Abstract
ObjectiveSerogroup B meningococci (MnB) are now the largest cause of invasive meningococcal disease (IMD) in Canada. We assessed the clinical and economic impact of 3 adolescent MenB-FHbp immunization strategies.MethodsA population-based dynamic transmission model was developed to simulate the transmission of MnB among the entire Canadian population over a 30-year time horizon. Age group-based IMD incidence, bacterial carriage and transmission, disease outcomes, costs, and impact on quality of life were obtained from Canadian surveillance data and published literature. The vaccine was assumed to provide 85% protection against IMD and 26.6% against carriage acquisition. The model estimated the impact of routine vaccination with MenB-FHbp in 3 strategies: (1) age 14, along with existing school-based programs, with 75% uptake; (2) age 17 with 75% uptake, assuming school vaccination; and (3) age 17 with 30% uptake, assuming vaccination outside of school. Costs were calculated from the Canadian societal perspective.ResultsWith no vaccination, an estimated 3974 MnB cases would be expected over 30 years. Vaccination with strategies 1–3 were estimated to avert 688, 1033, and 575 cases, respectively. These outcomes were associated with incremental costs per quality-adjusted life-year of $976,000, $685,000, and $490,000.ConclusionsOur model indicated that if the vaccine reduces risk of carriage acquisition, vaccination of older adolescents, even at lower uptake, could have a significant public health impact. Due to low disease incidence, MnB vaccination is unlikely to meet widely accepted cost-effectiveness thresholds, but evaluations of new programs should consider the overall benefits of the vaccination.
Highlights
Invasive meningococcal disease (IMD) is a rare but serious condition caused by Neisseria meningitidis, with potentially devastating consequences
While disease incidence is highest in infants and children under 5 years of age, a significant number of cases occur in adolescents and young adults (National Advisory Committee on Immunization 2014)—the population segment in whom meningococcal carriage prevalence is highest (Christensen et al 2010)
A significant number of cases occur in adolescents and young adults, who are at higher risk of carrying N. meningitidis and transmitting the disease
Summary
Invasive meningococcal disease (IMD) is a rare but serious condition caused by Neisseria meningitidis, with potentially devastating consequences. IMD can be fatal within 24 h of onset (Public Health Agency of Canada 2015; World Health Organization 2018). Up to one third of survivors will have permanent severe sequelae such as hearing loss, neurological disabilities, or limb loss (Bettinger et al 2013; Sadarangani et al 2015; Public Health Agency of Canada 2015; Ontario Ministry of Health and Long-Term Care 2015). While disease incidence is highest in infants and children under 5 years of age, a significant number of cases occur in adolescents and young adults (National Advisory Committee on Immunization 2014)—the population segment in whom meningococcal carriage prevalence is highest (Christensen et al 2010)
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