To the Editor:
MEDICC Review deserves accolades for presenting to the medical community information that has been poorly represented and even more poorly understood on the availability of meningococcal meningitis vaccines (Sotolongo F et al. Cuban Meningococcal BC Vaccine: Experiences & Contributions from 20 Years of Application. MEDICC Review, Fall 2007).
This lack of information is exemplified in a case report from Massachusetts General Hospital published in the June 21, 2007 issue of The New England Journal of Medicine (NEJM). In the final statement, the authors conclude: “vaccines against group B may lack immunogenicity or elicit immune reactions against self-antigens and potential immune injury. Therefore, currently available vaccines do not include group B antigens.”[1]
This statement is at variance with research on meningococcal serogroup B vaccines and with the multi-country experience using the VA-MENGOC- BC vaccine produced by Cuba’s Finlay Institute, the subject of the MEDICC Review article. The immunogenicity of serogroup B vaccines was validated, and concern over the potential for such vaccines to stimulate auto-antibody formation was put to rest by Stein et al who concluded that US clinical trials were warranted.[2] And as reported, international clinical trials of the Cuban vaccine estimate efficacy at over 70% in children ≥2 years.
Widespread information on this Cuban vaccine may be particularly scarce in the United States due to the embargo on Cuba, which also delayed application of promising Cuban vaccine technology in US clinical trials,[3,4] despite the fact that we are continually faced with outbreaks of group B meningitis. In my home state of Washington, there have been over 1,000 cases of meningococcal meningitis with over 100 deaths since the Cuban vaccine was developed;[5] increasingly, these are serogroup B infections similar to the outbreak in Fresno, California in March of this year.[6]
Robert W. Fortner, MD
Bainbridge Island, WA
Dr Robert Fortner is a nephrologist and Founding Board Member of the National Dialysis Council. In 2007 Dr Fortner published a three-part article on Cuban nephrology in Nephrology News & Issues.
- Davis BT, Pasternack MS. Case 19-2007 – A 19-year-old college student with fever and joint pain. Case records of the Massachusetts General Hospital. NEJM. 2007;356(25):2631-37.
- Stein DM, Robbins J, Miller MA, Lin FYC. Are antibodies to the capsular polysaccharide of Neisseria meningitidis group B and Escherichia coli K1 associated with immunopathology? A Review. Vaccine. 2006;24:221-8.
- SmithKline Beecham receives OFAC license for Cuban meningitis B vaccine. Economic Eye on Cuba [serial on the Internet]. 1999 July 19-25 [cited 2007 Nov 2]. Available from: http://www.cubatrade.org/eyeonz35.html
- Centers for Disease Control and Prevention. Serogroup B Meningococcal Disease – Oregon, 1994. MMWR 1995;44:7.
- State of Washington, Department of Health 2006.
- Ellis A. El Capitan students treated against meningitis outbreak. Fresno Bee. 2007 Mar 23.
MEDICC Review welcomes letters to the Editor: editors@medicc.org
MEDICC Review, Winter 2008, Vol 10, No 1
