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Vaccination of Infants with Meningococcal Group B Vaccine (4CMenB) in England
Shamez N Ladhani1, Nick Andrews1, Sydel R Parikh1
1From the Immunisation and Countermeasures Division (S.N.L., S.R.P., H.C., J.W., M.E., M.E.R.) and the Statistics, Modelling, and Economics Department (N.A.), Public Health England, and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and the Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester (X.B., J.L., R.B.) - all in the United Kingdom.
Insights
The United Kingdom's meningococcal group B vaccine (4CMenB) program significantly reduced disease incidence by 75% in eligible children. Protection was sustained for at least two years post-vaccination.
Area of Science:
- Immunology
- Vaccinology
- Public Health
Background:
- The UK introduced the 4-component meningococcal group B vaccine (4CMenB, Bexsero) in September 2015.
- The national immunization program utilized a reduced two-dose infant priming schedule with a 12-month booster.
Purpose of the Study:
- To evaluate the impact of the 4CMenB vaccine on meningococcal group B disease incidence in England.
- To assess vaccine effectiveness during the initial three years of the public health program.
Main Methods:
- Utilized enhanced national surveillance data for invasive meningococcal disease in England.
- Compared observed disease incidence in vaccine-eligible cohorts with expected incidence from a pre-vaccination period.
- Employed indirect screening methods to estimate vaccine effectiveness.
Main Results:
- High vaccine uptake: 92.5% completed primary immunization by age 1, 87.9% received three doses by age 2.
- Significant reduction in meningococcal B disease incidence by 75% in eligible cohorts (63 cases observed vs. 253 expected).
- Estimated vaccine effectiveness was 52.7% (two-dose) and 59.1% (two-dose plus booster), preventing an estimated 277 cases.
Conclusions:
- The 4CMenB vaccination program demonstrated a sustained positive effect against meningococcal group B disease in children.
- Protection conferred by three vaccine doses remained effective for at least two years.
Background:
In September 2015, the United Kingdom introduced the multicomponent meningococcal group B vaccine (4CMenB, Bexsero) into its publicly funded national immunization program at a reduced two-dose priming schedule for infants, with a 12-month booster.
Methods:
Using data from enhanced national surveillance of invasive meningococcal disease in England, we evaluated the effect of vaccination on the incidence of meningococcal group B disease during the first 3 years of the program. The effect of vaccination was assessed by comparing the observed incidence of disease with the expected incidence based on the incidence during the 4-year prevaccination period in equivalent cohorts and with the use of disease trends in cohorts of children younger than 5 years of age who were not eligible to receive the vaccine. Vaccine effectiveness was estimated with the use of the indirect screening method.
Results:
4CMenB uptake in England remained consistently high; data from the first 3 months of 2018 showed that 92.5% of children had completed the primary immunizations by their first birthday and 87.9% had received all three doses by 2 years. From September 2015 through August 2018, the incidence of meningococcal group B disease in England (average annual birth cohort, approximately 650,000 infants) was significantly lower in vaccine-eligible cohorts than the expected incidence (63 observed cases as compared with 253 expected cases; incidence rate ratio, 0.25; 95% confidence interval [CI], 0.19 to 0.36), with a 75% reduction in age groups that were fully eligible for vaccination. The adjusted vaccine effectiveness against meningococcal group B disease was 52.7% (95% CI, -33.5 to 83.2) with a two-dose priming schedule for infants and 59.1% (95% CI, -31.1 to 87.2) with a two-dose priming schedule plus a booster at 1 year). Over the 3-year period, there were 169 cases of meningococcal group B disease in the vaccine-eligible cohorts, and an estimated 277 cases (95% CI, 236 to 323) were prevented.
Conclusions:
The 4CMenB program was associated with continued positive effect against meningococcal group B disease in children in England, and protection after three doses of the vaccine was sustained for at least 2 years. (Funded by Public Health England.).
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