SETTING THE STAGE

Meningitis B is often referred to as the forgotten meningitis.  Vaccination options are newer than those against other strains.   Public coverage in Canada has yet to materialize. Finally, the incidence of Meningitis B is low (0.33 cases per 100,000 between 2006 to 2011) often overshadowing the severity of disease outcomes.

These raw statistics are misleading and do not convey the severity of disease outcomes.   Up to 1 in 10 cases may be fatal and for survivors, and up to 1 in 5 may have long-term complications:  cognitive deficits, auditory deficits or limb loss. While rare, these complications are tragic.

So easily forgotten….yet with possible tragic ramifications.

BACK TO BASICS

Meningococcal disease is caused by a bacteria known a as N. meningitidis subgroup B.   Other subtypes most responsible for disease are A, C, Y, W-135.  It is important to note, that we have routine immunizations for A, C Y and W-135, but it wasn’t until more recently that we were able to develop the science to address subtype B.  New does not mean dangerous.  New means progress. 

IS IT WORTH THE EFFORT?

The initial presenting symptoms of Invasive Meningococcal Disease are:

1. Non-specific
2. Evolve rapidly.

Within the first 12 hours, a patient may simply have flu like symptoms – fatigue, fever, muscle pains (often misdiagnosed as influenza, other viral illnesses) and obviously very hard to discern in infants.  Within 12-24 hours symptoms can be dramatic – lethargy, stiff neck, petechiae, lack of responsiveness, loss of consciousness.  Given these 2 facts, one can imagine that prompt diagnosis with appropriate treatment is difficult and may be missed, leading to shocking cases of sudden death or long-term complications. The average delay in admission is about 19 hours from the onset of these insidious symptoms. Men B can rob our youth of pivotal time of development-  sports, academics and relationships.  Survivors often describe feeling “left behind compared to their peers.

WHO IS AT RISK?

As per Health Canada, the following groups are most at risk of developing Invasive Meningococcal Disease (IMD):

• children under 5 years old
• people living in crowded living quarters
• adolescents 15 to 18 years old
• travelers to areas where the disease is more common, such as the sub-Saharan African meningitis belt
• individuals with specific genetic risk factors
• those experiencing another respiratory tract infection (such as influenza)
• smokers
• those with HIV infection

Given the fact that at present Meningitis B is not covered by publicly funded programs, as health care providers it is essential that we initiate a discussion with these high-risk groups.

1. Bexsero – indicated for patients 2 months to 25 years of age
2. Trumenba – indicated for patients 10 years to 25 years of age

Time is obviously a currency we do not have as health care providers. Nonetheless, research as consistently shown that the single most important factor influencing why a patient chooses to get a vaccine for themselves or their children is a recommendation from a trusted health care provider (us).  Even with a scarcity of time, the minutes that we have and spend counseling have incredible impact.

It is also helpful to provide global data.  In many countries (UK, Portugal, Italy), Meningitis B has been incorporated into public funded  programs.  This supports the argument that while Canada has yet to push approval for coverage, some of our global neighbours have already jumped on the MenB preventative bandwagon.  I find that patients (and myself) are reassured and even motivated by this realization.

 I GET IT…BUT HOW?

Practically focusing on “key” moments for vaccine discussion may include:

1. Well baby visits
2. Prenatal and post-partum care
3. Travelers
4. Age related visits – e.g. adolescents
5. Vaccine related visits - catch up for missed school based programs, influenza vaccination clinics
6. Life milestones – leaving for university/camp, starting a new job

LOOKING FORWARD -  PROACTIVE IS THE NEW REACTIVE

1. Make no assumptions – often reluctance is based on simple information, concerns relating to access, being overwhelmed by evolving guidance. Experts suggest asking specifics related to vaccination concerns

2. Provide resources – teach patients how to learn and access reliable information. This not only engages a patient but sets the stage for future clinical encounters. Include adolescent in discussions and empower them to be part of their health decisions.

3. Reframe risk – while patients often are concerned about side effects (rare), I often reframe the discussion. Acknowledge that there are potential risks to being vaccinated, but there is also a risk to not being vaccinated.

4. Set expectations – take a few moments to review expected side effects (fever, swelling, malaise) to avoid panic calls and /or unnecessary office visits following an immunization. Education is key.

5. Personalize the Discussion – Given the past two years, patients are more familiar with concepts such as incidence and relative risk. This can be a useful for discussions, but I find that personalizing the discussion for a patient’s specific risk factors can also go a long way.

6. Teamwork – include other healthcare professionals in patient care, including pharmacists, nurse practitioners etc.

7. Hybrid care –capitalize on our youth’s tech savviness and engage them in virtual consults to discuss risk factors, provide counseling and help them prepare for an “in vivo” appointment!

Our health care system is exhausted.  We are exhausted. Patients are exhausted.  

After months of lockdowns, health scares, rallying forward in a proactive way is the only option.  By educating patients about risks relating to Meningitis B you empower them to think ahead and move forward in a preventative way.

Click the links below to read our other CCRN blogs:

What has changed in terms of Herpes Zoster guidance and why we should continue to care?

What’s New in Insomnia Management and Treatment?

The development of this blog was overseen by the Canadian Collaborative Research Network and was supported through an educational grant from GlaxoSmithKline and Pfizer.