This page was last updated March 11, 2014
The University of California, Santa Barbara (UCSB) is experiencing an outbreak of serogroup B meningococcal disease, with four confirmed cases reported during November 2013. The Santa Barbara County Public Health Department (SBCPHD), the California Department of Public Health (CDPH), UCSB officials, and the Centers for Disease Control and Prevention (CDC) have been working closely together to monitor and respond to this outbreak and determine the best course of action to protect students’ health.
CDC, with support from UCSB, SBCPHD, and CDPH, moved forward with an Investigational New Drug (IND) application with the Food and Drug Administration (FDA) to use a serogroup B meningococcal vaccine that is licensed for use in Europe, Canada, and Australia in response to the UCSB outbreak. The IND allows access to the serogroup B meningococcal vaccine during the UCSB outbreak for those identified as being at increased risk. More than 9,000 UCSB students received the first dose of the vaccine in February and March 2014. To date, there have been no unusual patterns or occurrence of serious reactions associated with the vaccine. Additional serogroup B vaccine clinics are planned for April 2014 for eligible University community members to receive the second dose.
Q: Who is the serogroup B meningococcal vaccine recommended for and why?
A: The vaccine is recommended for all UCSB undergraduate students (those who live in dormitories or off-campus) and faculty, staff and graduate students who live in UCSB-owned dormitory-style residence halls or who have certain medical conditions. These medical conditions include problems with their spleen (including sickle cell disease) or complement pathway (a specific type of immune deficiency). These groups are recommended vaccine because they are at increased risk of getting this infection, especially those who live in close quarters, such as dormitories.
Meningococcal disease can be very serious and sometimes life-threatening. The best way to protect students during this outbreak is vaccination. It is important to get as many people vaccinated as possible to help stop the outbreak of serogroup B meningococcal disease at UCSB.
Q: Are those recommended to get the vaccine required to get it?
A: No, getting the vaccine is voluntary.
Q: Why are the residents of the city of Santa Barbara and Santa Barbara City College (SBCC) students not eligible to receive the vaccine?
A: Since the serogroup B meningococcal vaccine is not licensed for use in the United States, an Investigational New Drug application is being used to allow the vaccine to be offered to everyone associated with UCSB who is considered at increased risk for meningococcal disease. The vaccine cannot be given to anyone who does not fit the eligibility criteria established in the Investigational New Drug application.
CDC, the Santa Barbara County Health Department, and California Department of Public Health reviewed all cases of meningococcal disease in the current UCSB outbreak, as well as all cases in the Santa Barbara community and all cases occurring in college students in California dating back to 2008. In this outbreak, no cases have been identified in SBCC students, or in residents of the city of Santa Barbara or surrounding communities. In addition, there have been no cases of serogroup B meningococcal disease matching the outbreak strain among SBCC students or members of the wider community during this time period. In the past 5 years, 2 sporadic cases (not associated with an outbreak) of meningococcal disease occurred in SBCC students (one case of serogroup B in 2011 and one case of unknown serogroup in 2010); these findings are consistent with what we would expect to see in the absence of an outbreak. CDC and the Santa Barbara County and California Public Health Departments are committed to monitoring for additional cases of meningococcal disease and re-evaluating the situation if there are changes in how the disease is spreading.
Public health agencies involved also considered whether or not SBCC students are at increased risk due to interactions with UCSB students, spoke with SBCC officials to learn more about the college’s student community, and examined the various styles of housing available in the Isla Vista community. Taking into consideration all the available information and the restrictions on use of an unlicensed vaccine, it was determined that SBCC students and residents of the city of Santa Barbara are not recommended for vaccination with the serogroup B meningococcal vaccine.
The bacteria that cause meningococcal disease require prolonged (lengthy) or very close, person-to-person contact in order to spread. The bacteria are much harder to spread than the virus that causes the flu, and they cannot live outside of the body for very long. There is no evidence that says you are at risk of catching the infection by touching surfaces like doorknobs, keyboards, or exercise equipment. The bacteria are not spread by casual contact like being in the same room as someone who is sick or carrying the bacteria or handling items that they touched. It is important to note that sharing facilities like a cafeteria, gym, or classroom does not put someone at increased risk of infection. You must be in close contact with the person’s saliva (spit) or other respiratory secretions in order for the bacteria to spread. Close contacts include people in the same household, roommates, or anyone with direct contact with a patient’s saliva (such as a boyfriend or girlfriend through French kissing).
Adolescents and college students are known to get meningococcal disease more commonly than many other age groups. This is why they are routinely recommended the licensed meningococcal vaccines that protect against serogroups A, C, W and Y. However, the absolute risk is very low because the United States is experiencing record low rates of meningococcal disease of all serogroups including B. There are now about 500 cases reported each year, and 98 out of every 100 cases are sporadic. Tracking and investigation of cases of meningococcal disease is very complete. It is unlikely that cases go unrecognized and unreported.
Getting the Vaccine
Q: When will the vaccine campaign take place at UCSB?
A: The first dose of the serogroup B meningococcal disease vaccine campaign was offered February 24-March 7, 2014. More than 9,000 UCSB students received the first dose of the vaccine during that campaign. To date, there have been no unusual patterns or occurrence of serious reactions associated with the vaccine. Additional serogroup B vaccine clinics are planned for April 2014 for eligible University community members to receive the second dose. More details are available from UCSB.
Q: Will those getting the vaccine have to pay for it?
A: No. The vaccine will be provided at no cost to the recipient.
Q: What kind of consent is needed to get the vaccine?
A: Those who are 18 years of age and older give their own informed consent. Those younger than 18 years old of age need a signed consent form from their parent or guardian before receiving the vaccine. Before the vaccine campaign began, UCSB provided further information to everyone who is recommended to get the vaccine and parents of students to assist in the decision-making process.
Reasons to Get the Vaccine
Serogroup B Meningococcal Vaccine and Outbreaks
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Q: Who is investigating the meningococcal disease outbreak at UCSB?
A: State and local health officials, UCSB officials, and CDC have been working closely together to monitor and respond to this outbreak. At the request of the SBCPHD, CDC staff completed an on-site visit to UCSB and reviewed the four confirmed cases of meningococcal disease that occurred among UCSB students in November 2013. No additional cases have been diagnosed since November 21, 2013. All four cases were caused by meningococcal bacteria known as serogroup B (“strain” B). In addition to reviewing the four November cases, a careful review was completed of the historic epidemiology of meningococcal disease at the University and in the local community. Based on the history of sporadic cases of serogroup B meningococcal disease in the Santa Barbara community and November’s UCSB outbreak (four confirmed cases), moving forward with the IND and planning for a vaccine campaign was prudent.
Q: Will the vaccine help protect students against the strain of meningococcal disease identified at UCSB?
A: Yes. Based on studies of serogroup B meningococcus that cause disease in the United States, this vaccine covers 91% of circulating strains. Lab testing has been done to establish that the vaccine will help protect against the exact strain of meningococcal bacteria that is causing the outbreak at UCSB. The outbreak strain at UCSB is ST32.
Q: What was done to help protect the UCSB population until the vaccine campaign could take place?
A: For meningococcal disease outbreaks in schools, disease prevention strategies, in general, can include:
- Providing antibiotic treatment to close contacts of students who have been confirmed to have meningococcal disease (this is known as prophylaxis)
- Encouraging behaviors that minimize the likelihood of catching meningococcal disease
- Recommending vaccination against meningococcal disease if the outbreak strain is vaccine-preventable
For this outbreak, UCSB and local public health officials identified and provided prophylaxis to close contacts of each case, as well as to students identified by SBCPHD to be in high-risk social groups. UCSB and public health officials also focused on raising awareness of the symptoms of meningococcal disease so that students can receive immediate treatment to help prevent complications that can occur with this serious disease. In the weeks leading up to the winter break, UCSB urged students to refrain from attending large social gatherings and suspended social events for many of their student organizations (visit the UCSB Student Health website for more detailed information on UCSB’s response). However, since the outbreak at UCSB is caused by a strain of the bacteria that is not covered by any vaccine licensed in the United States, vaccination was not an immediate option.
Q: What was the process to determine that the serogroup B vaccine is warranted at UCSB?
A: The decision to use the serogroup B meningococcal vaccine is a multi-step process. Evaluation of and preparation for future response options involves a number of activities including:
- Analyzing the number of cases and duration of time between cases
- Defining the target population for possible serogroup B meningococcal vaccination
- Ensuring logistics to deliver the vaccine
- Establishing that the vaccine would help protect against the outbreak-causing strain
- Developing an Investigational New Drug application with the FDA
CDC and state and local health officials gathered and analyzed current and historical data and determined that additional cases are likely to occur at UCSB. Based on that conclusion, the request was made to FDA to gain access to the vaccine.
Another important step was to work closely with UCSB and the state and local health departments to learn more about campus life, living arrangements, and social interactions in order to better understand how the bacteria are spreading. CDC staff completed an on-site visit to UCSB to learn more about the students who became ill, assess the living arrangements and patterns of interactions among students, and to discuss logistics of a potential vaccination campaign.
Samples of the bacteria were sent for testing to see if the vaccine would help protect against the strain causing the outbreak at UCSB. The strain causing the UCSB outbreak is ST32 and laboratory tests suggest the serogroup B vaccine will be effective against that strain.
Q: Is the UCSB outbreak related to the Princeton University outbreak?
A: No. Although both outbreaks are caused by serogroup B, the “genetic fingerprints” do not match. The UCSB outbreak is caused by strain ST32. The Princeton University outbreak is caused by strain ST409.
If you have further questions about the serogroup B meningococcal vaccine, please email [email protected].