October 27, 2010
Meningitis Booster Urged for Teenagers
By GARDINER HARRIS

ATLANTA — Federal vaccine advisers recommended on Wednesday that 16-year-olds be given a booster dose of a vaccine against meningococcal meningitis and that people ages 11 to 64 get a booster to protect against whooping cough, diphtheria and tetanus.

The reason for the meningitis recommendation is that two popular vaccines against the disease do not seem to work as well as hoped. Instead of providing 10 years of protection, they may work for only five years or less.

That is not long enough to protect teenagers and young adults through the riskiest years because the vaccine is usually given at 11 or 12 years of age. The hope is that a booster dose at 16 would yield protection through the first few years of college, when outbreaks occur most often.

Members of the Advisory Committee on Immunization Practices debated whether to recommend that the first dose simply be delayed by three or four years or to add a second dose. The vaccine is about $100 a dose, and the disease is rare. So adding a second dose ensures that every death averted would be expensive. Federal officials estimated that while the current strategy prevents 9 deaths each year, delaying the first dose would prevent 14 deaths and adding a second dose would prevent 24.

Since the federal government pays for about half of all vaccines, the additional cost would be partly borne by taxpayers. The committee voted 6 to 5 to support a booster, but for the recommendation to take effect, the Department of Health and Human Services would need to endorse it, which generally happens but not always.

Dr. Janet Englund, a committee member from Seattle Children’s Hospital, said that delaying the vaccine by three or four years would result in fewer teenagers being vaccinated. A smaller share of 16-year-olds are vaccinated compared with preteenagers, she noted. And because teenagers may drop out of high school, she said, “by moving the age up, I very strongly fear we’re going to be missing at-risk youths.”

Dr. James Turner, a liaison representative to the committee from the American College Health Association, said that if the vaccines were truly so ineffective after five years, more meningitis cases would be popping up on college campuses. But he said a recent survey of 207 schools found just 11 cases, and fewer than half of those cases would have been prevented by vaccination because of differences in strains of the disease.

“If there is waning immunity, we’re not seeing any emerging disease yet,” he said. “So I don’t know that there’s a lot of urgency today in deciding on a booster.”

Meningococcal meningitis is a horrifying disease. It strikes so quickly that often only a day passes between the first signs of illness and the death of the child. Lori Buher of Mount Vernon, Wash., told the committee about how her 6-foot-4, 14-year-old son, Carl, was playing football one day and was being airlifted, near death, to Seattle Children’s Hospital the next. His heart stopped three times during the flight.

Carl survived but lost both legs below the knee, as well as three fingers and the use of his knuckles. He underwent 11 skin graft operations. She urged a booster shot, she said, because vaccination at age 11 would have saved Carl from his illness. His illness struck in 2003, before the current vaccines were approved.

“I can’t tell you what it would have meant if we’d been able to vaccinate him at 11,” Ms. Buher said.

Separately, the committee discussed a growing epidemic in California of whooping cough, also known as pertussis. The state so far this year has had 6,257 cases, the most since 1960. Ten infants have died in California this year, and cases have risen nationally as well.

One way to prevent infant deaths is to vaccinate family members. The committee voted to recommend a booster shot of a vaccine against diphtheria, tetanus and pertussis to those between ages 11 and 64, and to those over 65 if they come in close contact with infants. The committee said uncertainty about whether someone had recently received a combined tetanus and diphtheria vaccine should not rule out getting the combined vaccine that also protects against pertussis.