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Meningococcal Myth Busters: Strategies to Build Vaccine Confidence and Boost Uptake

Introduction

Myth 1: Healthy adolescents and young adults are unlikely to have severe manifestations of meningococcal disease 

Dr. Jana Shaw (SUNY Upstate Medical University): It's a pleasure to be here today. We'll start with the myth number one.

Today's presentation will focus on common myths - myths surrounding meningococcal vaccination in adolescents. And our goal is to address these misconceptions and provide accurate and evidence-based information to you.

The myth number one states healthy adolescents and young adults are unlikely to have severe manifestations of meningococcal disease. So let's go through the evidence to highlight why that may not be accurate.

Specific Age Group Are at Increased Risk of Infection  

Although rare, certain age groups are at higher risk for invasive meningococcal disease. Infants under one year of age, adolescents and young adults, particularly those ages 16 to 25 and those over 85 years of age are at particularly increased risk for invasive meningococcal disease.

For adolescents and young adults, increased risk is partly due to social behaviors and close contact settings such as schools, dormitories and social gatherings. The risk for invasive meningococcal infection is not limited to those with underlying health conditions. Healthy individuals in these age groups can still develop severe disease, and this is why vaccination is an important preventive measure for adolescents and young adults.

Risk Factors for Invasive Meningococcal Disease (IMD): High Risk Conditions and Exposures  

In addition to age, certain medical conditions and environmental behavioral factors can significantly increase the risk of invasive meningococcal disease. Those include individuals who have been in close contact with someone with IMD, patients with specific medical conditions or medications used that increase susceptibility to meningococcus. Those conditions include functional or anatomic asplenia, HIV infection, complement deficiencies, patients receiving complement inhibitor therapies.

Environmental and behavioral factors also play a role. For example, adolescents and college students living in dormitories or other congregate housing are at increased risk for IMD.

Clinical Presentation of IMD

Let's review clinical presentation of IMD. Meningococcal disease is particularly concerning because of its sudden and unpredictable onset. Early symptoms are often non-specific and can resemble common viral infections such as influenza. This can make early diagnosis challenging despite appropriate antibiotic treatment. The disease can progress quickly, sometimes within hours, leading to severe complications.

IMD can present in different forms and most commonly as meningitis, which accounts for about 50% of cases. Septicemia, which can occur with or without meningitis, is another manifestation of IMD and occurs in 30% of the cases.

Symptoms of meningitis include headache, stiff neck, nausea, photophobia, altered mental status. Symptoms of septicemia may include chills and cold extremities; muscle and joint pain; vomiting and diarrhea; skin findings such as petechiae or purpura; hypotension, which can rapidly progress to shock.

The key takeaway is that IMD can start like a mild illness, but escalate rapidly to a medical emergency.

IMD Is Difficult to Recognize in the Early Stages  

This slide highlights an important clinical challenge invasive meningococcal disease poses, as it can be difficult to recognize in its early stages. As shown in these two images, on the left, a child with meningococcal disease presenting with petechiae. On the right, a child with an enteroviral infection.

At first glance, these rashes may look very similar, which can make early diagnosis challenging. However, the implications are very different. In meningococcal disease, petechia can be an ominous sign of a severe and potentially life-threatening infection that may progress rapidly.

In contrast, an enteroviral rash is typically part of a self-limited illness in an otherwise healthy child.

IMD Is Extremely Rare…

Invasive meningococcal disease is a – is considered a very rare condition. Recent data show that the incidence was approximately 1.3 cases per million population in 2023. It's important to note that the incidence of IMD had already been declining even before the introduction of meningococcal vaccines.

However, following the introduction of MenACWY vaccines around 2005 and MenB vaccines in 2014 and 2015, the rates have continued to decline further. This trend suggests that vaccination has played an important role in sustaining and enhancing the reduction in disease incidents.

Despite being rare, IMD remains unpredictable and potentially severe, with significant consequences when it does occur.

But IMD Can Be Deadly  

The overall case fatality rate is estimated - estimated at 15% and increases with patient's age. What is particularly concerning is that despite advances in antibiotic therapy, critical care and supportive management, the case fatality rate has not substantially improved over time. This highlights the aggressive nature of this disease and how quickly it can progress, sometimes even with appropriate and timely treatment.

As such, treatment alone is not enough. Once infection occurs, outcomes can still be poor.

Limited Data Regarding IMD Sequelae  

Unfortunately, for many patients who survive, life is permanently changed after infection. Survivors can experience serious long-term complications, including neurological damage, hearing or vision loss, and in some cases, limb amputations or significant skin scarring. There are also important cognitive and psychological effects, such as difficulties with learning, anxiety, or post-traumatic stress.

Beyond physical health, IMD can have a lasting impact on quality of life, affecting patients, families and caregivers. And I'd like to turn the attention to Mary.

Mary Koslap-Petraco (Stony Brook University School of Nursing): Thank you so much, Jana. We're going to move on to the next myth.

IMD Can Be Difficult to Manage  

It can be very difficult to manage. And Jana went over these pieces with you already. So there we go. Okay.

Myth 2: MenACWY provides adequate protection from IMD for healthy adolescents and young adults

So this is myth number two. MenACWY provides adequate protection from IMD for healthy adolescents and young adults. Now we're going to talk a little bit about that and why that is not really.

2011-2019 College Outbreaks Caused By Serogroup B

So this just gives you an overview. It's - it's - it's a bit dated, this slide. But what the point of this slide is to clearly indicate that serogroup B is the dangerous serotype that we need to worry especially about with our adolescent population.

This shows the colleges, but invasive meningococcal disease serogroup B is not just in the colleges. We're going to talk a little bit today about why it's just this age group itself and why they're all at risk.

Available Meningococcal Vaccines for Healthy Adolescents  

So these are the vaccines that are available for us to use for our healthy adolescents. We have, for MenACWY, which is the routine one, which I live in New York and so does Jana. And this is a mandatory vaccine for our adolescents entering seventh grade. And that's the MenACWY, and it's under the brand names of Menveo and MenQuadfi.

And then there's MenB, which is the brand names of Trumenba and Bexsero. And that's the - that's the one that we give with shared clinical decision-making. But now we have a new option. We have a combination MenABCWY, which is the brand names for that are Penbraya and Penmenvy.

And you see the age indications noted under there as well. They're pretty much the same indications for all of them. But the MenB’s, we can use up to 25 years of age and the MenACWY will go up to 55 years of age.

MenACWY and MenB Vaccines: 2026 AAP Recommendations    

So MenACWY and MenB vaccines, these are the AAP recommendations. And that's specifically what we're going to be discussing today because AAP is using the best available evidence and their schedule is evidence based. Unfortunately, there have been changes in the ACIP schedule, not based on evidence. And that's why we're really going to be emphasizing the AAP schedule here.

So for the MenACWY, adolescents, it's routine. As I mentioned before, in my state, the children have to have it in order to - for seventh grade. And for MenB, it's shared clinical decision-making. But we're going to talk today about why - when we talk about shared clinical decision-making, it doesn't mean that it's just an optional vaccine. It just means that we need to explain to the parents why this is so important and to the adolescents as well that this vaccine is really important for their health.

And then the primary series for the MenACWY is - the first one is 11 to 12 years of age, and then they get the second one between 16 and 23. And we prefer to give it between 16 and 18 because that is really the highest risk period for these - these adolescents.

And then they can have a booster dose for the MenACWY. They get that at 16. And we are not boostering healthy individuals for MenB, but we are going to give you some indications a little bit later on about which people would be the ones that would be candidates to get booster doses.

So, as I mentioned, the CDC schedule may - may be moved to shared clinical decision-making for healthy children. But I mentioned before, we are following the American Academy of Pediatrics schedule, which says that this is a mandatory vaccine for the ACWY.

So coverage rates for the MenACWY are 88%, but for two doses, only 60%. Honestly, we haven't - like doctor - like - and Jana mentioned to you, we're - the - the - the - the serotype that we're seeing is MenB, because we've been doing a pretty decent job of getting the MenACWY into the adolescents. We rarely see that those strains in that adolescent group.

The coverage rates for one dose of MenB are only 32%. And for complete series, it's not - it's really even worse. It's only 13%.

Pentavalent (MenABCWY) Meningococcal Vaccines 

So now we have this pentavalent vaccine that we'd like to talk about. I have started using this in my practice as well, and we're going to talk a little bit about integrating it also.

So we have pentavalent MenACWY, which is the - and that was approved in 2023. And then we have a second one now, pentavalent MenACWY-CRM, that was approved in 2025. And I'm really happy that we have these two vaccines now, because you know with meningitis B, whatever brand you start with, you must finish with. You know, there's no interchanging of meningitis B vaccines.

So you can use this whenever all five strains are indicated in all at the same visit. I'm always looking to save a pinch for somebody, and if I can do it, that's what I'm going to do. So healthy people, 16 to 23. And the shared clinical decision-making is - what I start this out with is, you know, I tell the parents what the disease is, I tell them that we are so thrilled now that we have a vaccine. I tell them, this is the only strain that we've seen in this adolescent group for over 10 years. And I don't remember the last time a parent said no to me after I got finished chatting with them.

So the MenABCWY should be followed six months later by the MenB vaccine from the same manufacturers. And remember I mentioned before that we don't switch the - the - the strains.

Introduction of Pentavalent Vaccines: Considerations for Transitions

So how would you introduce this? So you want to - we want to simplify the schedule, of course, and we want to streamline the schedules so it benefit - there are benefits for healthcare professionals and staff. It does reduce by one vac - one shot. So that's one less thing that you have to give - you know, one less pinch that you have to give.

I have found that when I started it with children that hadn't had any vaccine, that was probably the easiest way to introduce it. But I have heard that a lot of people don't even know about this vaccine and aren't even stocking it in their offices. So I'm hoping that today, after we explain to you about what an added benefit it is to have this vaccine in our - on our - in our toolbox, this is something that you might consider for your practices.

So as I mentioned, the benefits are one less vaccine, simplifies the schedule. And, you know, trying to get these adolescents in to - all their follow ups is not easy. So it's one less office visit that they have to have.

Meningococcal Vaccine Uptake: Disparities

So we do have disparities in the uptake. We always seem to have disparities. The coverage rate by - by race really is challenging. The MenB update is the lowest in the multiracial and other racial - other racial adoles - from other adolescents from different racial adolescent groups. And you'll see what those numbers are there, 27%. I mean, that really is dismal. We have to do a much better job.

And the MenB uptake is highest in Black adolescents, which does make me very happy. So what that says to me is providers are explaining this to the parents. Older adolescents, the 12 to 18 year olds and the young adolescents, we have lower coverage to these children because there are fewer established vaccine platforms and fewer mandates for these kids. I mean, that's the problem.

We - it's the same thing with their physicals. We don't see them for physicals as often because of what the school mandates are. So we don't have as many opportunities to provide vaccines. That's why every - every office visit is an opportunity to vaccinate. They come in for acne. They come in for a strep throat. Consider giving them vaccines as well.

There are also geographic disparities. There are higher uptakes in states with secondary mandatory school - school mandates such as our Middle Atlantic region. I mentioned to you about how we have that mandate here in New York. And the geographic disparities from like the places like North Dakota shows potential with the highest MenB uptake in adolescents, which really makes me very happy. So whoever's explaining about this in - in men - in North Dakota is doing a terrific job.

There's also insurance disparities. There's uptake among some of the Medicaid insured versus privately insured. It is covered by The Vaccines for Children Program. So certainly something that you need to be considering in your practices.

Posttest 1

So let's talk about this first post-test question. A healthy adolescent received meningitis ACWY at 11 is now 16 years old for their check-up. What meningococcal vaccine schedule would you recommend? It's one choice. Would it be:

1. MenABCWY now, with MenB six months later;
2. MenABCWY now, with MenABCWY six months later;
3. MenACWY now, with MenB six months later; or
4. MenB now, and MenACWY six months later.

I'll give you a few moments to look at those answers and - and click one of those buttons. Okay. I think we can move on from that question.

All right. And there's our - like it shows. Okay. So MenABCWY now and MenB six months later. Good job. Good job. Let's close that out and go on to the next.

Posttest 1: Rationale

Okay. And there's our rationale. MenABCWY should be followed six months later by that second MenB. The second MenB should be in the form of the - should be the same from the exact same manufacturer. If you don't - if you get a child in who had MenB from a different manufacturer and you don't carry that one, then you have to give the two doses with the - the vaccine that you have in your office. Very, very important to remember.

They’re - these are like apples and oranges. They just don't mix.

Myth 3: 1 dose of MenACWY or MenB is enough to provide protection against IMD

Okay. So we're going to move on to myth three. And Jana, will you tell us about myth three, please?

Dr. Shaw: Happy to do that. Thank you, Mary. The myth three states that one dose of MenACWY or MenB is enough to provide protection against IMD. So let's talk about how this is not accurate.

Estimated Vaccination Coverage: Adolescents 13-17Yr 

Before I discuss the importance of completing the MenACWY and MenB vaccine series, let's first review the current vaccination coverage data for adolescents to demonstrate that as of 2023, teens ages 13 and 17 remain suboptimally protected.

This slide summarizes the percent of adolescents who received one or more doses of meningococcal vaccine between 2006 and 2023.

While vaccine uptake has increased over time, there's still a significant gap in series completion, leaving children susceptible to meningococcal infection. Only about 61% of adolescents receive two or more doses of MenACWY vaccine, and only 16% completed the MenB vaccination series.

For context, these rates are lower than uptake of Tdap vaccine that's shown at the top, which remains much higher at national average of 91%. Highlighting these gaps underscores the missed opportunities for meningococcal vaccination, and it's important to include meningococcal vaccination in the conversation with eligible patients when they come for their Tdap vaccine.

The Epidemiology Is Unpredictable 

High vaccine coverage across all meningococcal serotypes is essential because IMD is unpredictable and can emerge rapidly. This slide summarizes the serotype distribution in the US, with serotype B remaining to be the most common serotype. However, in 2023, there was an abrupt increase in circulation of MenY sero - serogroup among black adults living with HIV in the US.

While not shown this slide, there is also a recent outbreak of MenB serogroup in the UK and that is as of April 1st, there were 21 confirmed cases. All cases have been hospitalized and there have been two deaths reported. As such, vaccination against all five serogroups is essential as the serogroup distribution can change quickly.

MenACWY and MenB Vaccines: Duration of Protection

Now let's discuss why two doses of MenACWY and MenB vaccines are important for otherwise healthy adolescents. So let's start with MenACWY vaccine effectiveness. Single dose of MenACWY-D vaccine effectiveness was reported at 79% in the first year and declined to 61% at three to seven years after vaccination.

Adolescents who received a booster dose of MenACWY-D at one month post-vaccination, over 99% of them achieved the serum bactericidal titers greater or equal one to eight against all serogroups. And four years post-vaccination, this proportion remained at over 90%. So this highlights the importance of the booster to provide lasting protection at the time when adolescents are most vulnerable.

Because the immunity decreases over time, the booster is recommended during adolescence, as we discuss with the preferred ages 16 to 18 years of age to protect them through the high risk years.

And as such, one dose of MenACWY in New York State, children receive it at 11 to 12 years of age is not enough. They do need a second dose.

As far as MenB vaccines are concerned, MenB vaccines are licensed as two dose vaccines and the two doses are necessary for best protection. A single dose is insufficient. The clinical trials immunogenicity data clearly show that, so you do need two doses. Vaccine effectiveness after primary vaccination is over 92% at one to two years after vaccine series completion.

However, the long-term effectiveness data are currently limited, making the series completion essential.

Strategies to Optimize Meningococcal Vaccination  

So what can we do to optimize meningococcal protection for adolescents and young adults? There are several strategies that you can employ in your office to streamline vaccination delivery and facilitate conversation.

The healthcare provider's recommendation is the strongest predictor of vaccine uptake, and as such, ensure that every visit includes vaccine discussion. Checking the immunization registry, checking patient vaccination status is an opportunity to have that conversation with the patients to ensure we don't miss opportunities to vaccinate.

Integrating the routine doses of MenACWY into your patient workflows, taking advantage of the engineered EHR features, paying particular attention to the routine booster dose for MenACWY, and updating adolescent schedule to prioritize the combination vaccines since it reduces the number of injections needed. And as you know well, both parents and the children particularly like to get fewer shots.

Increasing vaccine uptake through targeted education and improved access for all adolescents, especially those at high-risk group is also important.

Myth 4: For high-risk children, meningococcal vaccination should be done in specialty clinics, not primary care          

So let's move on to myth number four. For high-risk children, meningococcal vaccination should be done in specialty clinics, not primary care.

MenACWY and MenB Vaccines: 2026 AAP/ACIP Recommendations Including High-Risk Individuals   

So this slide I think does tell the story and highlights why primary care is probably the best place to vaccinate high-risk individuals. As you can see, meningococcal vaccination for high-risk children can be complex, as shown in this slide. As such, it requires careful tracking of both the patient's condition and their vaccination history.

For MenACWY vaccines, high-risk individuals may need two to four primary dose series depending on age, with booster doses required at three to five-year intervals, depending on age. For MenB vaccines, three doses are needed with booster doses given one year after primary series and then every two, three years.

Meningococcal Vaccine Coverage: Individuals With Increased Risk for Disease  

Unfortunately, vaccine uptake among individuals at increased risk remains very low. For MenACWY, uptake ranges from 4.6% in people with complement deficiencies to 28.1% in those with asplenia. Uptake for MenB vaccine is even lower, with only 2.2% of patients with complement deficiencies and 9.7% of patients with asplenia having received a vaccine.

And these low rates highlight a critical gap in protection for the most vulnerable patients, emphasizing the importance of primary care engagement, proactive identification and vaccination.

Ensure Timely IMD Protection for Children with High-risk Conditions Through Collaborative Care  

Primary care providers are ideally positioned to vaccinate those patients. They provide a medical home with a ready access to the patient's full medical and vaccination histories. And as such, they play a key role in ensuring that high-risk patients are protected from meningococcal disease. They often have the most frequent contact with these patients and can coordinate care, administer vaccines safely and provide education to families.

Having said that, meningococcal vaccination is a shared responsibility between primary care and specialists. The best practice to ensure protection is for primary care providers to screen, recommend and vaccinate when indicated, while specialists reinforce these recommendations.

And let me turn the attention to Mary.

Mary Koslap-Petraco: Thank you much - very much, Jana.

Myth 5: MenB vaccination should be primarily discussed with adolescents who plan to attend college 

All right. Let's talk about the fifth myth. Meningi - MenB vaccination should be primarily discussed with adolescents who plan to attend college.

Serogroup B Cases Also Occur in Non-College Students  

Well, when we look at the serogroup B cases, it's also in non-college students. It's got to do with their behaviors. They all do the same dumb things. They share everything. And that's where the risk comes in.

MenB Vaccination Among Adolescents: How to Identify Risk Groups and Settings  

It's part of their adolescent behaviors of sharing everything they - you know like how babies put everything in their mouths. A lot of times adolescents put everything in their mouths as well and then share it with their friends. So these risk groups include not just people attending college, but anybody living in a congregate setting or anybody who's anticipated to remain in these kinds of settings.

Quite frankly, when we see adolescents together, that's a congregate setting. So that means all of the adolescents are at risk. Any adolescent who wants to be protected can receive meningitis B even if they're not sure they're high risk. But like I said, in my opinion, having watched and worked with adolescents for so long, they're all at high-risk because of the behaviors.

Considerations for Recommending the MenB Vaccine  

One of my favorite stories about that was being in the Sunrise Mall and watching two 14, 13 - they were either 13 or 14 year old girls. One had a wad of gum in her mouth and she was chewing the wad of gum. She took it out and handed it to her friend. So, you know, they do these dumb things. So we have to protect them from their own dumb behaviors.

So there are considerations for recommending the meningitis B. Shared clinical decision-making. You already heard Jana say that this is just our opportunity to explain to families why this vaccine is so important, and it applies to vaccines that we don't routinely recommend, like meningitis B. But I hope I get this message across to you and I - I hope Jana has gotten it off to you - across to you also.

In our opinion, meningitis B is really important for the health of all adolescents. It correlates with lower uptake versus routine recommendations because when people hear shared clinical decision-making, not just parents, but providers also think, well, it's not mandatory. It's not all that necessary. But it is. And it shifts the default from vaccinate to let's discuss, which is fine, which is what we do all the time anyway. So please do discuss meningitis B with all adolescents and their families.

So what are the talking points? Low risk doesn't mean that vaccination is unneeded. Low risk means there's just not a lot of children getting it, but the impact is terrible. Serogroup B has been the most common strain that we've seen in this age group for over 10 years, and I think we've mentioned that on more than one occasion. And serogroup B is primarily affecting our young adults who attend four year universities. Freshmen in colleges live in on-campus housing and participate in sororities and fraternities. Like I said, it's all about sharing everything.

How to Frame the Conversation  

So how are we going to frame the conversation? You need to know who you're talking to. You want to highlight the scientific rigor behind the vaccines. You want to encourage people to make informed choices and focus on vaccines’ ability to stop transmission and serious illness.

Strategies to Improve Immunization Rates  

I always want to make sure that I establish a rapport with - with families when I'm talking to them about the vaccines. I usually don't start out with the statistics. I usually start out with, “Did you know that this is the most common strain we see on the college campuses for the last 10 years? And this is really a devastating disease.” And that's how I start the conversation. You know, statistics don't often mean a lot to parents. It's those personal stories that do.

So use every opportunity for vaccination. I mentioned this before. If they come in for an acute care visit, if they come in because they have acne, this is always a time to review that shot record and catch those children up and discuss these vaccines.

And you always want a presumptive approach. I never say to the parent, “Do you want the meningitis B vaccine?” What I say to them is, “I think meningitis B vaccine is very important for your child's health. I would like to give it today.” So with that presumptive message that you're getting across.

Discuss those vaccines, including MenB, every single time you see one of these children or their families. A lot of times you can talk to the children. And when you're getting the message through to them, I've heard some of the adolescents say, “Mom, I'll take it. I'll take it. Please sign.” So the kids are really terrific and they really start asking good questions.

Posttest 2

All right, let's go on to post-test question two. Which of the following N. meningitidis serogroup predominates in adolescents? And you have one choice. Is it:

1. A;
2. B;
3. C;
4. W; or
5. Y.

And I'll give you a few seconds to answer. Okay. We'll end that test now. Oh, you guys are getting it. It's meningitis B. Terrific. We'll close that out.

[00:37:32]

Posttest 2: Rationale  

And it's B.

Myth 6: If someone declines vaccination, continuing to offer them vaccination at future visits will likely have no impact 

Now I'd like to pass it back to Jana to go over myth six.

Dr. Shaw: Thank you, Mary. That was terrific. So let's address myth six today. And that is if someone declines vaccination, continuing to offer them vaccination at future visits will likely have no impact. So let's talk how that may not be correct or accurate.

The Vaccine Hesitancy Continuum  

I'd like to briefly start with discussion on vaccine hesitancy, so we better understand the spectrum of what hesitancy means and understand that parents or children actually can come in different shapes and forms.

As you're probably all painfully aware - aware vaccine, hesitancy has become a major public health challenge and it exists on a spectrum from complete refusal to full acceptance where patients essentially do not questions. They just, “Yeah, please give me whatever is recommended, what my child needs.”

It's often driven by three key factors: confidence, complacency, and convenience. Lack of trust in vaccine safety effectiveness and recommending institutions along with misinformation, social media influence and inconsistent healthcare messaging can undermine confidence. Making clear and consistent communication is essential.

Complacency often arises when individuals perceive themselves at low risk for the disease, and as such, it reduces the sense of urgency to get vaccinated. And there are some practical barriers for some patients, such as cost, access and time, which highlights the need to make vaccination easy and accessible. Patients and parents may initially decline vaccination due to limited information, safety concerns or timing, but these perspectives can change over time.

The primary care visits, including blood checks, acute checks and chronic care appointments offer valuable opportunities to revisit discussions and provide education. And consistently recommending and offering meningococcal vaccination increases the likelihood of acceptance and helps to ensure that all adolescents and young adults are protected.

Putting it Into Practice  

So what can we do in practice? What does a real conversation with a vaccine-hesitant parent look like? And Mary has already alluded to it in the earlier part of the presentation, starting with a presumptive approach, stating which vaccines the child will receive today. The pediatric healthcare providers are the most trusted source of vaccine information for parents and can positively influence vaccination decisions, even among hesitant parents. It's important to recognize that if parent voices concerns, it does not mean that a parent does not want to get their child vaccinated. It doesn't mean that parent will refuse.

It may simply mean the parent has questions, wants to understand certain aspects of the vaccination, whether it is the risk for the child, vaccine safety issues, how well the vaccine will work for the child, how long the child will be protected, and so on and so - so forth.

So I'd like to encourage you not to be discouraged when patients ask questions, but listen to them and do your best to answer their question, because that alone may facilitate vaccine acceptance. In our practice, we use a five-step approach to address the parent's concern, and I'd like to review those with you now.

The 5-Step Approach

So first, the first step is to establish empathy and credibility. And the conversation can look something like, “I hear you. You want to do what's best for your child. I'm here to support that.” It's a very simple one sentence, followed by briefly addressing specific concern. You can say something like, “You’re clearly putting a lot of thought into your child's health. This vaccine was studied extensively and continues to be monitored for safety. Millions of doses have been given and most side effects are mild and short-lived.”

Here I just like to mention that please do not repeat the myth, if a parent comes in with myth. And do not use the same words and go more general by, “You know, I understand, you want your child to be safe.” You and I have the same interest for your child, because repeating the myth may further affirm the belief.

The step three includes the pivoting to the disease risk. Reminding parents that those diseases that we have vaccines for can be very severe. For example, meningococcal disease is rare, but it's unpredictable and severe, and teens are at increased risk for this disease.

The step four includes a conversation about the benefits of the vaccine. For example, thankfully we have a very good vaccine that can protect your child from this infection. And as such, I strongly recommend that your child receives this vaccine. And I typically include, you know, I have three children on my own - own and they are all fully vaccinated, including with the meningococcal vaccines just to show - to demonstrate to your patients that you strongly believe, and those are the choices you make for your children and your family and friends as well.

Education of Vaccine-Resistant Parents Has Limited Impact  

Unfortunately, not all parents will change their mind. The research shows that strategies like motivational interviewing and presumptive approach may not be effective in all patients and parents. There are several reasons why that happens, and it has to do with cognitive biases. For example, risk perception is subjective. People don't just respond to numeric - numerical risks. They respond to how things feel.

We tend to worry more about the risks to children than to adults. And as vaccines have become more successful and vaccine preventable diseases are either eliminated or very uncommon, the perceived benefit can feel less urgent.

In addition, the risks that are imposed on us feel scarier than those we choose. And human-made risks often seem more threatening compared to the natural ones, especially with trust in institutions is low.

Because of all this, motivational interviewing or presumptive approaches may have limited impact, particularly among most resistant parents.

And I'm going to turn it over to Mary again.

Mary Koslap-Petraco: Thank you, Jana.

Myth 7: Individuals cannot make a difference in closing meningococcal vaccination gaps 

All right. This is our last myth. Individuals cannot make a difference in closing meningococcal vaccination gaps. I'm going to convince you that that's not true.

How NPs Play a Crucial Role in Vaccination Efforts  

All right. So how can we, as NPs, play a crucial role in vaccination efforts. We play a very important role. We are really good at patient education and support. And you heard from Jana too about establishing that rapport with patients and making sure that - that they are all - that their questions are being answered. It all boils down to trust.

We have a very high degree of patient inter - interface with that trust and support leading functions across the vaccine compete, we - across the whole vaccine continuum by our advocacy. Vaccine administration and follow-up, we explain all of those things. Promotion of vaccines. Because of the health issues, we want to promote health. And the growing pre-eminence of nurse practitioners in US healthcare. There are over 460,000 of us practicing now. And there is going to be a growth of over 40% by the year of 3032[?].

So we have to use that power to work with patients, listen to them, address their concerns and help them to make those really good decisions for their children. We are seeing nearly a billion patients annually.

Strategies to Increase Vaccine Equity  

There, we want to evaluate current vaccine rates. I mean, one of the things that especially we as DNPs have been educated to do - to do are those QA/QI studies. You want to take a look at what the vaccine rates are in your practice and come up with ways that are going to work in your practice to increase them. Use those registries, do a run with your registry and find out how many children send - our registry in New York state will even send out reminder letters.

You want to flag patients. That's why the EMRs are really wonderful. They have these little pop-up devices that will let you know that the patients are due for these vaccines. You want to emphasize those health benefits of reducing vaccine preventable disease in our populations. And we want to also review reimbursement because it's not fair to pediatric practices to ask them to do things that they're not going to be reimbursed for.

In fact, the AAP now has codes for counselling. So utilize those codes. You want to reach out in your community. Don't miss any opportunity to speak to folks in your - in your community about why vaccines are important. I can't tell you how many conversations I've had in my church parking lot about adolescents and why they need to be updated with their vaccines.

And you - of course, you want to be culturally appropriate. And I think that's a really important thing always to nursing that we know what cultures we're working with and - and we appeal to their cultural preferences.

The 4 A’s

These are two more paradigms that you can use there. While motivational interviewing is the only evidence-based communication technique we have, we have other ones that we know anecdotally work and are faster to use. So this is the four A’s from the voices for vaccines.

Ask. Encourage the patient to ask specific questions. What are your questions?

Acknowledge. Recognize that you're - that you're talking that - that you're talking to already has - or that the person that you're speaking with already has knowledge and that's very empowering to them.

And then you want to affirm. Reassure the patient that it's okay to have questions. We encourage questions and answer. Get permission first. I always say, “Do I have your permission to share the information that I know about these vaccines?” I've yet to have a patient say no to me, even the most resistant ones.

And you will be getting copies of these slides so that you have those concrete examples that you can use for your practices.

The CASE Model  

This is another model that I really like. It's called the CASE model that was developed by Alison Singer from the Autism Science Foundation. You want to start with corroborate, acknowledge their concerns. That's where you're going to be asking them questions. You want to get on the same - I want the same thing for your child as you want for them, health.

About me. Talk about what you've done to enhance your knowledge and your expertise. You went to conferences, you took courses.

Science. Then talk about the science, and then you go - would go into as much detail in the science as the parent would like. And then advise and explain. And that's where you're going to give your recommendation, your presumptive recommendation, but you always end up all of your conversations. Have I answered all of your questions?

Parents, you want parents to realize that you are acknowledging them and what their - their concerns for their children.

Advocating for Meningococcal Vaccination in Your Clinic and Community  

So advocating for vaccine in your clinic and community. Kill them with kindness, listen to their concerns, know the community, be that vaccine champion, network with local community groups, offer to conduct information sessions. Share stories. Those stories are so important. If you don't know stories, let - I'd be happy to share mine with you that you can use.

Lead by example. You heard Jana say that her children are vaccinated. My grandchildren are vaccinated, so I share that with folks. Share those vaccine stories that, you know, there are children in my own community that it killed me, that they weren't vaccinated. And I don't want that to happen to their children.

Behaviors change attitudes faster than attitude change behaviors. So always remember that.

Making a Difference: 1 Patient at a Time  

So making a difference, one patient at a time. And I really believe that that's how we're going to do this. Listen to their concerns, share the stories about meningitis. Treat patients and parents with respect. Trust is developed over time. We are - as nurses, are the most trusted of all of the professions. So use that. Use our nurse power.

Posttest 3

All right. Let's go on to the post test question three. A healthy adolescent received MenACWY at age 11 and they received MenB - Men - excuse me, MenABCWY at their 16-year-old check-up. What do you recommend for this next visit?

1. The series is complete, no action is needed;
2. Return in six months for the second dose of MenABCWY;
3. Return in six months for MenB; or
4. Return in six months for MenB from the same manufacturer.

And I'll give you a few seconds to answer that one. Okay, let's move on to that next - next one.

Okay, so that's the right answer, return in six months for MenB from the same manufacturer. Let's close that out and move on to the next slide.

Posttest 4

All right. Here's another question. After completing this activity, I now have effective strategies to overcome barriers to meningococcal vaccination in adolescents and young adults.

1. Agree - strongly disagree;
2. Disagree;
3. Neither agree nor disagree;
4. Agree; or
5. Strongly agree.

I'll give you a few seconds to answer that one. Okay, we can move on. Agree. So that's wonderful. And we'll close that one out. And let's go on to the next slide.

Q&A 

Okay. Now this is our question and answer session. So we'll take any questions that have come in.

Dr. Shaw: And maybe Mary, while we are waiting for the questions to come in, I was really intrigued by your presentation of how you start a conversation with your high schoolers. I think it's really important because the data I shared, you know, the MenB vaccine initiation is so low, only 30% of the children actually, or parents are offered. So can you share with us what does the conversation look like in your office when you see a 16, 17, 18-year-old and they are due to get their meningococcal vaccines?

Mary Koslap-Petraco: Well, first I start - I start that conversation with “I'm so happy that you've had the MenACWY, but we have another vaccine that protects against meningitis B, which is the only strain that we've seen in this adolescent population for over 10 years. And then I will ask the - the - and then depending on what the parent's reaction is, I will ask them, “What questions do you have about this vaccine?”

And then I will also tell them stories about how there were children in our own community who were not vaccinated who came down with meningitis B and tragically had terrible outcomes. We lost four of them in my own community. And that really starts parents thinking and asking more questions.

And I think we do have some - some questions in the - in the - in the queue here. Jana, would you just - before we go on to those questions, could you just talk a little bit about the patients that you've seen in the - in your practice who did have meningitis B and how difficult, you know - and how fast this disease moves?

Dr. Shaw: Yeah. For me, it's a very frightening disease. You know, I do recognize it's very uncommon, but I cannot stress enough. You know, I do see children in academic setting. I see children in community health center. I – when I see those teenagers who come in during respiratory season, they have sore throat. They have myalgias. They have fever.

I fear this is going to be one of those kids where they will come out with meningococcal disease. You know, five, 10 years ago, I had a teenager I had to send quickly to ER. Back then, we didn't have these rapid tests like we do have now. PCR panels that will tell you quickly whether your child has flu or other virus.

But back then, it was very challenging to be able to discern at the early stages of the disease which one it's going to be this time. Is this flu or other virus? Or maybe this is meningococcal disease? Because we know once we start seeing these characteristic signs like petechiae or photophobia or neck stiffness, those are late manifestations and the disease progresses so quickly.

And I did see there was - there were questions actually. There were - let me see. Michelle is asking, I have a unique population HIV positive client. What is your recommendation?

So Michelle, excellent question. Those would be high-risk patients. They would be considered for not only boosters for MCV4 but MenB vaccine as well. So please these slides include guidance for vaccination of HIV positive patients as well. So please feel free to use our recommendations. They are AAP-based, and it will include boosters for both MCV4 and MenB for your patients.

There is another question. Is there a vaccination that combines MenB with MenACWY. Mary, do you want to answer that one?

Mary Koslap-Petraco: Yes, I would love to take that one. Yes, we do now have two vaccines that combine - combines MenB with ACWY. And we gave you the - the - the little framework about how to use this and how to bring this into your practices. Whenever you need to be able to give both MenACWY and MenB, you can use this vaccine when it's age appropriate.

And we - on your slides there, it says, you know, between - you know, what the parameters are for it. So please just take a look at those. So - and it cuts down on the number of shots that we have to give as well.

I see another one here. Since immunity against meningitis B wanes after one to two years, wouldn't it be better to give it closer to the college age to ensure better coverage during the college risk exposure?

My feeling on that is it's the behaviors. It's not just college. And like I explained to you about those kids and I - I saw on the Sunrise Mall sharing chewing gum, they share, unfortunately it's vapes. They share the vapes and a few other things. They share drinks, water bottles.

So I don't like to wait. If I feel that there is still a risk there when they're going to college, then I certainly would consider giving them another booster when they go to college. But I - you know, I just - unfortunately in my community, I've seen 16 and 17 year olds that haven't gone to college get - die from meningitis B, so I don't want to wait.

Let's see here. Jana, I see another one down there. Immunity - about waning immunity. Do you want to take that one?

Dr. Shaw: Sure. Do you mind just quickly read it to me? Because...

Mary Koslap-Petraco: Yes, I will. Since immunity against meningitis B wanes after one to two years - okay, we got - wouldn't it be - okay, I think I answered that one. And there was a question here about prisons. 19 to 70-year-old - aged men. Jana, I don't really have that much experience with that. Can you take that one?

Dr. Shaw: Yes, I can. You know, this would be considered probably congregate settings. So depending on your practice and institution, those people may be at increased risk. So I would talk to your institution and see what is the availability of the vaccine there. But certainly it's worthwhile exploring as prisons may be considered congregate settings. Although I'm not familiar with vaccination in prisons.

Mary Koslap-Petraco: Let's see. Here's some more down here. What recommendation for patients that are in their 50s that have college-aged kids that are commuters to the university daily? Should parents get the vaccine too, since they are exposed and their kids are coming home daily from the university?

They are not considered as much of a risk. Meningitis, it's communicable - I heard Dr. Osterholm from CIDRAP say it's sharing spit that puts people at risk. So the parents really aren't going to be sharing those kinds of things with their children. So the risk is to their children.

Jana, I see - do you want - I  said, did you want to answer - add anything to that or…

Dr. Shaw: No, no, no. I thought that was - that was great. I was just looking at some of the other questions as we are quickly trying to get through them. There's one, does the added B to ACWY cause an increase in side effects? Stephanie asked that question. It's really important one, because vaccine safety is really important concern for parents. So the answer is it does not.

The vaccines were pentavalent vaccines were compared to the current standard of care, which would be the quadrivalent vaccines. And when they looked at local and systemic reactions, they were very comparable. So the safety has not been affected in any significant manner when we looked at penta versus quadrivalent vaccines.

Mary Koslap-Petraco: And I see a question here from Catherine[?]. She says to clarify, if they receive MenACWY age 11, it's not necessary to repeat ACWY at 16. Yes, they do need it at 16. In addition to - and then in addition they need the meningitis B. It's - that you can start the meningitis B at 16.

So they need meningi - MenACWY at 11 and then again at 16. And that 16 visit is where you're going to start thinking about adding the meningitis B.

And then I see one here from Bridget about working with immigrant families in our community. Appealing to protection of babies and elders is a powerful talking point. I make it a point of pride in peds visits to express my thanks to their family for caring about the community's well-being.

Bridget, that is such an important point about considering the community. We don't - I mean, I've heard doctor often say this on so many occasions, “We don't just vaccinate for ourselves. We vaccinate to prevent our communities that we live in as well.”

Jana, did you want to add anything to any of those?

Dr. Shaw: I think that was fabulous. And this sounds like a wonderful note to end on, honestly. It's - it really speaks to the value of vaccines, which is to the individual and to those around us. And I'm really grateful for the opportunity to be able to share some of the knowledge and experience with all of you.

Go Online for More Coverage of Meningitis Vaccines!

Mary Koslap-Petraco: And thank you so much for attending today. And I think we're going to have a wrap up now.