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4CMenB sustained vaccine effectiveness against invasive meningococcal B disease and gonorrhoea at three years post
Bing Wang1, Lynne Giles2, Prabha Andraweera1
1Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia; Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia.
Objectives:
To evaluate persistence of vaccine effectiveness (VE) and vaccine impact (VI) on invasive meningococcal B (MenB) disease and gonorrhoea at three years after implementation of a state funded 4CMenB programme for infants, children, adolescents and young people in South Australia.
Methods:
VI was assessed using a Poisson or negative binomial regression model, and VE was estimated using screening and case-control methods. Chlamydia controls were used to estimate VE in the primary analysis to control potential confounding effects such as high-risk sexual behaviour associated with sexually transmitted infections.
Results:
During the three-year programme, reductions of 63.1% (95%CI 29.0-80.9%) and 78.5% (95%CI 33.0-93.1%) in incidence of MenB disease were observed in infants and adolescents, respectively. There were no cases in infants who had received three doses of 4CMenB. Two-dose VE against MenB disease was 90.7% (95%CI 6.9-99.1%) for the childhood programme and 83.5% (95%CI 0-98.2%) for the adolescent programme. Two-dose VE against gonorrhoea in adolescents was 33.2% (95%CI 15.9-47.0%). Lower VE estimates were demonstrated after 36 months post-vaccination (23.2% (95%CI 0-47.5%)> 36 months post-vaccination compared to 34.9% (95%CI 15.0-50.1%) within 6-36 months). Higher VE estimates were found after excluding patients with repeat gonorrhoea infections (37.3%, 95%CI 19.8-51.0%). For gonorrhoea cases co-infected with chlamydia VE was maintained (44.7% (95%CI 17.1-63.1%).
Conclusion:
The third-year evaluation results show persistent vaccine effectiveness of 4CMenB against MenB disease in infants and adolescents. As this is the first ongoing programme for adolescents, moderate vaccine protection against gonorrhoea with waning effectiveness three years post-vaccination was demonstrated in adolescents and young adults. The additional protection of 4CMenB vaccine against gonorrhoea, likely through cross-protection should be considered in cost-effectiveness analyses. A booster dose may need to be further evaluated and considered in adolescents due to waning protection against gonorrhoea demonstrated after 36 months post-vaccination.
Insights
The 4CMenB vaccine shows lasting effectiveness against meningococcal B disease in infants and adolescents. However, protection against gonorrhoea wanes over three years, suggesting a need for booster doses in adolescents and young adults.
Area of Science:
- Public Health
- Vaccinology
- Infectious Diseases
Background:
- The 4CMenB vaccine program was implemented in South Australia to reduce invasive meningococcal B (MenB) disease and gonorrhoea.
- Evaluating the long-term effectiveness and impact of this program is crucial for public health strategies.
Purpose of the Study:
- To assess the persistent vaccine effectiveness (VE) and vaccine impact (VI) of the 4CMenB vaccine against MenB disease and gonorrhoea.
- To evaluate these outcomes three years after the program's implementation in infants, children, adolescents, and young people.
Main Methods:
- Vaccine impact was analyzed using Poisson or negative binomial regression models.
- Vaccine effectiveness was determined through screening and case-control methods, utilizing chlamydia controls to mitigate confounding factors like high-risk sexual behavior.
Main Results:
- Significant reductions in MenB disease incidence were observed: 63.1% in infants and 78.5% in adolescents.
- Two-dose VE against MenB disease was high (90.7% in children, 83.5% in adolescents).
- Two-dose VE against gonorrhoea in adolescents was 33.2%, with waning effectiveness observed after 36 months post-vaccination.
Conclusions:
- The 4CMenB vaccine demonstrates sustained effectiveness against MenB disease in infants and adolescents.
- Moderate, but waning, protection against gonorrhoea was observed in adolescents and young adults, indicating potential need for booster doses.
- The cross-protective benefits against gonorrhoea should be considered in cost-effectiveness analyses of the 4CMenB program.
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