Providing Vaccine Guidance for Patients Requires Evidence-Based Clinical Decision Making
Over the past 20 years, incidence of MenB has decreased by approximately 90%.
According to survey results reported in Pediatrics, researchers found that the incidence of serogroup B meningococcal (MenB) disease and the efficacy and safety outcomes of MenB vaccines were key variables that influenced practitioners' likelihood of recommending the MenB vaccine to patients 10 years of age or older.
Over the past 20 years, incidence of MenB has decreased by approximately 90%; few data are available to establish the long-term safety of the vaccine. Despite this, many practitioners recommend the MenB vaccine to young patients, particularly young adults entering college. These recommendations were made even though no clear research has garnered supportive evidence of an increased risk for MenB disease in college students at the time of the survey.
Individual decision-making, a category B recommendation from the Advisory Committee on Immunizations Practices, represented the factor that was most likely to reduce the use of the MenB vaccine. Time for discussion of a Category B recommendations was not observed as an obstacle to recommendation of the vaccine, demonstrating that many clinicians may likely recommend the vaccine if time was not limited during routine clinical visits.
The survey may be more of a reflection of clinicians' desired recommendations rather than what occurs in clinical practice, according to Michael T. Brady, MD, who authored the associated editorial. The relatively low rates of MenB immunization observed in the survey may also be associated with the challenges in getting adolescents and young adults in for a routine doctor's visit.
"Recommendations that require clinical decision-making need to provide clear guidance that informs providers so that they can determine what needs to be discussed with their patients and families and determine how strongly to recommend the vaccine," Dr Brady wrote. "Without this guidance, providers will continue to be challenged with Category B or permissive recommendations as suggested in the survey."
Brady MT. Strength and clarity of vaccine recommendations influence providers' practice [published August 20, 2018]. Pediatrics. doi:10.1542/peds.2018-1633.