From the Department of Pediatric Infectious Diseases, Driscoll Children's Hospital, Corpus Christi, Texas.
Yale School of Medicine, Department of Pediatrics, New Haven, Connecticut.
Pediatr Infect Dis J. 2021 Mar 1;40(3):269-275. doi: 10.1097/INF.0000000000003033.
Meningococcal serogroup B (MenB) is the leading cause of invasive meningococcal disease among US adolescents and young adults, accounting for 62% of cases in 16-23-year-olds in 2018. Since 2015, the Advisory Committee on Immunization Practices (ACIP) has recommended vaccination of healthy adolescents against MenB based on shared clinical decision-making (previously called "Category B" or individual clinical decision-making). However, MenB vaccine coverage and series completion rates remain low. Herein we examine implementation experience of adolescent MenB vaccination in the United States under this nonroutine ACIP recommendation.
PubMed was searched for English-language articles published after 2015 examining MenB vaccination implementation in the United States. Studies reporting MenB vaccination awareness, coverage, knowledge of recommendations and implementation barriers or access disparities were included.
Identified studies provided evidence that ACIP's MenB vaccination recommendation is poorly understood and prone to misinterpretation by US healthcare providers. Parental awareness of MenB vaccines is low, and racial and socioeconomic disparities exist regarding vaccine receipt. Parents rely on providers to learn about MenB disease risk and benefits of vaccination, with provider recommendations carrying substantial weight in vaccination decisions.
Five years of evidence regarding the MenB vaccination implementation experience suggest that the nonstandard recommendation for MenB vaccines is partly responsible for low vaccine coverage. Further, inconsistent implementation of ACIP recommendations could be limiting access to MenB vaccines. Providers need additional support and guidance to implement the shared clinical decision-making recommendation, in turn ensuring equitable access for vaccine-eligible adolescents to enable comprehensive protection against meningococcal disease.
脑膜炎奈瑟菌 B 群（MenB）是导致美国青少年和年轻人侵袭性脑膜炎球菌病的主要原因，占 2018 年 16-23 岁人群中病例的 62%。自 2015 年以来，免疫实践咨询委员会（ACIP）基于共同的临床决策（以前称为“B 类”或个体临床决策）推荐对健康青少年进行 MenB 疫苗接种。然而，MenB 疫苗接种覆盖率和系列完成率仍然很低。在此，我们研究了在美国根据非常规 ACIP 建议实施青少年 MenB 疫苗接种的经验。
在 PubMed 上搜索了 2015 年后发表的关于美国 MenB 疫苗接种实施情况的英文文章。纳入了报告 MenB 疫苗接种意识、覆盖率、对建议的了解以及实施障碍或获取差异的研究。
确定的研究提供了证据表明，ACIP 的 MenB 疫苗接种建议理解不佳，容易被美国医疗保健提供者误解。父母对 MenB 疫苗的认识很低，在疫苗接种方面存在种族和社会经济差异。父母依赖提供者了解 MenB 疾病的风险和疫苗接种的益处，提供者的建议在疫苗接种决策中具有重要作用。
关于 MenB 疫苗接种实施经验的五年证据表明，非标准的 MenB 疫苗建议部分导致了低疫苗覆盖率。此外，ACIP 建议的实施不一致可能限制了 MenB 疫苗的获取。提供者需要额外的支持和指导来实施共同的临床决策建议，从而确保有资格接种疫苗的青少年能够公平地获得疫苗，以实现对脑膜炎球菌病的全面保护。
