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Volume 23, Number 5—May 2017
Research Letter

Serogroup B Meningococcal Disease Vaccine Recommendations at a University, New Jersey, USA, 2016

Heidi M. SoetersComments to Author , Jill Dinitz-Sklar, Prathit A. Kulkarni, Jessica R. MacNeil, Lucy A. McNamara, Elizabeth Zaremski, How-yi Chang, Eduardo Lujan, Dan Granoff, Melodee Lasky, and Barbara Montana
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (H.M. Soeters, P.A. Kulkarni, J.R. MacNeil, L.A. McNamara, H. Chang); New Jersey Department of Health, Trenton, New Jersey, USA (J. Dinitz-Sklar, P.A. Kulkarni, E. Zaremski, B. Montana); University of California San Francisco Benioff Children’s Hospital, Oakland, California, USA (E. Lujan, D. Granoff); Rutgers University, New Brunswick, New Jersey, USA (M. Lasky)

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Table

Molecular profile and flow cytometry analysis of the university outbreak strain with reference to MenB vaccine antigens, New Jersey, 2016*

Antigen
Outbreak strain
MenB-4C vaccine (Bexsero)
MenB-FHbp vaccine (Trumenba)
Interpretation
FHbp A22†/2.19‡ B24†/1.1‡ A05†, B01† The 2 FHbp subfamilies (A and B) are not expected to be cross-reactive. The outbreak strain has a subfamily A FHbp. MenB-FHbp contains FHbp from subfamilies A and B. Although the subfamily A FHbp contained in MenB-FHbp (A05) is not the same peptide allele as that in the outbreak strain (A22), some level of cross-reactivity is expected based on prior testing by the manufacturer (2). However, based on flow cytometry, the strain had relatively low expression of FHbp, which would be expected to decrease susceptibility to anti-FHbp bactericidal activity (4). MenB-4C contains a subfamily B FHbp, which is not expected to provide protection against the outbreak strain FHbp.
PorA
P1.5–1,10–1
P1.7–2.4
Not included
The PorA present in MenB-4C and in the outbreak strain are 2 different PorA variable region sequence types and are not expected to be cross-reactive; therefore, no protection based on PorA is expected for either vaccine.
NHba
p0020
p0002
Not included
The NHba present in MenB-4C and in the outbreak strain are 2 different peptide alleles. The extent of cross-reactivity is not known. By flow cytometry, low binding to the outbreak strain was observed by using antisera against NHba p0002, but it is unclear whether this low binding is attributable to the difference in sequence between p0020 and p0002, low NHba expression in the outbreak strain, or both. Low binding with NHba p0002 antisera is consistent with decreased susceptibility to anti-NHba bactericidal activity in persons vaccinated with MenB-4C, but the correlation between flow cytometric binding and hSBA response has not been established. No protection based on NHba is expected for MenB-FHbp.
NadA Negative 2/3.8 Not included The outbreak strain does not contain NadA; therefore, no protection based on NadA is expected for either vaccine.

*FHbp, factor H binding protein; hSBA, serum bactericidal activity testing using human complement; MenB, serogroup B meningococcal; NadA, Neisserial adhesion A; NHba, Neisserial heparin binding antigen.
†Pfizer classification scheme.
‡GlaxoSmithKline classification scheme.

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References
  1. US Food and Drug Administration. Bexsero US package insert [cited 2016 Nov 18]. http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM431447.pdf
  2. US Food and Drug Administration. Trumenba US package insert [cited 2016 Nov 18]. http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM421139.pdf
  3. MacNeil  JR. Considerations for use of 2- and 3-dose schedules of MenB-FHbp (Trumenba®). Presented at: meeting of the Advisory Committee on Immunization Practices; October 16, 2016; Atlanta, GA, USA [cited 2016 Nov 18]. https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2016-10/meningococcal-05-macneil.pdf
  4. Pajon  R, Fergus  AM, Koeberling  O, Caugant  DA, Granoff  DM. Meningococcal factor H binding proteins in epidemic strains from Africa: implications for vaccine development. PLoS Negl Trop Dis. 2011;5:e1302. DOIPubMed
  5. MacNeil  JR, Rubin  L, Folaranmi  T, Ortega-Sanchez  IR, Patel  M, Martin  SW. Use of serogroup B meningococcal vaccines in adolescents and young adults: recommendations of the Advisory Committee on Immunization Practices, 2015. MMWR Morb Mortal Wkly Rep. 2015;64:11716. DOIPubMed
  6. Beernink  PT, Giuntini  S, Costa  I, Lucas  AH, Granoff  DM. Functional analysis of the human antibody response to meningococcal factor H binding protein. MBio. 2015;6:e0084215. DOIPubMed
  7. Giuntini  S, Lujan  E, Gibani  MM, Dold  C, Rollier  CS, Pollard  AJ, et al. Serum bactericidal antibody responses of adults immunized with the MenB-4C vaccine against genetically diverse serogroup B meningococci. Clin Vaccine Immunol. 2017;24:e0043016. DOIPubMed
  8. MacNeil  JR, Rubin  L, McNamara  L, Briere  EC, Clark  TA, Cohn  AC; Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC. Use of MenACWY-CRM vaccine in children aged 2 through 23 months at increased risk for meningococcal disease: recommendations of the Advisory Committee on Immunization Practices, 2013. MMWR Morb Mortal Wkly Rep. 2014;63:52730.PubMed
  9. Borrow  R, Balmer  P, Miller  E. Meningococcal surrogates of protection—serum bactericidal antibody activity. Vaccine. 2005;23:22227. DOIPubMed

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Page created: April 17, 2017
Page updated: April 17, 2017
Page reviewed: April 17, 2017
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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