Disease Dynamics Unit, University of Cambridge, United Kingdom.
Disease Dynamics Unit, University of Cambridge, United Kingdom.
Vaccine. 2024 Oct 3;42(23):126240. doi: 10.1016/j.vaccine.2024.126240. Epub 2024 Aug 22.
Meningococcal disease control in the UK relies on various vaccines, with the discontinuation of the Hib/MenC combination vaccine Menitorix® in 2018 necessitating reassessment of the immunisation strategy. The quadrivalent MenACWY vaccine emerges as a promising long-term solution, already integrated into the teenage immunisation regimen. While indirect control of group W and C cases is anticipated through existing programs, the high incidence of meningococcal disease in infancy underscores the potential benefits of infant/toddler vaccination.
Utilizing data from two UK studies, we recalibrated age-specific carriage prevalence curves and estimated the proportion of meningococcal carriage attributed to ACWY and non-ACWY strains. Employing a dynamic transmission model, we evaluated the combined indirect effects of the teenage MenACWY vaccination initiative and the direct impact of administering MenACWY vaccine at either 3 or 12 months, alongside ongoing 4CMenB vaccination efforts. Given the pandemic-induced decline in cases and alterations in social contact patterns reported in prior research, we also simulated the transmission model to reflect periods of COVID-19 lockdown.
Our projections indicate effective control of carriage and disease associated with groups A, C, W, and Y through the teenage vaccination campaign. Assuming sustained high uptake of teenage vaccines amid pandemic scenario, we forecast MenACWY carriage prevalence to be below 1% by 2025. Across all scenarios, the impact of an infant/toddler MenACWY program on case reduction remains modest. Notably, administering the MenACWY dose at 3 months yields a greater number of prevented cases compared to administration at 12 months. With sustained uptake of teenage vaccination, our estimates suggest that between 3 and 22 cases could be averted in a 2025 birth cohort through a 3-month MenACWY dose.
Provided teenage uptake remains high and the infant 4CMenB programme is maintained, we suggest that few cases will be prevented from an infant/ toddler MenACWY dose.
英国的脑膜炎球菌病控制依赖于各种疫苗，2018 年 Hib/MenC 联合疫苗 Menitorix®的停用需要重新评估免疫策略。四价脑膜炎球菌疫苗 MenACWY 作为一种有前途的长期解决方案已经被纳入青少年免疫计划。虽然通过现有计划可以预期对 W 组和 C 组病例的间接控制，但婴儿期脑膜炎球菌病的高发病率突出表明婴儿/幼儿疫苗接种的潜在益处。
我们利用来自两项英国研究的数据，重新校准了特定年龄的带菌率曲线，并估计了 ACWY 和非 ACWY 菌株引起的带菌率比例。我们使用动态传播模型，评估了青少年 MenACWY 疫苗接种计划的联合间接效应以及在 3 或 12 个月时接种 MenACWY 疫苗的直接影响，同时还考虑了正在进行的 4CMenB 疫苗接种工作。鉴于大流行导致的病例减少和先前研究报告的社会接触模式改变，我们还模拟了传播模型以反映 COVID-19 封锁期间的情况。
我们的预测表明，青少年疫苗接种运动可以有效控制与 A、C、W 和 Y 组相关的带菌和疾病。假设在大流行情况下青少年疫苗持续高接种率，我们预计到 2025 年 MenACWY 带菌率将低于 1%。在所有情况下，婴儿/幼儿 MenACWY 疫苗接种计划对病例减少的影响仍然较小。值得注意的是，在 3 个月时接种 MenACWY 剂量比在 12 个月时接种可以预防更多的病例。在青少年疫苗接种持续高接种率的情况下，我们的估计表明，通过在 2025 年出生的队列中接种 3 个月的 MenACWY 剂量，可以预防 3 至 22 例病例。
只要青少年接种率保持高位且婴儿 4CMenB 计划得以维持，我们建议从婴儿/幼儿 MenACWY 剂量中预防的病例将很少。
