Primary Care Docs Not Up to Speed on MenB Vax

Only half of pediatricians and around 30% of family physicians said they discussed the serogroup B meningococcal vaccine with their patients, researchers found.

There were 51% of pediatricians and 31% of family physicians who reported that during routine visits, they "always or often" discussed the MenB vaccine, reported Allison Kempe, MD, of the University of Colorado Anschutz Medical Campus, and colleagues.

Moreover, greater awareness about outbreaks of the disease was linked with a greater likelihood of discussing the vaccine (RR 1.25, 95% CI 1.07-1.45), the authors wrote in Pediatrics.

They noted that the CDC Advisory Committee on Immunization Practices (ACIP) recommended that young people, ages 16-23 years, may be vaccinated with the MenB vaccine, with ages 16-18 as the preferred age of administration (Category B recommendation). A prior recommendation had said all persons ages ≥10 who were at increased risk for MenB disease should be vaccinated (Category A recommendation).

Because this is the "first widespread use of a Category B recommendation, it was unclear how the MenB vaccine would be adopted," the authors said, adding that no national data are available about how state or local public health agencies advised implementing the MenB vaccine recommendations for healthy adolescents and young adults.

Researchers surveyed a nationally representative sample of 660 pediatricians and family physicians. The authors found that among pediatricians and family physicians who "always or often" initiated a discussion about the MenB vaccine during routine visits for patients ages 16-18, over 90% recommended the MenB vaccine (with 66% recommending it strongly). Conversely, among those who "never or rarely" initiated a discussion, only 11% recommended the vaccine (with 3% recommending it strongly), the authors said.

"The fact that the MenB vaccine was given a Category B as opposed to a Category A recommendation by the ACIP was the major issue identified by both specialties with not recommending the MenB vaccine," they wrote. Recommendation for another meningococcal vaccine (MenACWY) and "consistency of reimbursement" were linked to a lower likelihood of recommendation, the authors added.

In addition to the occurrence of MenB outbreaks, the authors found that incidence of the MenB disease, effectiveness, and safety of the MenB vaccine, as well as the duration of protection of the MenB vaccine, were associated with a higher likelihood of recommending the MenB vaccine.

Providers who said they were "somewhat aware" of the MenB vaccine and those who were "not at all aware" were associated with a lower frequency of initiating a discussion about the vaccine at routine well visits for their patients ages 16-18 (RR 0.35, 95% CI 0.27-0.45 and RR 0.19, 95% CI 0.09-0.40, respectively).

The authors addressed the potential varying interpretations of a Category B recommendation from the ACIP, arguing that "physicians may interpret 'individual clinical decision-making' to reflect their own decision about whether to initiate a discussion of the MenB vaccine, given their assessment of the risks and benefits of vaccinating, without involving parents or providers in decision-making."

They concluded that because Category B recommendations are likely to occur in certain situations, "it will be key for national clinical organizations, such as the AAP [American Academy of Pediatrics] and AAFP [American Academy of Family Physicians] to provide as much guidance as possible about how to implement Category B recommendations for different vaccines."

Currently, the AAFP has frequently asked questions about the MenB vaccine, "but no specific talking points," while AAP recommendations encourage providers to work with patients and "determine what is in their best interest" in terms of benefits, risks, and costs of the vaccine.