A comprehensive alert from the Oregon Public Health Division is pasted below. Please share widely with colleagues. The key points are:
- 6 cases of invasive of meningococcal disease have been identified in OSU students in the last 13 months
- At least 5 of the cases are serogroup B, a strain not included in the quadrivalent vaccine
- Always consider the diagnosis of meningococcal disease in patients with fever, rash, headache or stiff neck
- OSU now requires all students, age 25 and under, to receive one of the two available series of meningococcal B vaccine.
- Please facilitate vaccination of OSU students on winter break with one of the two, not interchangeable, serogroup B meningococcal vaccines
- Under Oregon law, health plans cannot restrict or deny coverage for this vaccine in an outbreak setting (see below)
From the Oregon Public Health Division
A sixth case of meningococcal disease was reported this week in an Oregon State University (OSU) undergraduate student. We urge healthcare providers and pharmacists to encourage vaccination and to take every opportunity to vaccinate all OSU undergraduate student 25 years of age and under with a series of serogroup B meningococcal vaccine. Winter break, which began December 9th, will continue through January 8th, so many students have returned home and could present for care far from Corvallis.
We ask that healthcare providers consider meningococcal disease in the differential diagnosis for college students — particularly students with links to OSU — presenting with unexplained high fever, headache, stiff neck, or rash. Please report any suspected cases promptly to your local public health department.
Between November 2016 and December 2017, Benton County Health Department and colleagues have investigated five cases of confirmed serogroup B meningococcal disease in undergraduate students attending OSU’s Corvallis campus. A sixth case of meningococcal disease was reported in an OSU student this week; confirmatory and serogroup testing is underway.
Vaccination is now required for all OSU undergraduate students age of 25 and under.
Two brands of Men B vaccines are licensed in the United States, and they are NOT interchangeable.
- Bexsero®, a 2-dose series, with the 2nd dose given at least 1 month after the first; and
- Trumenba®, a 3-dose series, with the 2nd dose given 1 month after the first, and the 3rd dose given 6 months after the first. (The so-called 2-dose series of Trumenba® is NOT recommended in the urgency of an outbreak.)
Either vaccine may be used, but because they are NOT interchangeable, the follow-up doses should be of the same brand as the initial dose. Please make sure that recipients are fully aware of the importance of knowing the brand name, and the dates and timing of follow-up doses. Likewise, we ask providers to check the ALERT immunization information system (IIS) for any Men B vaccination history; and to record in ALERT IIS any vaccination that you administer, so that records will be available any providers subsequently called upon to vaccinate. Some students may recall vaccination but lack documentation in ALERT IIS; please ask such students for more information, e.g., dates, brand and location of vaccination. Questions can be directed to the ALERT IIS Help Desk at 1-800-980-9431.
Newly enacted legislation (House Bill 3276) applies to this outbreak of meningococcal disease. This new law requires health insurers to cover the cost of vaccines and antibiotics necessary to prevent the spread of the outbreak for enrollees in a health benefit plan offered by the insurer who are 25 years of age and under, and who are attending or enrolled to attend OSU at the Corvallis campus.
The law also specifically prohibits health insurers from restricting required coverage by doing any of the following:
- Requiring that services be administered by an in-network provider
- Imposing cost-sharing requirements that are greater than cost-sharing requirements for similar covered services
- Requiring prior authorization or other utilization control measures
- Limiting coverage in any manner that prevents an enrollee from accessing necessary health services
- Requiring prescriptions from in-network providers restricts access to coverage and is prohibited.
The law applies to health insurers, including health care service contractors and multiple employer welfare arrangements, offering health benefit plans in Oregon. The law does not affect students covered by self-insured employer plans. (The state is federally preempted from regulating these plans.) Similarly, if a student is from out-of-state and is insured by a plan in another state, Oregon has limited regulatory authority. A consumer advocacy line is available for patients and providers facing challenges with insurers in the implementation of this law. Connect with advocates at 1-888-877-4894 or firstname.lastname@example.org.