Abstract
Background
In the United States, most invasive meningococcal disease (IMD) is caused by serogroup B, followed by C, W, and Y. ACIP recommends universal vaccination against MenACWY (Category A) and MenB based on individual clinical decision-making (Category B) (Figure 1). In 2017, MenACWY vaccine uptake among adolescents was 44.3% for ≥2 doses and MenB uptake was 14.5% for ≥1 dose of a multi-dose series. A pentavalent vaccine (MenABCWY or Penta) has the potential to simplify immunization schedules and improve uptake to achieve further reductions in IMD. Our objective was to estimate the potential public health impact of Penta.
Methods
Using CDC’s enhanced meningococcal disease surveillance data (2015–2017 average), a dynamic transmission model was constructed to estimate the reduction in IMD over 10 years resulting from various implementation strategies including Penta within the existing United States meningococcal vaccination platform. The model assumed that 2-doses of Penta could provide 95% and 85% direct and 25.5% and 0% indirect protection, respectively, against serogroups ACWY and B for 5 years, with 10% relative waning per year. For partial compliance (1 dose Penta only), we assumed protection against ACWY equal to 2-doses but partial protection against B. Future uptake of Penta was assumed higher than 2017 uptake, and sensitivity analyses with lower uptake were conducted.
Results
Based on 2015–2017 epidemiology, the current schedule and uptake of MenACWY and MenB vaccines (total 4 doses) was estimated to avert 149 IMD cases over 10 years. Replacing MenACWY and/or MenB doses with Penta at 11 and/or 16 years could avert more cases, ranging from 172 to 243 (Figure 2). The most beneficial schedule was 2-doses of Penta at 11 years and 1-dose Penta at 16 years. Additional sensitivity analyses indicated that, even assuming current uptake rates, more cases could be prevented by utilizing Penta.
Conclusion
Replacing one or more MenACWY/MenB vaccine doses with Penta could improve prevention of IMD caused by all 5 meningococcal serogroups among the US adolescent population and provide substantial public health benefit while reducing the recommended number of vaccine administrations.
Disclosures
All authors: No reported disclosures.
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