5 Questions About Shared Decision-Making for MenB Immunization
The National Foundation of Infectious Diseases is hosting a webinar on meningococcal B immunization and implementing clinical decision-making recommendations.
Today we are joined by one of the presenters of the webinar, Tamera Coyne-Beasley, MD, MPH, who is the division director of the Division of Adolescent Medicine, a professor and the vice chair of the Pediatrics Department, the Derroll M. Dawkins, MD, Endowed Chair in Adolescent Medicine, and the vice chair for Community Engagement at the University of Alabama at Birmingham. Dr Coyne-Beasley also serves on the Board of Directors of the National Foundation for Infectious Diseases.
She is answering our questions about vaccination, meningococcal infection, and more.
ID CON: Can you start by giving us some background on the meningococcal B vaccine and what role it plays in the public health landscape?
Tamera Coyne-Beasley: Meningococcal B infection is a rare but serious disease that can lead to life-threatening complications and death. Its infection rates are highest among children younger than 1 year old and adolescents and young adults aged 16 to 23 years. People transmit meningococcal bacteria to other people by sharing nasal, respiratory, and throat secretion through everyday behaviors such as kissing, coughing, living in close quarters and sharing smoking devices. College students are at increased risk for serogroup B meningococcal disease and outbreaks. Between 2013 and 2019, 13 outbreaks have been due to meningococcal B.
Other individuals are also at increased risk of meningococcal B disease including individuals with persistent complement component deficiency, complement inhibitor use, anatomic or functional asplenia, and microbiologists routinely exposed to Neisseria meningitidis.
ID CON: What are the current recommendations for shared clinical decision-making for meningococcal B vaccination?
TCB: For adolescents aged 16 to 23 years who are not at increased risk of meningococcal B infection, MenB vaccination for the primary series is based on shared clinical decision-making, preferably at ages 16 to 18 years.
There are two MenB vaccines available for vaccination; both of these vaccines require two doses to complete the primary series. These vaccines are not interchangeable. It is important that the same vaccine product is used for all doses in a series.
ID CON: Who should be involved in the decision-making process?
TCB: There are multiple individuals who should be involved in the decision-making process. If the patient is 18 years of age or older, a conversation should take place between a health care provider and the patient. In this context, the Centers for Disease Control and Prevention defines a health care provider as anyone who provides or administers vaccines: primary care physicians, specialists, physician assistants, nurse practitioners, registered nurses, and pharmacists. If the patient is younger than 18 years of age, his or her parents and/or other caretakers should also be involved in the shared clinical decision-making with the provider.
ID CON: What are some strategies for implementing shared clinical decision-making for meningococcal B vaccination? Do these strategies differ between health care provider and specialty?
TCB: Some strategies that providers use for implementing shared clinical decision-making for meningococcal B include (1) providing information about MenB when scheduling a visit for the booster dose of MenACWY, (2) having a discussion about MenB with potential administration of MenB at age 16 years with the booster dose of MenACWY, and (3) providing a MenB vaccine information statement with other information at the visit, or prior to the visit, to aid in shared clinical decision-making. These strategies generally do not differ between health care provider and specialty, though the conversation may be more likely to occur in the office of a primary care provider.
ID CON: What tips do you have for your peers in pediatrics and public health for facing patients (and families of patients) who might be hesitant of receiving the meningococcal B vaccine?
TCB: The first thing is to actively listen to identify the concerns of the patient and/or his or her family that are the source of their hesitancy. Acknowledge their concerns, then provide them with scientific information that addresses their concerns.