New England Journal of Medicine
July 21, 2016 Vol. 375 No. 3
http://www.nejm.org/toc/nejm/medical-journal
Perspective
Beyond the Ebola Battle — Winning the War against Future Epidemics
Victor J. Dzau, M.D., and Peter Sands, M.P.A.
N Engl J Med 2016; 375:203-204 July 21, 2016 DOI: 10.1056/NEJMp1605847
[Initial text]
The battle to contain and ultimately defeat the Ebola epidemic of 2014–2015 has been vividly described.1-3 Caught off guard from the start and hindered by myriad coordination, communication, and other problems, a combination of local and international teams fought back with determination, courage, and eventually the deployment of substantial resources to stem the contagion and save lives. Yet more than 11,000 people died, and local economies were brought to a halt. The battle was won, but at immense cost.

With the immediate crisis over, the world’s attention has moved on. Ebola has vanished from the headlines and seemingly from policymakers’ to-do lists. Attention has shifted to Zika and other competing priorities. Yet it would be a huge mistake to turn away and declare the war over, for West Africa remains vulnerable to a resurgence of Ebola. There will undoubtedly be new outbreaks; the only question is how well they will be contained…

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Original Article
Immunogenicity of a Meningococcal B Vaccine during a University Outbreak
Nicole E. Basta, Ph.D., Adel A.F. Mahmoud, M.D., Ph.D., Julian Wolfson, Ph.D., Alexander Ploss, Ph.D., Brigitte L. Heller, B.S., Sarah Hanna, A.B., Peter Johnsen, M.D., Robin Izzo, M.S., Bryan T. Grenfell, D.Phil., Jamie Findlow, Ph.D., Xilian Bai, Ph.D., and Ray Borrow, Ph.D.
N Engl J Med 2016; 375:220-228 July 21, 2016 DOI: 10.1056/NEJMoa1514866
Abstract
Background
In December 2013, a multicomponent meningococcal serogroup B (4CMenB) vaccine was used before licensure on the basis of special consideration by the Food and Drug Administration to respond to an outbreak of Neisseria meningitidis B at a U.S. university. Data suggested that vaccination would control the outbreak because isolates expressed antigens that were closely related to the vaccine antigens (factor H–binding protein [fHbp] and neisserial heparin-binding antigen). We quantified the immune responses induced by 4CMenB during the outbreak.
Methods
We conducted a seroprevalence survey among students to assess vaccination status and collect serum specimens to quantify titers of serum bactericidal antibodies (SBA) with an assay that included human complement (hSBA). We compared the proportion of vaccinated and unvaccinated participants who were seropositive for the outbreak strain and for one closely related reference strain (44/76-SL, which included fHbp) and one mismatched reference strain (5/99, which included neisserial adhesin A), both of which were used in vaccine development. Seropositivity was defined as an hSBA titer of 4 or higher.
Results
Among the 499 participants who received two doses of the 4CMenB vaccine 10 weeks apart, 66.1% (95% confidence interval [CI], 61.8 to 70.3) were seropositive for the outbreak strain, although the geometric mean titer was low at 7.6 (95% CI, 6.7 to 8.5). Among a random subgroup of 61 vaccinees who also received two doses but did not have a detectable protective response to the outbreak strain, 86.9% (95% CI, 75.8 to 94.2) were seropositive for the 44/76-SL strain, for which there was a geometric mean titer of 17.4 (95% CI, 13.0 to 23.2), whereas 100% of these vaccinees (95% CI, 94.1 to 100) were seropositive for the 5/99 strain and had a higher geometric mean titer (256.3; 95% CI, 187.3 to 350.7). The response to the outbreak strain was moderately correlated with the response to the 44/76-SL strain (Pearson’s correlation,0.64; P<0.001) but not with the response to the 5/99 strain (Pearson’s correlation,−0.06; P=0.43).
Conclusions
Eight weeks after the second dose of the 4CMenB vaccine was administered, there was no evidence of an hSBA response against the outbreak strain in 33.9% of vaccinees, although no cases of meningococcal disease caused by N. meningitidis B were reported among vaccinated students. (Funded by Princeton University and others.)

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Editorial
A Challenge in Vaccine Development — Neisseria meningitidis Serogroup B
Jerome H. Kim, M.D.
N Engl J Med 2016; 375:275-278 July 21, 2016 DOI: 10.1056/NEJMe1606015
This article has no abstract; the first 100 words appear below.
Proving the clinical efficacy of Neisseria meningitidis serogroup B (MenB) vaccines has been difficult. There is substantial genetic (and corresponding antigenic) diversity, and serogroup B meningococcal disease is both uncommon and in decline in countries where the burden is well understood. The incidence of meningococcal disease in the United States is at a historic low (0.18 per 100,000 person-years in 2013, including serotypes A, C, W, Y, and B). However, from 2009 through 2015 there were seven outbreaks of MenB meningitis at U.S. universities that resulted in 43 cases and 3 deaths.1 Because no MenB vaccine had been approved by…