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General Practitioner, National Health Service UK, Bracknell, Berkshire, United Kingdom
This educational activity is intended for an international audience of non-US healthcare professionals, specifically primary care physicians, pediatricians, and infectious disease/HIV specialists.
The goal of this activity is to improve clinicians' competence in discussing vaccines to prevent serogroup B meningococcal (MenB) disease in adolescents and young adults.
Upon completion of this activity, participants will have greater competence related to:
WebMD Global requires each individual who is in a position to control the content of one of its educational activities to disclose any relevant financial relationships occurring within the past 12 months that could create a conflict of interest.
General Practitioner, National Health Service UK, Bracknell, Berkshire, United Kingdom
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Host: Hello, I'm Kevan Chambers, the host for Meningitis B Television on Medscape. Welcome to the third episode in our series on "Adolescents and Young Adults: A Critical At-Risk Population." In the previous program, we looked at the benefits of immunizing adolescents and young adults against serogroup B meningococcal disease (MenB). Two vaccines are now available for use in this population, and there are good data showing that both of these vaccines can help protect individuals from developing invasive meningococcal disease, a serious and potentially fatal infection.
But, how can we make sure that patients in our own clinical practice who most need immunization do actually receive the vaccine? And what impact will vaccination have on the overall risk of developing invasive meningococcal disease due to MenB? I'm joined today by Dr George Kassianos, who is going to discuss how the benefits of immunization against MenB can be achieved in real-world, everyday clinical practice.
Host: Hello Dr Kassianos, thank you for joining me for the final episode in this 3-part series. What I would like to do today is look at real-world aspects of MenB immunization: what doctors can tell their patients, and how they can overcome barriers to vaccination.
Dr Kassianos: Alright.
Host: Where are we today, in terms of immunizing individuals who should be immunized against MenB?
Dr Kassianos: Well, let's start with young infants, where the situation is most straightforward. In Europe, as you know, serogroup B causes the majority of cases of invasive meningococcal disease,[1] and immunization is the most effective strategy for prevention of meningococcal disease.[2]
Host: Immunization policies involve weighing the epidemiologic and clinical benefits of vaccination against economic projections. At the moment, there do not appear to be sufficient data for any countries to recommend routinely immunizing all adolescents and adults against MenB.[5,6] So I wondered whether doctors can confidently recommend vaccination for their own patients.
We know from work with other vaccines that when a physician or healthcare professional clearly and confidently communicates the importance of immunizing against a disease, patients very often follow that professional's recommendation,[7,8] even if they have to pay for the vaccine.
Dr Kassianos: Yes, I agree. The family doctor (or pediatrician, because in many countries 16- and 18-year-olds are still being seen by a pediatrician) should consider recommending the vaccine. If the physician strongly recommends a vaccine, any recommended vaccine, it is more or less guaranteed that vaccination will take place -- that it will be accepted. If the family doctor is not sure, however, and is not confidently giving advice, the patient will be unsure about the benefit of immunization. Therefore, family doctors and other healthcare professionals who are recommending vaccination must do so confidently and with enthusiasm.
Host: In the absence of policy recommendations regarding MenB immunization in adolescents and young adults, can physicians still recommend the vaccine in these age groups with enthusiasm?
Dr Kassianos: I think so. It's important to separate the economic issues, which are a major driver of government policy,[9] from the clinical issues that we must prioritize when advising our own individual patients.
Host: When should a family doctor give such advice?
Dr Kassianos: There are a few clinical factors that support confident recommendation of MenB vaccination for our patients. First and foremost, if our patients fall into certain high-risk categories, there is a clear-cut recommendation for them to be immunized against MenB.
Host: So those would be the groups that Professor Martinón-Torres described in the previous episode:
Host: The majority of adolescents and adults do not fall into those high-risk groups. Yet behavioral changes and, in some cases, group living arrangements increase the opportunity for MenB infection in these age groups.[12] Physicians have no clear guidance on how to protect these individuals.
What about patients who do not fall into that high-risk category? What do you tell those individuals about MenB?
Dr Kassianos: For all patients, regardless of whether they are at increased risk for meningococcal disease, I think that it's important to explain the serious risks associated with meningococcal disease, including MenB.
Host: Although available data indicate that MenB vaccines are safe, it is important for doctors to let patients know that they may experience some side effects. In adolescents and young adults, the most common side effects include soreness, redness, and swelling where the shot was given.[21] Fatigue, headache, muscle or joint pain, and nausea or diarrhea can occur in these age groups, but they are not very common[21] and they usually get better on their own within 3 to 7 days.[22]
Across most infectious diseases, not just meningococcal disease, there often seems to be concern about side effects and risks due to the use of vaccines. How do you handle that?
Dr Kassianos: Of course, we do need to give patients -- and, when appropriate, their parents -- information about the possible side effects of the vaccine so they are fully informed.
Host: In many high-income countries, the coverage rates for recommended vaccines remain below the target levels established by national and international advisory committees.[23] So I wanted to explore how physicians can increase the chances of adolescents and young adults in their practice being protected against meningococcal disease.
Of course, you cannot vaccinate patients unless they show up at your office. How do you try to make sure that adolescents come in for immunization.
Dr Kassianos: It's a challenge. Many adolescent patients are not seeing their family doctor for immunizations. If there is an outbreak of meningitis, they will all be at our doorstep; otherwise, it is not a priority for them. So, it's important for us to remember, opportunistically in the clinic, when we see a patient who is in the group at risk (ie, in the target group for meningitis vaccination) we must bring up the subject. If we see them for something else and we fail to actually recognize that they are due to be immunized against meningitis -- whether it is the MenB vaccine, the ACWY vaccine, or both -- then we have failed them.
Host: How do you make sure that you don't overlook the need to vaccinate the patients?
Dr Kassianos: In the UK, it's relatively straightforward for me to identify them. I have a contract with the government regarding who I should immunize against MenB, and we have a national information technology (IT) system, so these patients are flagged in the notes on my computer. In other countries that don't have such a system, I would advise physicians to find another way to be informed when they open their notes; some way of flagging that the patient is in the target group for immunization against MenB and has not yet been given the vaccine. When we were using paper notes in the previous century, I used to put a colored card in the patient's file to remind me. The card would say which vaccines were due and had not been given. No matter where you live, how you practice, there are ways to remind yourself, opportunistically, to promote vaccination.
Host: What about patients who you may not have a chance to immunize opportunistically?
Dr Kassianos: We need to write to these patients and tell them they are due for this vaccination, let them know why they are in a group that is at increased risk for meningococcal disease, give them information, and invite them to come and see us for vaccination. In our clinic, we take our patients' mobile numbers -- hardly anybody does not have a mobile nowadays -- and we make phone calls and more often send out text messages as a reminder. For patients who are at school or university, it's sometimes possible to target them through their educational organization.
Host: It's quite typical; however, for adolescents to have multiple activities competing for their time and attention.
Dr Kassianos: That's true. But a recent study conducted in London found that text message reminders can be particularly effective with this age group.[24] And another thing that I think is important for me to do, as a family doctor, is ensure that I am providing a convenient time for teenagers to come in for their vaccinations. If I say that vaccination can take place between 8 and 10 in the morning, and they are at school or university, how are they going to come in? We need to think about times that are convenient for our patients so that it does not become a problem. We will hear adolescents say, "I did not have the time." If we enable them to come in when it is more convenient for them, they are more likely to make the time.
Host: I think that's a good suggestion. This has been an interesting conversation with some valuable insight that can be used in clinical practice. Thank you, Dr Kassianos.
Host: As we have heard throughout this series, adolescents and young adults have an increased risk of developing invasive meningococcal disease. And in Europe, serotype B is responsible for around two thirds of all cases of this disease. So, there is good reason to vaccinate patients in this age group against MenB. Some patients have underlying medical conditions that increase their risk of complications from infectious diseases, so it is especially important that we make sure those individuals are immunized.
Of course, there are barriers that sometimes make it difficult to administer vaccines to all patients who should be immunized. But as Dr Kassianos explained, a proactive, organized, and confident approach by pediatricians and general practitioners can overcome those barriers and help ensure that patients in their practice receive the appropriate vaccines. And, although it is too soon to be able to measure the benefits of immunizing adolescents and young adults at the population level, surveillance data demonstrate a substantial reduction in the incidence of meningococcal disease due to MenB in infants through routine immunization.
Thank you for joining us for Meningitis B TV on Medscape. We hope that you have found this series both interesting and informative. You may now take the posttest by clicking on the "Earn CME Credit" link. Please also take a moment to complete the program evaluation that follows. Goodbye, and thank you again for watching.
This transcript has been edited for style and clarity.
