Abstract
BackgroundIn 1999, the United Kingdom (UK) was the first country to introduce meningococcal group C (MenC) conjugate vaccination. This vaccination programme has evolved with further understanding, new vaccines and changing disease epidemiology.AimTo characterise MenC disease and population protection against MenC disease in England.MethodsBetween 1998/99–2015/16, surveillance data from England for laboratory-confirmed MenC cases were collated; using the screening method, we updated vaccine effectiveness (VE) estimates. Typing data and genomes were obtained from the Meningitis Research Foundation Meningococcus Genome Library and PubMLST Neisseria database. Phylogenetic network analysis of MenC cc11 isolates was undertaken. We compared bactericidal antibody assay results using anonymised sera from 2014 to similar data from 1996–1999, 2000–2004 and 2009.ResultsMenC cases fell from 883 in 1998/99 (1.81/100,000 population) to 42 cases (0.08/100,000 population) in 2015/16. Lower VE over time since vaccination was observed after infant immunisation (p = 0.009) and a single dose at 1–4 years (p = 0.03). After vaccination at 5–18 years, high VE was sustained for ≥ 8 years; 95.0% (95% CI: 76.0– 99.5%). Only 25% (75/299) children aged 1–14 years were seroprotected against MenC disease in 2014. Recent case isolates mostly represented two cc11 strains.ConclusionHigh quality surveillance has furthered understanding of MenC vaccines and improved schedules, maximising population benefit. The UK programme provides high direct and indirect protection despite low levels of seroprotection in some age groups. High-resolution characterisation supports ongoing surveillance of distinct MenC cc11 lineages.
Highlights
Neisseria meningitidis is a major cause of meningitis and septicaemia worldwide
The Meningococcal Reference Unit (MRU) provides free national Polymerase Chain Reaction (PCR)-testing of clinical samples from patients with suspected invasive meningococcal disease (IMD); Diagnostic laboratories are required by law to notify Public Health England (PHE) when they identify Neisseria meningitidis and samples are requested to be sent to the MRU for confirmation and characterisation
We found evidence for rapid waning of immunity following routine infant immunisation, even with a 12-month booster, which was introduced in 2006
Summary
Neisseria meningitidis is a major cause of meningitis and septicaemia worldwide. Efforts to control meningococcal disease have been aimed at the development of effective vaccines and subsequent implementation in appropriate immunisation schedules. In 1999, the UK became the first country to introduce the MenC conjugate (MCC) vaccine in a phased national campaign targeting all those aged less than 18 years over a 12-month period, alongside a routine three-dose infant programme [2]. In 1999, the United Kingdom (UK) was the first country to introduce meningococcal group C (MenC) conjugate vaccination. This vaccination programme has evolved with further understanding, new vaccines and changing disease epidemiology. Methods: Between 1998/99–2015/16, surveillance data from England for laboratory-confirmed MenC cases were collated; using the screening method, we updated vaccine effectiveness (VE) estimates. Conclusion: High quality surveillance has furthered understanding of MenC vaccines and improved schedules, maximising population benefit. High-resolution characterisation supports ongoing surveillance of distinct MenC cc lineages
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