bexsero, a meningitis B vaccine approved in Europe, Australia and Canada—but not yet by the FDA.
Princeton, where students began falling ill last March, imported and distributed the vaccine to 5,268 people on campus in December, and will give a second and final dose in February. In early January, UCSB, which suffered an outbreak in November, was going through the process of getting the vaccine to its campus.
The process of getting an imported vaccine to campus is lengthy and requires that federal health officials get emergency clearance to use it. In responding to an outbreak, the CDC must first submit an Investigational New Drug (IND) application to the FDA, says Elizabeth Briere, a CDC medical epidemiologist working on the higher ed meningitis cases.
The IND for Princeton was submitted in August, and it wasn’t until December that vaccinations got underway, says Briere.
Other steps include setting up logistics for a vaccine campaign, deciding where to distribute the vaccine, ensuring temperature stability and setting up a plan to monitor the safety of the vaccine. The physical transportation of the vaccine from Europe to the U.S. also poses challenges.
The meningitis B strain is more complicated to create a vaccine against. Bexsero has not been submitted for approval in the U.S. because its manufacturer, Novartis, is developing another medicine for U.S. use that will work in conjunction with its currently licensed meningitis C and Y vaccine, says Amanda Cohn of the Meningitis and Vaccine Preventable Diseases Branch at the CDC, another medical epidemiologist who has been working with Princeton and UCSB.
“The decision to use this vaccine is really complicated and based on lots of factors, including the type of school, how many cases, and how frequently they’re occurring,” says Cohn. “If there is a cluster of cases, [schools] should work with the health department and contact the CDC to go through scenarios for vaccinations.”