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Modeling the Public Health Impact of Introducing 4CMenB Vaccination for Infants in the Brazilian National
Thatiana Pinto1, Zeki Kocaata2, Ana Medina3
1GSK, Wavre, Belgium. thatiana.x.pinto@gsk.com.
Introduction:
Invasive meningococcal disease (IMD) caused by meningococcal serogroup B (MenB) is a rare but serious illness with potentially life-threatening outcomes, particularly in infants. In Brazil, IMD is endemic, with the highest incidence in infants and most cases being due to MenB. The four-component MenB vaccine (4CMenB), with potential cross-protection against other meningococcal serogroups, is approved in Brazil for active immunization of individuals aged 2 months to 50 years. This modeling study assessed the public health impact on all age groups in Brazil of introducing routine vaccination with the 4CMenB vaccine in infants aged < 1 year.
Methods:
A static multigenerational multicohort model was developed using a discrete-time Markov approach over a 100-year time horizon. The model incorporates vaccine effectiveness, coverage, and waning rates to estimate the decrease in IMD incidence under the vaccination strategy (2 + 1 schedule at ages 3, 5, and 12 months) evaluated vs. no vaccination. Annual incidence rates of IMD by age group and serogroup between 2007 and 2023, excluding the COVID-19 pandemic period, were retrieved and adjusted for underreporting. Annual IMD-related deaths were calculated from age-specific case fatality rates.
Results:
Assuming 69% cross-protection against serogroup W (MenW), the 4CMenB vaccination of infants would avert 63,038 (- 21%) IMD cases caused by MenB and MenW, and 11,301 (- 20%) deaths in all age groups. The model predicted a reduction of 21,408 (- 43%) MenB cases and 3335 (- 43%) deaths due to MenB in the < 1-year age group.
Conclusion:
This modeling study highlights the considerable public health impact of introducing the 4CMenB vaccine for infants as part of Brazil's routine vaccination schedule. By reducing IMD morbidity and mortality, routine 4CMenB immunization has the potential to substantially decrease the disease burden, improve long-term health outcomes, and reinforce the potential impact of preventive measures within the national immunization program. Graphical Abstract available for this article.
Insights
Introducing routine infant vaccination with the four-component meningococcal B vaccine (4CMenB) in Brazil could significantly reduce invasive meningococcal disease (IMD) cases and deaths across all age groups. This strategy is projected to avert over 63,000 IMD cases and 11,000 deaths.
Area of Science:
- Public Health
- Epidemiology
- Vaccinology
Background:
- Invasive meningococcal disease (IMD) caused by serogroup B (MenB) poses a significant threat, especially to infants in Brazil, where it is endemic.
- The four-component MenB vaccine (4CMenB) offers potential cross-protection against other serogroups and is approved for individuals aged 2 months to 50 years.
Purpose of the Study:
- To assess the public health impact of introducing routine infant vaccination with the 4CMenB vaccine in Brazil.
- To model the reduction in IMD incidence, morbidity, and mortality across all age groups.
Main Methods:
- A static, multigenerational, multicohort model using a discrete-time Markov approach over a 100-year horizon.
- Incorporation of vaccine effectiveness, coverage, waning rates, and adjusted incidence data (2007-2023, excluding COVID-19).
- Calculation of IMD-related deaths based on age-specific case fatality rates.
Main Results:
- Infant 4CMenB vaccination is projected to avert 63,038 IMD cases (21% reduction) and 11,301 deaths (20% reduction) in all age groups, assuming 69% cross-protection against MenW.
- A significant reduction of 21,408 MenB cases (43%) and 3335 deaths (43%) is predicted in infants (<1 year).
Conclusions:
- Routine infant 4CMenB immunization in Brazil can substantially decrease IMD burden, improving long-term health outcomes.
- This preventive measure reinforces the national immunization program's potential impact on reducing disease morbidity and mortality.
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