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First statewide meningococcal B vaccine program in infants, children and adolescents: evidence for implementation in South Australia

Helen S Marshall, Noel Lally, Louise Flood and Paddy Phillips
Med J Aust 2020; 212 (2): . || doi: 10.5694/mja2.50481
Published online: 3 February 2020

Summary

  • Invasive meningococcal disease (IMD) is an uncommon but life‐threatening infection caused by Neisseria meningitidis. Serogroups B, C, W and Y cause most IMD cases in Australia. The highest incidence occurs in children under 5 years of age. A second peak occurs in adolescents and young adults, which is also the age of highest carriage prevalence of N. meningitidis.
  • Meningococcal serogroup B (MenB) disease predominated nationally before 2016 and has remained the predominant cause of IMD in South Australia with 82% of cases, compared with 35% in New South Wales, 35% in Queensland, 9% in Victoria, 29% in Western Australia and 36% nationally in 2016.
  • MenB vaccination is recommended by the Australian Technical Advisory Group on Immunisation for infants up to 2 years of age and adolescents aged 15–19 years (age 15–24 years for at‐risk groups, such as people living in close quarters or smokers), laboratory workers with exposure to N. meningitidis, and Aboriginal and Torres Strait Islander children from age 2 months to 19 years.
  • Due to the epidemiology and disease burden from MenB, a meningococcal B vaccine program has been implemented in South Australia for individuals with age‐specific incidence rates higher than the mean rate of 2.8/100 000 population in South Australia in the period 2000–2017, including infants, young children (< 4 years) and adolescents (15–20 years).
  • Program evaluation of vaccine effectiveness against IMD is important. As observational evidence also suggests 4CMenB may have an impact on Neisseria gonorrhoeae with genetic homology between bacterial species, the vaccine impact on gonorrhoea will also be assessed.

  • 1 Women's and Children's Health Network, Adelaide, SA
  • 2 Robinson Research Institute, University of Adelaide, Adelaide, SA
  • 3 Communicable Disease Control Branch, Department for Health and Wellbeing, , Adelaide, SA



Acknowledgements: 

Helen Marshall is supported by the National Health and Medical Research Council: Career Development Fellowship (1084951). We thank Rodney Pearce and Celia Cooper, members of the South Australian Meningococcal B Expert Working Group, for reviewing the manuscript.

Competing interests:

The University of Adelaide, Helen Marshall's employer, has received funding from GlaxoSmithKline and Pfizer to undergo investigator‐led research. Helen Marshall is a member of ATAGI, but the views expressed in this article are her own views. She does not receive any personal payments from the pharmaceutical industry.

  • 1. Rouphael NG, Stephens DS. Neisseria meningitidis: biology, microbiology, and epidemiology. Methods Mol Biol 2012; 799: 1–20.
  • 2. Stephens DS, Greenwood B, Brandtzaeg P. Epidemic meningitis, meningococcaemia, and Neisseria meningitidis. Lancet 2007; 369: 2196–2210.
  • 3. Australian Government Department of Health. Invasive Meningococcal Disease National Surveillance report — 1 October to 31 December 2018. Canberra: Commonwealth of Australia, 2018. https://www1.health.gov.au/internet/main/publishing.nsf/Content/5FEABC4B495BDEC1CA25807D001327FA/$File/1Oct-31Dec19-qrt3-IMD.pdf (viewed Dec 2019).
  • 4. Lahra MM, Enriquez R. Australian Meningococcal Surveillance Programme annual report, 2016. Commun Dis Intell Q Rep 2017; 41: E369–E382.
  • 5. Wang B, Santoreneos R, Afzali H, et al. Case fatality rates of invasive meningococcal disease by serogroup and age: a systematic review and meta‐analysis. Vaccine 2019; 9(37): 2768–2782.
  • 6. Wang B, Clarke M, Thomas N, et al. The clinical burden and predictors of sequelae following invasive meningococcal disease in Australian children. Pediatr Infect Dis J 2014; 33: 316–318.
  • 7. Christensen H, May M, Bowen L, et al. Meningococcal carriage by age: a systematic review and meta‐analysis. Lancet Infect Dis 2010; 10: 853–861.
  • 8. McMillan M, Walters L, Turra M, et al. B Part of It study: a longitudinal study to assess carriage of Neisseria meningitidis in first year university students in South Australia. Hum Vaccin Immunother 2019; 15: 987–994.
  • 9. Australian government Department of Health. National Notifiable Disease Surveillance reports. Canberra: Commonwealth of Australia, 2019. http://www9.health.gov.au/cda/source/rpt_3.cfm (viewed Dec 2019).
  • 10. Australian Government, Department of Health. Invasive Meningococcal Disease National Surveillance report – 1 January to 31 March 2018. Canberra: 2018. http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-meningococcal-W.htm (viewed Dec 2019).
  • 11. Archer BN, Chiu CK, Jayasinghe SH, et al. Epidemiology of invasive meningococcal B disease in Australia, 1999–2015: priority populations for vaccination. Med J Aust 2017; 207: 382–387. https://www.mja.com.au/journal/2017/207/9/epidemiology-invasive-meningococcal-b-disease-australia-1999-2015-priority
  • 12. Booy R, Gentile A, Nissen M, et al. Recent changes in the epidemiology of Neisseria meningitidis serogroup W across the world, current vaccination policy choices and possible future strategies. Hum Vaccin Immunother 2019; 15: 470–480.
  • 13. Parikh SR, Campbell H, Gray SJ, et al. Epidemiology, clinical presentation, risk factors, intensive care admission and outcomes of invasive meningococcal disease in England, 2010–2015. Vaccine 2018; 36: 3876–3881.
  • 14. MacNeil JR, Blain AE, Wang X, et al. Current epidemiology and trends in meningococcal disease — United States, 1996–2015. Clin Infect Dis 2018; 66: 1276–1281.
  • 15. McNamara LA, Shumate AM, Johnsen P, et al. First use of a serogroup B meningococcal vaccine in the US in response to a university outbreak. Pediatrics 2015; 135: 798–804.
  • 16. Soeters HM, McNamara LA, Whaley M, et al. Serogroup B meningococcal disease outbreak and carriage evaluation at a college — Rhode Island, 2015. MMWR Morb Mortal Wkly Rep 2015; 64: 606–607.
  • 17. Soeters HM, Whaley M, Alexander‐Scott N, et al. Meningococcal carriage evaluation in response to a serogroup B meningococcal disease outbreak and mass vaccination campaign at a college — Rhode Island, 2015–2016. Clin Infect Dis 2017; 64: 1115–1122.
  • 18. Marshall H, Wang B, Wesselingh S, et al. Control of invasive meningococcal disease: is it achievable? Int J Evid Based Healthc 2016; 14: 3–14.
  • 19. Australian Technical Advisory Group on Immunisation (ATAGI). The Australian immunisation handbook. Canberra: Australian Government, Department of Health, 2018. https://immunisationhandbook.health.gov.au (viewed Jan 2019).
  • 20. Parikh SR, Andrews NJ, Beebeejaun K, et al. Effectiveness and impact of a reduced infant schedule of 4CMenB vaccine against group B meningococcal disease in England: a national observational cohort study. Lancet 2016; 388: 2775–2782.
  • 21. Prymula R, Esposito S, Zuccotti GV, et al. A phase 2 randomized controlled trial of a multicomponent meningococcal serogroup B vaccine (I): effects of prophylactic paracetamol on immunogenicity and reactogenicity of routine infant vaccines and 4CMenB. Hum Vaccin Immunother 2014; 10: 1993–2004.
  • 22. Bai X, Findlow J, Borrow R. Recombinant protein meningococcal serogroup B vaccine combined with outer membrane vesicles. Expert Opin Biol Ther 2011; 11: 969–985.
  • 23. Marshall HS, Vesikari T, Richmond PC, et al. The meningococcal serogroup B vaccine MenB‐FHbp (bivalent RLP2086) is safe and immunogenic in healthy toddlers aged ≥ 12 to < 24 months [abstract]. European Society Paediatric Infectious Diseases Meeting; Malmo (Sweden), May, 2018. https://espidmeeting.org/wp-content/uploads/sites/21/2018/08/ESPID-2018-Abstracts.pdf (viewed Jan 2019).
  • 24. Pharmaceutical Benefits Advisory Committee. Multicomponent meningococcal group B vaccine (4CmenB); 0.5 mL suspension for injection pre‐filled syringe; Bexsero® — July 2015 (Section 7. PBAC Outcome). Canberra: Pharmaceutical Benefits Scheme, 2015. http://www.pbs.gov.au/info/industry/listing/elements/pbac-meetings/psd/2015-07/mulit-component-meningococcal-group-b-vaccine-psd-july-2015 (viewed June 2018).
  • 25. South Australian Meningococcal B Expert Working Group. A Meningococcal B Program for South Australia. Adelaide: SA Health, 2018. https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/about+us/reviews+and+consultation/meningococcal+b+program+for+south+australia (viewed Sept 2018).
  • 26. Australian Government Department of Health. Invasive Meningococcal Disease National Surveillance report, with a focus on MenW — 9 January 2017. Canberra: Commonwealth of Australia, 2017. http://www.health.gov.au/internet/main/publishing.nsf/Content/5FEABC4B495BDEC1CA25807D001327FA/$File/1Jan-31-Dec2017-Consol-Invasive-Men-W.pdf (viewed Dec 2019).
  • 27. Plikaytis BD, Stella M, Boccadifuoco G, et al. Interlaboratory standardization of the sandwich enzyme‐linked immunosorbent assay designed for MATS, a rapid, reproducible method for estimating the strain coverage of investigational vaccines. Clin Vaccine Immunol 2012; 19: 1609–1617.
  • 28. Tozer S, Whiley D, Smith H, et al. Use of the meningococcal antigen typing system to assess the Australian meningococcal strain coverage with a multicomponent serogroup B vaccine. 20th International Pathogenic Neisseria Conference (IPNC); Manchester (UK); 4–9 September, 2016; p 257. http://ipnc2016.org/IPNC2016AbstractBook.pdf (viewed Nov 2019).
  • 29. Koutangni T, Boubacar Mainassara H, Mueller JE. Incidence, carriage and case‐carrier ratios for meningococcal meningitis in the African meningitis belt: a systematic review and meta‐analysis. PLoS One 2015; 10: e0116725.
  • 30. Australian Bureau of Statistics. Net interstate migration [Cat. No. 3412.0]. Canberra: ABS, 2018. https://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/3412.0Main%20Features52017-18?opendocument&tabname=Summary&prodno=3412.0&issue=2017-18&num=&view= (viewed Jan 2019).
  • 31. Australian Bureau of Statistics. Net overseas migration. Canberra: ABS, 2018. https://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/3412.0Main%20Features42017-18?opendocument&tabname=Summary&prodno=3412.0&issue=2017-18&num=&view= (viewed Dec 2019).
  • 32. Bryan P, Seabroke S, Wong J, et al. Safety of multicomponent meningococcal group B vaccine (4CMenB) in routine infant immunisation in the UK: a prospective surveillance study. Lancet Child Adolesc Health 2018; 2: 395–403.
  • 33. Marshall H, Koehler A, Pratt N, et al. Enhanced passive surveillance of adverse events following implementation of a meningococcal B vaccine program in senior school students. 16th National Immunisation Conference; Adelaide (Australia); 4–6 June, 2018; p 63.
  • 34. Nainani V, Galal U, Buttery J, et al. An increase in accident and emergency presentations for adverse events following immunisation after introduction of the group B meningococcal vaccine: an observational study. Arch Dis Child 2017; 102: 958–962.
  • 35. Fiorito TM, Baird GL, Alexander‐Scott N, et al. Adverse events following vaccination with bivalent rLP2086 (Trumenba): an observational, longitudinal study during a college outbreak and a systematic review. J Pediatr Infect Dis 2018; 37: e13–e19.
  • 36. Marshall HS, McMillan M, Koehler A, et al. B Part of It protocol: a cluster randomised controlled trial to assess the impact of 4CMenB vaccine on pharyngeal carriage of Neisseria meningitidis in adolescents. BMJ Open 2018; 8: e020988.
  • 37. Marshall HS, McMillan M, Koehler AP, et al. Meningococcal B vaccine and meningococcal carriage in adolescents, Australia. N Engl J Med 2019. In press.
  • 38. Petousis‐Harris H, Paynter J, Morgan J, et al. Effectiveness of a group B outer membrane vesicle meningococcal vaccine against gonorrhoea in New Zealand: a retrospective case‐control study. Lancet 2017; 390: 1603–1610.
  • 39. Longtin J, Dion R, Simard M, et al. Possible impact of wide‐scale vaccination against serogroup B Neisseria meningitidis on gonorrhea incidence rates in one region of Quebec, Canada. Open Forum Infect Dis 2017; 4 (Suppl): S734–S735.
  • 40. Graham S, Guy RJ, Donovan B, et al. Epidemiology of chlamydia and gonorrhoea among Indigenous and non‐Indigenous Australians, 2000–2009. Med J Aust 2012; 197: 642–646. https://www.mja.com.au/journal/2012/197/11/epidemiology-chlamydia-and-gonorrhoea-among-indigenous-and-non-indigenous

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