1. Ray Borrow ray.borrow@phe.gov.uk
Meningococcal disease/vaccination update
Ray Borrow
19th April 2018, Wrexham, Wales

2. More than £10,000 has been raised for the family who have been told their 10-month-old daughter will have all her limbs amputated
Petition signed by more than 800,000 people calling for the meningitis B vaccine to be given to all children under 11.

3. Evolving UK meningococcal immunisation programme
Sept 2006
June
2013
Sept 2015
July 2016
Nov 1999
UK first country to introduce MCC at 2, 3, 4 months of age with catch-up campaign
MCC programme changed to 3, 4 & 12 months of age
MCC programme changed to 3 & 12 months & 13/14 years of age
MCC changed to ACYW at 13/14 years of age & catch-up started for all 13 to 18 year olds
UK first country to introduce 4CMenB, 2, 4 & 12 months of age
3 month of age MCC removed

4. Outline Invasive meningococcal disease laboratory-confirmed cases
England and Wales 1995 to 2018 (Jan 17th)
Outline

5. UK MenB programme
Negotiations to procure at cost-effective price were concluded in late March 2015
MenB vaccine given with routine immunisation appointments from 1st September 2015
Routine cohort: infants born on or after the 1 July 2015
Schedule: 2, 4 and 12 months (2+1)
Catch-up cohort: infants born from 1 May to 30 June 2015
Schedule: 3, 4 and 12 months (2+1)
Schedule: 4 and 12 months (1+1)

6. Invasive Meningococcal Disease in <2 year-olds England & Wales (2006/07-2010/11)

7. Cases vaccinated / total Average matched coverage
Doses
Cases vaccinated / total
Average matched coverage
VE* (95 %CI)
2+0
9/13 (69%)
92.9%
82.9%
(24.1% to 95.2%)
Assuming 88% of MenB strains covered by 4CMenB, then VE against vaccine-preventable strains ~94%

8. Vaccine eligible cohort update
Data until 31st December 2017
198 laboratory-confirmed IMD cases in infants eligible for the MenB vaccine – 28 months of surveillance (born on or after 01/05/ 2015)
11 cases of MenB disease in children who received 3 doses of 4CMenB.
1 case of MenW disease in a child who had received 3 doses of 4CMenB (6 months post booster). PCR only. PorA P1.5,2 fHbp 1.318
143
MenB 12
MenC 46
MenW 8
MenY 6
Non-groupable or Ungroupable

9. MenB cases following 3 doses of 4CMenB
Data until 31st December 2017
Culture MATS Covered ~ Months post-booster
fHbp NHBA NadA PorA
Y -ve -ve -ve -ve No
Y -ve +ve -ve -ve Yes
Y +ve ve -ve -ve Yes 5
Y -ve -ve -ve -ve No 7
Y -ve -ve -ve -ve No (fatal)
PCR only PorA fHbp
Y P1.5, Unknown 3
Y P1.22, No* 7
Y P1.19-1, Unknown 8
Y no product no product Unknown (Ct39)
Y P1.19, Yes 13
Y P1.22, No*
* Not covered by PorA or fHbp. Coverage of NadA & NHBA unknown

10. Cases in <1 year-olds

12. Vaccine Safety So far, 3 million doses given to children so far
Concerns before vaccine introduction
? Kawasaki Disease – very rare in <6m, no evidence of increase
? Seizures – no evidence of increase in any kind of seizure
? Less likely to have subsequent vaccination – no evidence (97-98% return for their subsequent vaccines)
Primary Care consultations for fever
1.5-fold increase in infants attending GP for fever post-vaccination with 4CMenB
Secondary care consultations for fever
3-4 fold increase in infants attending the ED for fever post-vaccination with 4CMenB
Hospitalisations for fever
Around half the infants attending the ED have septic screens +/- antibiotics
? Did the parents give prophylactic paracetamol as recommended?

13. Lab number
Site
Type
Pre-vacc
Pool1
Post 3rd
Pool2
Pool3
Post 4th
Pool4 M
CSF
W:2aP1.5,2 cc11
<2 64
128
>128 M
Blood 32 M
>64 M M
W:NT:P1.5,2 cc11 M
W:NTP1.5,2 cc11
Suggests that children immunised with 4CMenB may have some protection against MenW cc11

14. Any Impact on W ? (up to 2016/17)

15. England & Wales lab confirmed cases of serogroup W
W cc11 split tree analysis

16. W:cc11
1970 to 2000
- Sporadic cases – ‘Early’ and ‘Hajj strain-related’ strains

17. W:cc11
2000
- Hajj outbreak - Hajj strain

18. 2001-2002 W:cc11 - Hajj outbreak continues - Hajj strain
1st African Epidemic – Hajj strain-related strain
Persistence of Hajj strain in South Africa and middle East

19. W:cc11 2003-2008 - Endemic disease South Africa (Hajj Strain)
Emergence and Spread of South American strain

20. W:cc11 2003-2008 - Endemic disease South Africa (Hajj Strain)
Emergence and Spread of South American strain

21. W:cc11 2008/9 2003-2008 - South American strain spreads to UK
- Endemic disease South Africa (Hajj Strain)
Emergence and Spread of South American strain

22. W:cc11
2008/9
- South American strain spreads to UK

23. W:cc11
2010 onwards
Further African Epidemics (Hajj strain-related strains)
South American/UK strain spreads to Europe, Australia, Canada

24. W:cc11
2010 onwards
Further African Epidemics (Hajj strain-related strains)
South American/UK strain spreads to Europe, Australia, Canada

25. MenACWY vaccination programme roll-out
Birth cohort
2014/15
year - age
Academic year
2015/16
2016/17
2017/18
2018/19
01/09/ /08/2004
Y6 – 10/11
Y9 ACWY
01/09/ /08/2003
Y7 - 11/12
01/09/ /08/2002
Y8 - 12/13
Y10 ACWY
01/09/ /08/2001
Y9 - 13/14
 Y10 ACWY
Y11 ACWY
01/09/ /08/2000
Y /15
Y10 MenC 
01/09/ /08/1999
Y /16
Y13 ACWY
01/09/ /08/1998
Y /17
01/09/ /08/1997
Y13 – 17/18
Routine schedule MenC
Routine schedule ACWY
School based catch-up ACWY
Primary care catch-up cohorts
Key 25

26. Cumulative totals of lab confirmed MenW disease, England

27. Age distribution of MenW cases by epidemiological year (July- Jan only)

28. Decision to Stop 3 month MenC dose
MenC disease is extremely rare in the UK
Most children currently rely on herd protection – rapid waning of immunity in infants and toddlers
Recent adolescent MenC  MenACWY programme likely to maintain high levels of herd protection
Only 0-2 cases annually in infants (<1 year-olds)
800,000 doses of MCC at 3 months of age
Gap for additional vaccines at 3m [? PCV13]
Removing the 3-month MenC dose may lead to 4 additional cases in infants and <1 additional case in toddlers annually
PHE REPORT TO JCVI

29. MenC cases < 1 year, England
2009/10 was <1M too young
2010/11 were 1.8M too young and 9.3M (unimmunised)
2011/12 were 1.2M too young, 3.5M unimmunised and 4.9M (2D MenC – 2nd dose just over 1M previously)
2012/13 – none
2013/14 was 2.1M too young
2014/15 was 1.1M too young
2015/16 was 1.8M too young
2016/17 were 2.5M, 3.3M, 3.97M, 8.4M – they were all born after MCC had been removed from the schedule
2017/18 a 6.5 month period
10 infant cases arisen from July 2016 to mid-Jan 2018.
9 previously would have been eligible for 3 month dose.
Of the 10 infants, 6 were appropriately vaccinated with 4CMenB.

30. Summary
MenB cases continue to decline from 349 in 2015/6 to 277 in 2016/17.
4CMenB continues to have a significant impact on MenB disease in infants and toddlers.
Surveillance on-going … > 3 million doses ...No safety concerns so far.
MenW cases across all age groups have declined for the first time in 2017/18.
In infants, there is some evidence of 4CMenB impact on MenW disease, but very few cases.

31. Acknowledgements PHE Manchester:
Stephen Clark, Stephen Gray, Xilian Bai, Aiswarya Lekshmi, Jay Lucidarme, Andrew Walker
PHE Colindale:
Sydel R. Parikh, Nick J. Andrews, Kazim Beebeejaun, Helen Campbell, Sonia Ribeiro, Mary E. Ramsay, Shamez N. Ladhani, Vanessa Saliba, Sema Mandal (