Meningitis B outbreaks: vaccination and risk in university settings

On this episode of the CMAJ Podcast, Dr. Blair Bigham and Dr. Mojola Omole explore the ongoing public health concern of meningococcal disease, focusing on meningitis B outbreaks in Canadian universities. They are joined by Dr. Cristin Muecke, a medical officer of health in Halifax, and Dr. Savita Rani, a public health specialist at the University of Saskatchewan. The episode also features the personal story of Megan Plamondon, a Queen’s University student who contracted invasive meningococcal disease.

The discussion opens with a look at recent meningitis B outbreaks, including cases at Dalhousie University in 2022 and Queen’s University in 2023. The Halifax outbreak led to a targeted vaccination effort offering publicly funded MenB vaccines to students in congregate living environments, such as dormitories and residences.

Dr. Muecke provides insights into the Halifax outbreak and the public health response that followed. She discusses the complexities of identifying and controlling meningococcal disease in university settings, where asymptomatic carriers of Neisseria meningitidis can unknowingly contribute to the spread of the infection.

Dr. Rani expands on the current state of MenB vaccination, explaining why the vaccine is not included in routine immunization schedules and outlining the challenges of securing broader vaccine coverage across the country. She emphasizes the importance of early detection, given that meningitis can present with nonspecific symptoms which complicates diagnosis.

Megan Plamondon’s story brings a lived experience perspective to the conversation, highlighting the severe impact of meningococcal disease and the critical need for prevention efforts, particularly among students entering congregated living environments for the first time.

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Transcript

Dr. Mojola Omole:

I'm Mojola Omole.

Dr. Blair Bigham:

I'm Blair Bigham. This is the CMAJ podcast.

Dr. Mojola Omole:

So as we're coming out of summer, like everyone else, we're all focused on either returning to school, or like me, my kiddo is starting pre-K.

Dr. Blair Bigham:

And it's not just kiddos. Also teenagers are heading back to university this week.

Dr. Mojola Omole:

And as you might have noticed in the news in the last few years, there have been outbreaks of meningitis B on university campus. There was one in Dalhousie back in 2022, and more recently at Queen's University.

Dr. Blair Bigham:

And so it's really timely that we have these two articles in CMAJ looking at meningococcal disease. The first article is a case study that kind of scared me, Jola. It was a meningitis case that didn't present as meningitis. Maybe I should be more specific. It was a Neisseria meningitidis case that didn't present as headache photophobia, stiff neck, fever, all those usual symptoms that we think of in meningitis. It was a little bit trickier to find. It presented more like Neisseria gonococcus disease. Joint pain, tenosynovitis, but not your typical headache.

Dr. Mojola Omole:

The whole thing about meningitis scares me because I thought it wasn't a thing anymore, and now I have to figure out if I need to get vaccinated.

Dr. Blair Bigham:

It is one of those diseases that I think emergency docs and family docs are a little bit scared of because like some... You know how pulmonary embolism, it presents very mild at first. You can miss it. Same with meningococcal disease. Meningitis can present as early flu. And you go, "Okay, well we don't LP everybody with a headache and fever." Most of those people have influenza. We send them on their way. So it is kind of scary because this is one of those diseases that you might not catch right off the hop.

Dr. Mojola Omole:

Off the hop?

Dr. Blair Bigham:

That's why it is... Off the hop.

Dr. Mojola Omole:

Off the hop.

Dr. Blair Bigham:

Is that not right?

Dr. Mojola Omole:

Ooh.

Dr. Blair Bigham:

Right off the bat? I don't know. How do you say?

Dr. Mojola Omole:

Oh, okay.

Dr. Blair Bigham:

Anyways, that's why the second article in CMAJ is particularly salient because since meningitis is kind of hard to catch early on, and if you catch it too late, it can be deadly, it's kind of nice that we can be vaccinated against it.

Dr. Mojola Omole:

And if you like me, need a little bit of a primer about meningitis, we're going to be speaking to the medical officer of health in Halifax about the outbreak that happened in their city a few years ago.

Dr. Blair Bigham:

And then we'll move on to speak to somebody who can tell us about meningococcus vaccination, particularly the MenB vaccine, which I thought I had as a kid, but I didn't.

Dr. Mojola Omole:

But first, we will hear a story from one student at Queen's who contracted invasive meningococcal disease in November of 2023.

Dr. Blair Bigham:

Megan Plamondon's story is up next.

Megan Plamondon:

So my name is Megan Plamondon. I'm in my third year of commerce at Queen's University, and I'm from Ottawa, Ontario. So I'm on the triathlon team at Queen's, and something we do every Sunday is we do a long run with the team. So one Sunday in November, I woke up, I wasn't feeling so great, but I went for the long run with the team. I didn't feel great on the run and I started to feel a little bit sick after, but I brushed it off because I was like, "Okay, I just ran 17 kilometers. It makes sense I don't feel so great right now." I remember having just an awful headache, so I went to sleep for the afternoon, and when I woke up, my symptoms were worse. At this point, I had an awful headache. I was very photophobic. I couldn't really turn my head left to right that much, and so I was very stiff-neck, and I was pretty nauseous.

At this point. I was like, "Okay, I probably just have the flu or something. I'm just going to go back to bed. Maybe I'll call my mom if it gets worse." It ended up getting a lot worse to the point that I felt so weak I couldn't really walk, and I attributed the stiff neck to just sleeping funky or something. So I called my mom again. I was like, "I don't really know what to do. I don't feel great right now." I felt so weak. I couldn't eat anything. I couldn't really walk. I was just in my bed with an eye mask on because it was just so bright. My mom had heard about the cases in the Maritimes the year before, and she's like, "You could have meningitis, but the odds of that are very low."

I ended up going to the hospital the Monday night just to kind of rule it out. I didn't think I actually had meningitis. I don't know if they were really taking me seriously in the waiting room, because all my vitals were fine, and it was just so bright that I couldn't do it. So I actually went home. So I ended up going to a different hospital the next morning, and at this point I had name-dropped meningitis to them, so I think that might've gotten me in a little bit quicker. And at this point they had determined that I had meningitis through doing a spinal tap, but they weren't sure what kind of meningitis it was, and they determined that I needed... I was in critical care. So they transferred me back to the initial hospital I went to that rejected me to get my antibiotics and I just also needed 24-hour treatment.

And then I was in that other hospital for almost two weeks. To be honest, it all feels like a little bit of a dream to me. They couldn't put me in ICU because it was an infectious disease. So I was in this little dark room, and everyone was in hazmat suits and I was on very intense pain meds at this point, so everything is a little bit blurry. I remember being in a lot of pain. I remember having an awful headache, and I was in bed. I couldn't really move for three, four days and then eventually could go to the washroom. And by the end of my time in the hospital, I was just there because I needed to give me antibiotics, but at this point I was fine. They said that in my case, if I had gotten to the hospital even a couple hours later, I might've not lived.

But they didn't tell me any of this, and I'm very glad they didn't tell me. I was very much in the dark before going to the hospital. All I knew about meningitis was that my roommate in nursing told me I didn't want to have it. That's all I knew. It was very much like a concussion recovery, and they couldn't give me any dates on anything because meningitis is so rare. They were just like, "You'll feel better when you feel better," which was pretty tough from my point. But it was definitely week by week. The first month or so, I would describe it as I just felt stupid. I would forget everything. I remember leaving my house one day to run errands, and I made it a block away and then I forgot why I had left my house, so I had to come home.

And also, so this happened in November, and my recovery was mostly in December, which is exactly when exam season is, which was not great timing for me. It was very hard to study. It was hard to focus. And as an athlete it was also very difficult, because they told me I couldn't really exercise and it might prolong my recovery, so I didn't get back into actually exercising until around February or so. I'm fine now. Pretty much a hundred percent. I do triathlons so I get my heart rate pretty high, and in the past few months when I've gotten my heart rate super, super high in a race or something, not just at practice, but in a race, I'll get a very bad headache after which I'm not sure if that's related to meningitis or not, but I will just take the pain meds I had from when I had meningitis and it goes away.

I think the biggest thing I'd want to touch on is that before getting bacterial meningitis, I was under the impression that I was vaccinated, because you get your vaccines in what grade? Seven or eight? And at this point we got our meningitis vaccines, and I thought that kind of just covered all meningitis and that for some reason vaccines would never expire, and I was okay for life. But evidently that was not the case. So I would just urge physicians to not be afraid to have that conversation with patients, because as a patient, I'm under the impression that my doctor will tell me exactly what it is I need. I don't know. It shouldn't really have to be the patient's responsibility to bring this up because it's not really their area of expertise, and that physicians should be having these conversations with patients, especially if they have children who are going to stay in university residences.

Dr. Blair Bigham:

That was Megan Plamondon in Kingston Ontario. As Megan mentioned, her case follows the two cases in 2022 of students at Dalhousie contracting invasive meningococcal disease. This prompted Nova Scotia Public Health to declare an outbreak and now, they're providing publicly funded MenB vaccines for young adults, but only if they're entering congregate living settings like a dormitory for the first time.

Dr. Mojola Omole:

Dr. Cristin Muecke is the regional medical officer of health for Nova Scotia Public Health. Cristin, thank you so much for joining us today.

Dr. Cristin Muecke:

No problem.

Dr. Mojola Omole:

So, Megan's case and two other cases in Halifax all involve university students. Why does meningitis show up in this demographic?

Dr. Cristin Muecke:

So meningitis does have different incidence rates according to age. So we do see, epidemiologically, we do see a peak in meningitis in the under-five-year-olds, in particular infants, we see a peak in the elderly, and we also see a small peak in the 15 to 24-year-olds. So that age range, people tend to have a slightly higher nasopharyngeal carriage rate, and there is some relationship as well between meningococcal disease and congregate living because it is a direct contact, large droplet transmission. So you do need to have direct contact with the oropharyngeal secretions of another person.

Dr. Mojola Omole:

So these cases that happened at Dalhousie, can you tell us a little bit about it? Were they close contacts? Did they know each other?

Dr. Cristin Muecke:

So just to give you a little bit of context to start, this particular outbreak occurred in December of 2022 as we were coming into our first respiratory season out of Omicron and the major COVID pandemic. So we were seeing some really interesting changes in the epidemiology of a variety of different diseases. So we had a very early and quite a significant peak of influenza. We were seeing unusual numbers of RSV. And one of the things we do know about Neisseria meningitidis is there is a relationship between invasive infection and respiratory virus epidemiology. So what we do see is often if there's a peak in the flu season, we'll see increased cases of IMD shortly thereafter. So this was the case as well in Nova Scotia and in other parts of the world.

Dr. Blair Bigham:

I'm curious about that. Is that because they get infected with the virus and that makes-

Dr. Cristin Muecke:

Yeah. So there's-

Dr. Blair Bigham:

... that sort of resident bacteria more likely to sneak in deeper and become disease?

Dr. Cristin Muecke:

Yeah, you've got it. So yeah, there's co-infection, typically, and then that does seem to increase people's susceptibility to invasive disease. So in the case of Dalhousie, we had our first case in an individual who was living in residence. And that in and of itself, it is rare but not completely unexpected. But because of the nature of the and severity of the illness, in Public Health, we do react very quickly to those situations. And so once we were notified, we conducted some case interviews, identified all of the immediate close contacts, which is the standard of practice with IMD, and provided the close contacts, so this would be friends, family, people who would've been in regular close contact if they were living in the same room, that kind of thing, provided them with chemoprophylaxis, so prophylactic antibiotics. A couple of days later, the second case presented itself.

And interestingly enough, although two cases do constitute an outbreak in the case of IMD because it is suggestive of transmission, and also because these two individuals were in the same residence. Although it was a very large residence and they weren't in the same section, we did formally declare it an outbreak, which put more resources into the investigation also resulted in a vaccination campaign for that residence. But the interesting part about the Dal outbreak is those two cases actually didn't have any direct contact with each other. So they didn't know each other, they didn't run in the same social circles, they didn't attend the same activities or sports or events. It was unusual in that sense that we couldn't make any direct social connection between the two, and so the feeling is that there may have been some asymptomatic nasopharyngeal carriage transmission occurring in the residence, but that the two cases,

Dr. Blair Bigham:

So they didn't get it from each other.

Dr. Cristin Muecke:

... they didn't get it directly from each other.

Dr. Blair Bigham:

But they got it from somebody else,

Dr. Cristin Muecke:

Yeah, yeah.

Dr. Blair Bigham:

... maybe.

Dr. Cristin Muecke:

Which is part of the reason-

Dr. Blair Bigham:

Oh, okay.

Dr. Cristin Muecke:

... why we very quickly initiated a vaccination campaign just to try and halt any further transmission.

Dr. Blair Bigham:

So what percentage of students could be asymptomatic carriers of Neisseria?

Dr. Cristin Muecke:

So Neisseria meningitidis is a sneaky bacterium in that it can live in the back of your nose and throat undetected and not causing you illness, and it can also cause invasive meningococcal disease, which is very serious and rare, but very serious and has significant sequelae. We do see a little bit of a peak in young adulthood, and it can be upwards of 20% of people who are asymptomatically infected. It sounds alarming, but as I said, most of the time, this is with a non-invasive bacterium, causes no issues. People are asymptomatic, but unfortunately, we do rarely see invasive cases, which are obviously quite serious.

Dr. Blair Bigham:

And other than co-infection, what else might lead just the asymptomatic Neisseria to become disease?

Dr. Cristin Muecke:

Well, there are individuals that are at high risk. So folks that have had a splenectomy, folks with complement deficiencies. So there are folks that are at higher risk for Neisseria in general, and those folks in pretty much all provinces I think are eligible for publicly funded Neisseria vaccine. But otherwise, unfortunately, it can hit perfectly healthy people as well for reasons that we're not entirely sure of other than, like I said, oftentimes there is co-infection with a common respiratory virus.

Dr. Mojola Omole:

So we talked about Halifax and we talked about Kingston. What do we know is currently what's happening across the country with IMD?

Dr. Cristin Muecke:

Well, one of the interesting things, so the National Advisory Committee on Immunization in 2023 did a review of the epidemiology of invasive meningococcal disease in Canada in part to inform whether or not they needed to be providing additional recommendations around meningococcal vaccination. And this is in response in part to situations like the one I described. And one of the interesting things that they found is that the serogroup distribution does vary across the country.

So as most people know, there's multiple serogroups of Neisseria meningitis, so A, C, W, Y, and B, and what they found was that for reasons that aren't super clear, I wouldn't say, meningitis B is the predominant serogroup in the Atlantic provinces, but as you move west, you start to see a more even distribution, and as you go towards the prairies in BC, the predominant serogroup is the W serogroup. So it did mean that NACI in the end basically directed the provinces to look at their own epidemiology when determining what the recommended vaccination schedule would be, which is not unusual. But in this case, it was quite notable that there was a significant difference between the east and the west of Canada.

Dr. Mojola Omole:

So what are the hallmark signs of IMD that clinicians should be watching out for?

Dr. Cristin Muecke:

So it starts off looking like probably the majority of colds and viral infections. If you don't feel well, maybe you have a little bit of a fever, or you want to lay in bed. But at that point probably indistinguishable from a lot of common viral infections, but it does progress quite quickly. And so within 24 to 48 hours, you can get very ill. So high fever, bad headache, confusion, stiff neck, nausea, vomiting. The real hallmark one is a particular rash, but it's not present in everybody, sometimes photophobia. So what we see often is people presenting more than once. They feel like something's off, but they're not really sure what it is, but may or may not, if they present early enough, may or may not look significant. And so people sometimes get sent home only to come back a few hours later and be quite ill. So it does require a bit of a high index of suspicion and knowing who the typically affected age groups are, keeping an eye out for more severe headaches, stiff neck, that kind of thing, and just knowing that it can deteriorate quite quickly.

Dr. Mojola Omole:

And how is the diagnosis confirmed?

Dr. Cristin Muecke:

Typically confirmed with a lumbar puncture, so CSF analysis or blood cultures, because invasive meningitis, it can cause meningitis obviously, but it can also cause septicemia. So you can sometimes pick up the Neisseria in blood.

Dr. Mojola Omole:

And should primary cases, primary care be reporting to public health when they're suspecting or when there's a confirmed diagnosis of this?

Dr. Cristin Muecke:

Absolutely. So Neisseria meningitis will be a reportable disease in pretty much all provinces, and most provinces will accept both clinical notification and lab notification. So if you're seeing someone in the emergency department, for example, that has all the hallmark signs of invasive meningococcal disease, absolutely give public health a call. We'll typically confirm it with lab findings, but the earlier that they can be identified, the better, because we do have a limited time window to provide chemoprophylaxis to close contacts.

Dr. Mojola Omole:

We're going to talk more about vaccines, and we've talked a little bit about them. Is there any other public health measures that are done once we know there's a suspected case?

Dr. Cristin Muecke:

Well, like I mentioned, there is chemoprophylaxis as provided to close contacts. So we do provide prophylactic antibiotics to folks that live in the same house or sharing sleeping arrangements or who would've had direct contamination with secretions from the nose or mouth, so people that kissing, sharing, drinking bottles, et cetera. And there is a timeframe in which we need to do that. So it is important to notify as soon as you can and then get those pieces underway. Once we find out which serogroup it is, we do occasionally offer vaccine as well as chemoprophylaxis to those same individuals. And in cases like the Dal situation I described, sometimes that involves a larger campaign as well.

Dr. Blair Bigham:

We've been talking a lot about Neisseria meningitidis specifically.

Dr. Cristin Muecke:

Yes, yes.

Dr. Blair Bigham:

What about other causes of meningitis? Are there concerns around strep or listeria similar to how we're concerned about Neisseria, or is it really Neisseria that is just so wickedly able to go into an outbreak?

Dr. Cristin Muecke:

Yeah, no, that's a really good point because often people talk about meningitis in general, but of course meningitis as a general infection category is just an infection of the meninges, the lining with the brain and spinal cord. And so that can be caused by bacteria, it can be caused by viruses, it can be caused by fungi. Typically, Neisseria meningitidis causes the most severe cases of invasive disease, but it's also one of the few ones where we have specific public health interventions that we can employ. So it is one that we spend more focus on as a result.

Dr. Blair Bigham:

Gotcha. That makes sense. Thank you.

Dr. Mojola Omole:

Thank you so much for joining us today, Cristin.

Dr. Cristin Muecke:

No problem. No problem.

Dr. Mojola Omole:

Dr. Cristin Muecke is the regional medical officer of health for Nova Scotia Public Health. Our love affair for public health officials continues.

Okay. After that great primer, we're very fortunate to have Dr. Savita Rani, a public health specialist in the Department of Community Health and Epidemiology at the University of Saskatchewan joining us today. Thank you for spending time with us, Savita.

Dr. Savita Rani:

Thank you so much for having me.

Dr. Blair Bigham:

Savita, you recently authored, and the timing is quite excellent, a “Five things to know about meningitis B vaccination” in CMAJ. What is up with the B in meningitis B vaccines?

Dr. Savita Rani:

Okay, sure. So invasive meningococcal disease, which is the condition that we're concerned with, is the bacterial infection caused by meningococcal bacteria, so Neisseria meningitidis. And there's 12 different serotypes of this bacteria, six of those which include serotype, A, B, C, X, W, Y, are more associated with IMD in Canada. So that's why those are focused on.

Dr. Blair Bigham:

Okay. And tell us about our options for protection. What vaccines are on the market right now?

Dr. Savita Rani:

Yeah. So the vaccines protecting against meningitis serogroups A, C, Y, and W, they have been around for quite a while. And so as you may or may not be familiar with those vaccines tend to be part of provincial routine childhood immunization schedules. And so these programs began back in the early 2000s, starting in 2002, with the vaccine against the meningitis C. Then by 2007, we were also having vaccines targeted against A, Y, and W. So now A, C, Y, W, those serotypes are part of the routine childhood schedules.

The two vaccines available for meningitis B, which are 4CMenB and MenB-FHbp, they don't really roll off the tongue, these vaccines were approved by Health Canada in 2013 and 2017 respectively. So their availability in Canada has been a lot later than the vaccines that are protecting against the other serotypes. And truly, that does explain a lot of why things are different between the meningitis B vaccines and the vaccines for the other serotypes. They're a newer vaccine.

Dr. Blair Bigham:

So these two new vaccines for MenB then, they're on the market. Who should be asking for the meningitis B vaccine?

Dr. Savita Rani:

Right.

Dr. Blair Bigham:

Or who qualifies for it?

Dr. Savita Rani:

Yeah, so that's a good question. There's criteria for being eligible for the publicly funded dose of meningitis B vaccine, and these can be high-risk medical conditions that include things like functional or anatomic asplenia, sickle cell disease, combined T- and B-cell immunodeficiencies, congenital complement, or primary antibody deficiencies, HIV, especially if congenitally acquired. There's a list of conditions, or if you have any high-risk exposures. So for instance, if you're a traveler going to an area with high rates of endemic meningococcal disease or transmission, any research, industrial or clinical lab personnel who might potentially be routinely exposed to Neisseria meningitidis as part of their occupation, military personnel during recruit training or certain deployments, and young people living in group settings where that local epidemiology indicates higher risk.

Dr. Blair Bigham:

Okay.

Dr. Savita Rani:

So-

Dr. Blair Bigham:

So Nova Scotia just expanded their availability or their access. Do you think other provinces will follow suit? Is there a world in the near future where students who are worried about this can go and get vaccinated without having to pull out their credit card?

Dr. Savita Rani:

Yeah, it's a good question. There does seem to be sufficient preliminary evidence that the MenB vaccines are immunogenic. They have acceptable safety profiles so that it makes sense that at that individual level, if you have certain risk factors for developing IMD, that you can be offered the MenB vaccine. But at that population level, there's still limited data available on the effectiveness of the vaccines or on their effect on meningococcal carriage, because a lot of asymptomatic carriers of the bacteria, and also limited evidence on herd immunity. So that's why at that population level, it's still not recommended to include meningitidis B vaccines as part of routine programming.

Dr. Blair Bigham:

What about people who should not get it? Can it be given to infants, very elderly people? Are there certain groups where it's not approved for use?

Dr. Savita Rani:

Yeah. So there's the two vaccines, the 4CMenB, and then the MenB-FHbp. 4CMenB can be used in those aged two months old and older, but the MenB-FHbp can be used in those who are 10 years of age or older. So there is a difference in terms of the age group that both those vaccines have been approved for.

Dr. Blair Bigham:

So help me do a little summary for a family doc in clinic. A parent comes in and says, "I have a three-month-old and a 16-year-old, and we're going to Europe," or "I'm worried about meningitis on campus." What should a family doctor have ready to advise when it comes to people who are curious about the vaccine?

Dr. Savita Rani:

Yeah. So I suppose being familiar with what those eligibility criteria for publicly funded doses are is important to know, just to inform the patients that if you meet those, then you can be eligible for a publicly funded dose. But if you don't meet those, then if you're still interested, then that would be an out-of-pocket expense. But certainly, a patient's potential for clinical benefit from receiving the vaccine might not always be congruent with the eligibility criteria for a publicly funded dose. So that's certainly something to keep in mind in terms of providers and patients undergoing that shared decision making together.

So, essentially having those high-risk medical conditions and high-risk exposure factors in mind is something that I think would be helpful. And then also just remembering that your friendly local public health unit is certainly there to support as well. The communicable diseases, immunization teams within local public health units are certainly there for supporting community providers. And so not being afraid to reach out, certainly if this isn't something that you see very often, I think is something to make note of.

Dr. Blair Bigham:

Savita, thank you so much for joining us.

Dr. Savita Rani:

Well, thank you so much for having me, Blair. Really appreciate the time.

Dr. Blair Bigham:

Dr. Savita Rani is a public health specialist in the Department of Community Health and Epidemiology at the University of Saskatchewan.

Dr. Mojola Omole:

So, Blair, my first thoughts was I didn't know that there were so many different types of meningitis, and there's part of me that's like, well, should we be having more of a conversation about vaccinations for meningitis for students who are going to universities or those who live in congregate settings?

Dr. Blair Bigham:

Yeah. I feel like if decades ago the technology for a MenB vaccine was around, it would've just been thrown into the meningitis vaccine that everybody gets as part of their routine immunizations. So I'm still left a little unclear on why, to qualify for a publicly funded MenB vaccine, the criteria are still so limited. Why aren't we just adding this in so that nobody gets meningitis, especially with so many asymptomatic carriers walking around?

Dr. Mojola Omole:

That I didn't even know that I lived in my nose.

Dr. Blair Bigham:

Yeah. It could be there right now, Jola.

Dr. Mojola Omole:

Well, that's a great feeling to think about. Thanks, Blair.

Dr. Blair Bigham:

So it's kind of odd that the criteria are so restrictive and on a province-by-province basis. And I get that the epidemiology is tricky on this because not many diseases have an outbreak when just two people get infected. But I think that speaks to just how important it is to prevent a meningitis outbreak. These are deadly or leave people severely disabled sometimes. So it seems like we're maybe lacking just the data to support it, but it certainly sounds like MenB vaccine is not on the radar right now of a lot of people. I didn't even know I wasn't vaccinated against it.

Dr. Mojola Omole:

Well, hopefully Megan's story is persuasive enough to get people moving to, especially if you're going to be in congregate settings, to get vaccinated.

That's it for this episode of the CMAJ Podcast. If you like what you've heard, please give us a five-star rating wherever you get your podcasts, share it with your networks, and please leave a comment. The CMAJ Podcast is produced by our amazing producer for CMAJ, Neil Morrison by PodCraft Productions. Thanks so much for listening. I'm Mojola Omole.

Dr. Blair Bigham:

And I'm Blair Bigham. Until next time, be well.