Abstract
Meningococcal serogroup C (MenC) vaccination of men who have sex with men (MSM) was temporarily recommended to control an outbreak of invasive MenC disease among MSM in Berlin in 2012-2013. Vaccination was offered to HIV-infected MSM free of charge; others had to request reimbursement or pay out of pocket. We aimed to assess (i) awareness and acceptance of this recommendation through an online survey of MSM, (ii) implementation through a survey of primary care physicians and analysis of vaccine prescriptions, and (iii) impact through analysis of notified cases. Among online survey respondents, 60% were aware of the recommendation. Of these, 39% had obtained vaccination (70% of HIV-infected, 13% of HIV-negative/non-tested MSM). Awareness of recommendation and vaccination were positively associated with HIV infection, primary care physicians' awareness of respondents' sexual orientation, and exposure to multiple information sources. Most (26/30) physicians informed clients about the recommendation. Physicians considered concerns regarding reimbursement, vaccine safety and lack of perceived disease risk as primary barriers. After the recommendation, no further outbreak-related cases occurred. To reach and motivate target groups, communication of a new outbreak-related vaccination recommendation should address potential concerns through as many information channels as possible and direct reimbursement of costs should be enabled.
Highlights
Neisseria meningitidis (Nm) is a gram-negative diplococcus that commonly colonises the human pharynx and respiratory tract [1]
Acceptance and impact of a temporary meningococcal C (MenC) vaccination recommendation issued in response to a MenC outbreak among men who have sex with men (MSM) in Berlin in 2013
Our results show that repeated information via different sources led to higher vaccination uptake, similar to the findings of Friedman et al during a community-wide hepatitis A vaccination campaign [33]
Summary
Neisseria meningitidis (Nm) is a gram-negative diplococcus that commonly colonises the human pharynx and respiratory tract [1]. Nm can sometimes cause invasive meningococcal disease (IMD), presenting as meningitis and/or sepsis. 13 serogroups have been identified; of these A, B, C, W, X and Y cause virtually all IMD [2]. Similar to other European and North American countries [3], serogroup B, followed by C, predominate in Germany, with IMD incidence showing a decreasing trend, from 0.95 cases/100,000 inhabitants in 2001 to 0.45/100,000 in 2011 [4]. Overall case fatality from 2009 to 2011 was 7.8%, significantly higher for meningococcal C (MenC) (10.9%) than for meningococcal B (MenB) disease (7.6%). Incidence was highest in infants (8.1 cases/100,000 inhabitants) and toddlers (4.8), with a second, smaller peak in 15-19 year-old adolescents (2.0) [4]
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