Exclusive Q&A with CDC’s Head of Meningitis and Vaccine Preventable Disease Branch Dr. Thomas Clark

Recently, a student at Drexel passed away from meningitis caused by the serogroup B bacteria which caused an outbreak here at Princeton. The student had been in close contact with Princeton students a week before becoming ill. Further studies revealed that the bacterial strain in the Drexel student was the same as the outbreak strain at Princeton, according to the Centers of Disease Control and Prevention (CDC). Find out about the concerns regarding the transmission of the bacteria and further steps to be taken directly from Dr. Thomas Clark, head of the meningitis vaccine initiative at CDC.

PPHR: Are there any concerns about spreading the disease even after students are vaccinated (both doses)?

Dr. Clark: Yes. When it comes down to it, we study vaccines and learn if they work or not, and whether they are effective at protecting against disease in people. With this vaccine, we feel confident that it can help prevent vaccinated students from getting sick with meningitis. However, we don’t know everything there is to know about this vaccine and whether it protects you from getting or carrying the bacteria and whether it interrupts the transmission. I think given the clear indication that the strain is still present because of the Drexel case, we have to worry and be careful as it can still be transmitted.

PPHR: Are students who have been vaccinated still at risk?

Dr. Clark: The best way to protect against meningococcal disease is vaccination. We expect a high proportion of the students who got both doses of the vaccine to be protected against the disease. But we can’t tell at this point if they could still carry the bacteria or not. Even if they did carry it, we would expect the immune response from vaccination to protect them against the disease.

PPHR: What are the potential ways of transmitting the disease after students have been vaccinated?

Dr. Clark: Vaccine or no vaccine, it’s still the same. It’s still relatively difficult to acquire the bacteria and transmit it. The bacteria live in your nose and throat and transmission requires direct contact with someone’s oral secretions or direct face to face contact that might lead to exposure to oral secretions. That is why we are worried about the roommates of people who have the disease because they live in close proximity or boyfriend-girlfriends, that sort of thing.

Again, it’s not casual contact, shaking hands, or doorknobs and other surfaces which lead to transmission.

PPHR: Are there any ways of preventing further transmission of the bacteria?

Dr. Clark: I think the message that Princeton and others have used so far is to limit behaviors which may lead to exposure with others’ oral secretions. This is a reasonable thing to follow—not sharing cups and water bottles, being careful about drinking games etc. None of these are really specific and don’t ensure that you are protected. We still think the best protection is the vaccine.

PPHR: Were the individuals who were in contact with the Drexel student previously vaccinated?

Dr. Clark: We can’t really comment on that since we did not lead the case investigation. That responsibility belongs to the Philadelphia Department of Health.

PPHR: What steps will be taken by CDC and university officials at Princeton and Drexel after this incident? If more cases occur at Drexel, will a vaccine initiative be implemented?

Dr. Clark: Certainly the response to the one case at Drexel has mostly been done. It involves identifying everybody who has been in close contact and giving them antibiotics to prevent infection. It also involves making students aware of signs and symptoms and being really careful to find and recognize any additional cases which may happen. We hope they don’t but if they do, they need to be recognized quickly. So the response to one case has been done at Drexel.

One case is not considered to be an outbreak. We have to be vigilant for additional cases at Drexel. I think this has implications for Princeton as well because it is the same strain which was at Princeton, so we can’t say that the outbreak is over. Certainly we will continue to talk with Princeton officials about whether other steps are needed and communicate those in a timely way.

The vaccine initiative will not be implemented because of a single case, but if there are further cases, we’ll certainly have to consider it.

PPHR: What precaution measures should vaccinated students, family and friends take?

Dr. Clark: Folks should be aware that this is going on, be aware of the signs and symptoms of meningococcal disease—fever, severe headache, and especially the rash that characterizes the blood stream infection. It’s prudent now to not think that it’s fatigue or the flu but to really get checked out, get to the doctor quickly.

We don’t want folks to be too paranoid about travelling, going home or going about their usual social interactions. We are discussing with the administration about some of the events at Princeton. It’s not routine in public health to interrupt or cancel social events to curtail transmission. For a lot of reasons, it is not an effective strategy. Clearly what is going on at Princeton is unusual and we’ll have to keep talking with them about what they want to do going forward.

PPHR: Should admitted students attending Princeton Preview in April be concerned? Are there plans to vaccinate the incoming Class of 2018? What circumstances would most call for a plan to vaccinate incoming students?

Dr. Clark: These are the specific things we are talking about with the Princeton Health Services and the administration. And so they will be able to communicate with the students about that.

PPHR: Is there a chance that the vaccine will be approved by the FDA in the near future?

Dr. Clark: There are two vaccines in development and investigation in the US right now. There is Bexsero made by Novartis. It is the vaccine we used at Princeton and UC Santa Barbara and which is licensed in several countries. There is also another vaccine made by Pfizer pharmaceuticals and it’s also in development and is being studied in the US and in other countries. It is not licensed anywhere yet. But both of those companies have been engaged with FDA and in their plans for the development for the vaccine. Both of them are moving forward with the licensing of the vaccine in the US.

I think Pfizer has put out a press release today and Novartis has indicated that they are moving forward with licensing in the US.

PPHR: Students who were vaccinated were told that they will be receiving questionnaires from the CDC. How will this information as well as past year’s incidents and the vaccination campaign help CDC to tackle future cases or incidents?

Dr. Clark: I think the questionnaire is going to be used to identify any adverse events associated with gaining the vaccine which we don’t know about yet or haven’t found out from the University Health Services. It will be similar to the questionnaire which people hopefully filled out right before the second dose − about the first dose. This is actually really useful information about the safety of the vaccine, what we call the safety profile of the vaccine. It provides us with information about the occurrence of any serious adverse effects after the vaccination, which may be related to the vaccine. So far, the serious adverse events have been uncommon. We are working through the determination of causality. But nothing has been a serious concern. The safety profile of the vaccine looks good. Everybody always wants as much data as possible when thinking about using a vaccine or implementing a vaccination program.

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