Impact of meningococcal ACWY conjugate vaccines on pharyngeal carriage in adolescents: evidence for herd protection from the UK MenACWY programme

Jeremy P Carr; Jenny M MacLennan; Emma Plested; Holly B Bratcher; Odile B Harrison; Parvinder K Aley; James E Bray; Susana Camara; Charlene M C Rodrigues; Kimberly Davis; Angela Bartolf; David Baxter; J Claire Cameron; Richard Cunningham; Saul N Faust; Katy Fidler; Rohit Gowda; Paul T Heath; Stephen Hughes; Sujata Khajuria; David Orr; Mala Raman; Andrew Smith; David P J Turner; Elizabeth Whittaker; Christopher J Williams; Christos S Zipitis; Andrew J Pollard; Jennifer Oliver; Begonia Morales-Aza; Aiswarya Lekshmi; Stephen A Clark; Ray Borrow; Hannah Christensen; Caroline Trotter; Adam Finn; Martin C Maiden; Matthew D Snape; UKMenCar4 and ‘Be on the TEAM’ Study Collaborators

doi:10.1016/j.cmi.2022.07.004

Impact of meningococcal ACWY conjugate vaccines on pharyngeal carriage in adolescents: evidence for herd protection from the UK MenACWY programme

Clin Microbiol Infect. 2022 Dec;28(12):1649.e1-1649.e8. doi: 10.1016/j.cmi.2022.07.004. Epub 2022 Jul 13.

Authors

Jeremy P Carr¹, Jenny M MacLennan², Emma Plested³, Holly B Bratcher², Odile B Harrison², Parvinder K Aley³, James E Bray², Susana Camara³, Charlene M C Rodrigues², Kimberly Davis³, Angela Bartolf⁴, David Baxter⁵, J Claire Cameron⁶, Richard Cunningham⁷, Saul N Faust⁸, Katy Fidler⁹, Rohit Gowda¹⁰, Paul T Heath⁴, Stephen Hughes¹¹, Sujata Khajuria¹², David Orr¹³, Mala Raman¹⁴, Andrew Smith¹⁵, David P J Turner¹⁶, Elizabeth Whittaker¹⁷, Christopher J Williams¹⁸, Christos S Zipitis¹⁹, Andrew J Pollard³, Jennifer Oliver²⁰, Begonia Morales-Aza²¹, Aiswarya Lekshmi²², Stephen A Clark²², Ray Borrow²², Hannah Christensen²³, Caroline Trotter²⁴, Adam Finn²⁰, Martin C Maiden²⁵, Matthew D Snape³; UKMenCar4 and ‘Be on the TEAM’ Study Collaborators

Collaborators

UKMenCar4 and ‘Be on the TEAM’ Study Collaborators:
Keith A Jolley²⁶, Karen Ford²⁶, Hannah Roberts²⁶, Karen Palmer²⁷, Debbie Suggitt²⁸, Nicola Pemberton²⁹, Samantha Ray³⁰, Mandy Wootton³⁰, Shamez N Ladhani³¹, Daniel Owens³², Katrina Cathie³², Simon Royal³³, Neil Oldfield³⁴, Roisin Ure³⁵, Jennifer Richards³⁶, Rebecca Ramsay³⁷, Samantha Thomson Hill³⁸, Kaltun Duale³⁸

Affiliations

¹ Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford, UK; Monash University and Monash Children's Hospital, Melbourne, Australia.
² Department of Biology, University of Oxford, Oxford, UK.
³ Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford, UK.
⁴ St George's Vaccine Institute, Institute of Infection & Immunity, St George's University of London, UK.
⁵ Stockport NHS Foundation Trust, UK.
⁶ Public Health Scotland, Glasgow/Edinburgh, Scotland, UK.
⁷ University Hospitals Plymouth NHS Trust, Plymouth, UK.
⁸ NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK.
⁹ Brighton and Sussex Medical School, Royal Alexandra Children's Hospital, University Hospital Sussex NHS Foundation Trust, Brighton, UK.
¹⁰ Maidstone and Tunbridge Wells NHS Trust, UK.
¹¹ Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, UK.
¹² Northamptonshire Healthcare NHS Foundation Trust, UK.
¹³ Lancashire Teaching Hospitals NHS Foundation Trust, UK.
¹⁴ University Hospitals Plymouth NHS Foundation Trust, UK.
¹⁵ Glasgow Dental Hospital & School, College of Medical, Veterinary & Life Sciences, University of Glasgow, UK.
¹⁶ School of Life Sciences, University of Nottingham & Nottingham University Hospitals NHS Trust, UK.
¹⁷ Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK; Section of Paediatric Infectious Diseases, Imperial College London, UK.
¹⁸ Communicable Disease Surveillance Centre, Public Health Wales, Cardiff, UK.
¹⁹ Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, UK.
²⁰ Bristol Vaccine Centre, University of Bristol, UK; School of Population Health Sciences, Bristol Medical School, University of Bristol, UK.
²¹ Bristol Vaccine Centre, University of Bristol, UK.
²² UK Health Security Agency Meningococcal Reference Unit, Manchester Royal Infirmary Manchester, UK.
²³ School of Population Health Sciences, Bristol Medical School, University of Bristol, UK.
²⁴ Department of Veterinary Medicine, University of Cambridge, UK.
²⁵ Department of Biology, University of Oxford, Oxford, UK. Electronic address: martin.maiden@zoo.ox.ac.uk.
²⁶ Oxford, UK.
²⁷ Preston, UK.
²⁸ Stockport, UK.
²⁹ Wigan, UK.
³⁰ Cardiff, UK.
³¹ UKHSA, UK.
³² Southampton, UK.
³³ The University of Nottingham Health Service, UK.
³⁴ School of Life Sciences, University of Nottingham, UK.
³⁵ Meningococcal Reference Lab, Glasgow, UK.
³⁶ Public Health Wales Microbiology, UK.
³⁷ Brighton, UK.
³⁸ Bristol, UK.

PMID: 35840033
DOI: 10.1016/j.cmi.2022.07.004

Abstract

Objective: Serogroup W and Y invasive meningococcal disease increased globally from 2000 onwards. Responding to a rapid increase in serogroup W clonal complex 11 (W:cc11) invasive meningococcal disease, the UK replaced an adolescent booster dose of meningococcal C conjugate vaccine with quadrivalent MenACWY conjugate vaccine in 2015. By 2018, the vaccine coverage in the eligible school cohorts aged 14 to 19 years was 84%. We assessed the impact of the MenACWY vaccination programme on meningococcal carriage.

Methods: An observational study of culture-defined oropharyngeal meningococcal carriage prevalence before and after the start of the MenACWY vaccination programme in UK school students, aged 15 to 19 years, using two cross-sectional studies: 2014 to 2015 "UKMenCar4" and 2018 "Be on the TEAM" (ISRCTN75858406).

Results: A total of 10 625 participants preimplementation and 13 438 postimplementation were included. Carriage of genogroups C, W, and Y (combined) decreased from 2.03 to 0.71% (OR 0.34 [95% CI 0.27-0.44], p < 0.001). Carriage of genogroup B meningococci did not change (1.26% vs 1.23% [95% CI 0.77-1.22], p = 0.80) and genogroup C remained rare (n = 7/10 625 vs 17/13 438, p = 0.135). The proportion of serogroup positive isolates (i.e. those expressing capsule) decreased for genogroup W by 53.8% (95% CI -5.0 - 79.8, p = 0.016) and for genogroup Y by 30.1% (95% CI 8.946·3, p = 0.0025).

Discussion: The UK MenACWY vaccination programme reduced carriage acquisition of genogroup and serogroup Y and W meningococci and sustained low levels of genogroup C carriage. These data support the use of quadrivalent MenACWY conjugate vaccine for indirect (herd) protection.

Keywords: ACWY; Adolescents; Conjugate vaccines; Herd immunity; Meningococcal Disease; Neisseria meningitidis; Pharyngeal carriage.

Publication types

Observational Study

MeSH terms

Adolescent
Cross-Sectional Studies
Humans
Meningococcal Infections* / epidemiology
Meningococcal Infections* / microbiology
Meningococcal Infections* / prevention & control
Meningococcal Vaccines*
Neisseria meningitidis* / genetics
United Kingdom / epidemiology
Vaccines, Conjugate

Substances

MenACWY
Vaccines, Conjugate
Meningococcal Vaccines