GSK, Avenue Fleming 20, 1300 Wavre, Belgium.
ICON plc, Klarabergsviadukten 90 Hus B, 111 64 Stockholm, Sweden.
Vaccine. 2020 Nov 3;38(47):7558-7568. doi: 10.1016/j.vaccine.2020.08.007. Epub 2020 Aug 15.
Invasive meningococcal disease (IMD), an uncommon but severe disease, affects mainly infants, young children and adolescents. Meningococcal B (4CMenB) and ACWY (MenACWY) vaccines targeting IMD-causing serogroups B and A, C, W and Y, respectively are available for these mostly-affected age-groups. The objective was to assess the impact of 4CMenB and/or MenACWY vaccination strategies on IMD in England, considering MenACWY carriage protection and potential cross-protection of 4CMenB against non-B serogroups. A novel dynamic transmission model was developed, accounting for vaccine characteristics, with separate variables for meningococcal carriage and IMD for three groups: B; ACWY; and 'Other' mostly non-pathogenic serogroups. A dynamic force of infection is assumed for each group. The model analysis uses data from England before 2015 (when 4CMenB and MenACWY were introduced), and accounts for existing MenC vaccination impact. Compared with no vaccination, the smallest decrease in IMD cases is observed for MenACWY strategies (toddler and/or adolescent). 4CMenB (infant or infant/adolescent), alone or with MenACWY, always results in the most rapid and steep decline in IMD cases. Combined strategies with adolescent 4CMenB result in the largest decrease in IMD cases, whereas adding MenACWY for toddlers has a minor impact. With potential 4CMenB cross-protection, 4CMenB infant strategy has a notable impact on reduction of MenW and MenY IMD cases in strategies where MenACWY toddler and/or adolescent vaccination is absent. This novel model allows for analysis of combined 4CMenB and MenACWY strategies including potential 4CMenB cross-protection. In settings comparable to England, a comprehensive meningococcal vaccination programme should include infant 4CMenB as essential building block. Decisions to include MenACWY toddler programmes should consider herd effects of MenACWY adolescent programmes and 4CMenB potential cross-protection effects. Extending 4CMenB infant and MenACWY adolescent programmes with a 4CMenB adolescent programme allows for the largest overall reduction in IMD cases.
侵袭性脑膜炎球菌病（IMD）是一种罕见但严重的疾病，主要影响婴儿、幼儿和青少年。针对导致 IMD 的 B、C、W 和 Y 血清群的脑膜炎球菌 B（4CMenB）和 ACWY（MenACWY）疫苗可用于这些主要受影响的年龄组。目的是评估 4CMenB 和/或 MenACWY 疫苗接种策略对英格兰 IMD 的影响，同时考虑到 MenACWY 对携带的保护作用以及 4CMenB 对非 B 血清群的潜在交叉保护作用。开发了一种新的动态传播模型，考虑到疫苗的特点，针对三个组（B、ACWY 和“其他”主要非致病性血清群）分别有脑膜炎球菌携带和 IMD 的单独变量。假设每个组都有一种动态的感染力。模型分析使用了 2015 年之前（引入 4CMenB 和 MenACWY 时）英格兰的数据，并考虑了现有的 MenC 疫苗接种效果。与未接种疫苗相比，MenACWY 策略（幼儿和/或青少年）观察到 IMD 病例减少幅度最小。4CMenB（婴儿或婴儿/青少年）单独使用或与 MenACWY 联合使用，始终导致 IMD 病例的快速而陡峭下降。青少年 4CMenB 联合策略导致 IMD 病例减少最多，而在幼儿中添加 MenACWY 则影响较小。由于潜在的 4CMenB 交叉保护作用，在没有 MenACWY 幼儿和/或青少年疫苗接种的情况下，4CMenB 婴儿策略对减少 MenW 和 MenY IMD 病例有显著影响。这种新模型允许分析包括潜在的 4CMenB 交叉保护作用的 4CMenB 和 MenACWY 联合策略。在与英格兰类似的环境中，全面的脑膜炎球菌疫苗接种计划应包括婴儿 4CMenB 作为基本组成部分。决定是否纳入 MenACWY 幼儿计划应考虑到 MenACWY 青少年计划的群体效应和 4CMenB 的潜在交叉保护作用。通过在 4CMenB 婴儿和 MenACWY 青少年计划中扩展 4CMenB 青少年计划，可以最大程度地减少 IMD 病例的总体数量。
