For decades, there was no licensed vaccine for prevention of endemic capsular group
B meningococcal disease, despite the availability of vaccines for prevention of the
other most common meningococcal capsular groups. Recently, however, two new vaccines
have been licensed for prevention of group B disease. Although immunogenic and considered
to have an acceptable safety profile, there are many scientific unknowns about these
vaccines, including effectiveness against antigenically diverse endemic meningococcal
strains; duration of protection; whether they provide any herd protection; and whether
there will be meningococcal antigenic changes that will diminish effectiveness over
time. In addition, these vaccines present societal dilemmas that could influence how
they are used in the U.S., including high vaccine cost in the face of a historically
low incidence of meningococcal disease. These issues are discussed in this review.
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