Meningococcal disease and vaccines update

Cyra Patel

Senior Research Officer, Policy

National Centre for Immunisation Research & Surveillance

Outline

• Recent trends in invasive meningococcal disease (IMD)

epidemiology

• Recent changes to NIP (meningococcal ACWY

vaccines)

• Meningococcal B vaccine update

• Special risk groups

2

Who most needs meningococcal

vaccines?

3

IMD epidemiology – analysis methods

• Cases of IMD reported to National Notifiable Diseases

Surveillance System (NNDSS)• 1 January 1999 to 31 December 2018

• Data extracted February 2019

• Detailed examination of years 2016 to 2018

• Calculation of IMD incidence and mortality by:

• Serogroup

• Age group

• Aboriginal and/or Torres Strait Islander status

4

Who most needs meningococcal vaccines?

• Greatest IMD burden observed in:• Children <5 years but especially <2 years (highest in 3–5

months)

• Adolescents 15–19 years

• Aboriginal & Torres Strait Islanders <15 years

• Based on deaths, MenW similar in severity to MenC;

MenB and MenY similar severity

5

Jurisdictional MenACWY vaccination

programs commenced from 2017 onwards

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State/

territory

Date of commencement Eligibility How program is being/has been

delivered

ACT 2018 school Term 1 (February

2018)

Year 10 students (approximately age 15

years); catch-up for 16–19 year olds

School program for Year 10 students; GPs

and other primary care providers for catch-

up

NSW 2017 school Term 2 (May

2017)

Year 10–11 students (approximately age

15–17 years)

School program; GPs for those not in

school

NT 1 Dec 2017 (plus outbreak

response)

12 month old children, given in lieu of

MenC vaccine (replaced by NIP in July

2018)

Routine vaccination at GP clinics and

other primary care providers

Qld 2017 school Term 2 for school

delivery

Year 10 students (approximately age 15

years); catch-up for age 15–19 years

School program for year 10 students; GPs

and other primary care providers for those

aged 15–19 years not in school

Tas 2017 school Term 3; program

concluded in April 2018 (plus

outbreak response)

Age 15–19 years (Years 10, 11, 12

students) in 2017;

Year 10 students in 2018

School program for year 10–12; GPs and

other primary care providers for those

aged 15–19 years not in school

Vic 2017 school Term 2 Year 10 students (approximately age 15

years)

School program; GP or local council

immunisation provider for those not in

school

WA 1) 2017 school Term 2 for

adolescents

2) Sep 2018 for children 1–

4 years

1) Year 10 students (approximately

age 15 years) in 2018 with catch-up

up to age 19 years

2) Children aged 1–4 years

1) School program for year 10 students,

GPs for others age 15–19 years not

in school

2) GPs and other primary care providers

+ additional vaccination programs

in response to outbreaks

Recent addition of MenACWY vaccine to

the NIP

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Age group Toddlers age 12 months Adolescents age 14–19 years

Vaccine schedule 1 dose Nimenrix 1 dose Nimenrix

Date implemented 1 July 2018 1 April 2019

Program delivery Primary care /

immunisation providers

School program for 14–16 year

olds; catch-up for older

adolescents through primary

care / immunisation providers

MenACWY vaccine: recommended vs.

funded populations

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Population group Recommended Funded Notes

Infants <12 months

old ✔ ✖ Multiple doses required;

varies by vaccine brand

Toddlers 12–23

months ✔ ✔ 12 month NIP schedule

point

Adolescents 15–19

years ✔ ✔ Can prevent

transmission to other

age groups

Aboriginal & Torres

Strait Islander

children 2–14 years

✔ ✖ (recommended for all

Indigenous persons <20

years)

Persons with

medical risk

conditions*

✔ ✖ 2 doses (min.) required +

booster doses

*Conditions associated with a higher risk of IMD include: complement deficiency, treatment with eculizumab, asplenia, HIV

and haematopoietic stem cell transplant

Real-world effectiveness of MenACWY

vaccines

• No vaccine effectiveness data for Nimenrix or Menveo• Immunogenicity studies

• Effectiveness estimates available for Menactra from USA

9Cohn et al Vaccine 2017:139(2)

Meningococcal B vaccine

Two MenB vaccines available

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Bexsero Trumenba

Date first registered August 2013 September 2017

Age indication 2 months and older 10 years and older

Schedule Infants <12

months

2+1 N/A

12 months – 9

years

2 doses (2 months apart) N/A

≥10 years 2 doses (2 months apart) 2 doses (6 months apart)

Medical risk

groups

2 to 4 doses, varies by

age

3 doses (0, 1, 6 months)

(≥10 years only)

Boosters ? ?

Vaccines are not interchangeable

Meningococcal B vaccine recommendations

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Population group Vaccines

available

Recommended

schedule

Notes

Infants <12 months

old

Bexsero 3 doses (2+1) Prophylactic

paracetamol required

Toddlers 12–23

months

Bexsero 2 doses (≥2

months apart)

Prophylactic

paracetamol required

Adolescents 15–19

years

Bexsero or

Trumenba

2 doses Interval between

doses varies by

vaccine

Aboriginal & Torres

Strait Islander

children 2–14 years

Bexsero or

Trumenba (≥10

years)

2 doses Interval between

doses varies by

vaccine

Persons with medical

risk conditions*

Bexsero or

Trumenba (≥10

years)

Varies by age Booster doses not

currently required

*Conditions associated with a higher risk of IMD include: complement deficiency, treatment with eculizumab, asplenia, HIV and

haematopoietic stem cell transplant

Meningococcal B vaccine use in Australia

• Currently not funded under NIP

• South Australia offering state-funded MenB vaccine

(Bexsero)

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Infant/childhood Adolescents

Ongoing

program

Age eligibility 6 weeks to 12 months 15–16 years (School Year 10)

Date

implemented

1 October 2018 1 February 2019

Program delivery Primary care School program

Catch-up

program

Age eligibility 12 months to 3 years 16–20 years

Conclusion date

(expected)

31 December 2019 31 December 2019

Program delivery Primary care School program for Year 11

students; primary care for

older adolescents

UK meningococcal B vaccine program

• Infant program introduced in September 2015• 3 dose schedule of Bexsero – age 2, 4 and 12 months

• Preliminary short-term estimates of vaccine

effectiveness are encouraging• 82.9% (95%CI 24.1–95.2) for 2 doses in <6 month olds

• 1 dose not effective (22%, 95%CI -105 to 67)

• 42% reduction in MenB IMD in vaccine-eligible population

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Lancet 2016:388(10061);2775-82

Reduction in MenB disease in the UK

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Source: Parikh et al Lancet 2016:388(10061);2775-82

Safety of Bexsero – findings from the UK

• Good safety profile – no new or unexpected findings• Persistent skin nodules

• No increase in rates of serious events (febrile seizures,

Kawasaki disease, SIDS)

• Increase in fever presentations• GP visits, ED presentations, hospitalisations

• Mild to moderate

• Paracetamol receipt unknown

• Increase in healthcare utilisation

• Fever in premature infants

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Meningococcal B vaccine and gonorrhoea

• Emerging evidence that MenB vaccine may provide

some cross-protection against gonorrhoea• New Zealand: 31% against incident gonorrhoea, 24%

against gonorrhoea hospitalisations

• Additional data from Norway, Cuba and Canada

16

Meningococcal B vaccine and gonorrhoea

• Emerging evidence that MenB vaccine may provide

some cross-protection against gonorrhoea• New Zealand: 31% against incident gonorrhoea, 24%

against gonorrhoea hospitalisations

• Additional data from Norway, Cuba and Canada

17

Medical risk conditions for meningococcal

disease

• Conditions known to increase the risk of IMD:• Complement deficiency

• Treatment with eculizumab

• Asplenia

• HIV

• Haematopoietic stem cell transplant

• Additional doses of vaccine required

• Vaccination known to be less effective in some groups• Vaccine studies demonstrating lower immunogenicity

• Cases of IMD in vaccinated patients undergoing

eculizumab treatment

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Others recommended to receive

meningococcal vaccines

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Population Recommended

schedule – MenACWY

Recommended

schedule – MenB

Travellers to areas where

meningococcal disease is

more common

Varies by age Not currently

recommended

Laboratory workers

exposed to Neisseria

meningitidis

1 dose MenACWY

vaccine + regular

boosters

2 doses of MenB

vaccine (boosters not

required)

Adolescents 15–24 years

living in closer quarters

1 dose MenACWY

vaccine

2 doses of MenB

vaccine

Adolescents 15–24 years

who smoke

1 dose MenACWY

vaccine

2 doses of MenB

vaccine

Summary

• NIP funding for MenACWY vaccine a significant

achievement for prevention of meningococcal disease

• Gaps in national program remain, notably:• MenB vaccination

• Vaccination for infants, Aboriginal & Torres Strait

Islanders aged < 20 years and medically at risk

• Important for providers to identify patients with risk

factors when they present to clinic and discuss/offer

vaccination

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Acknowledgements

• Clayton Chiu

• Nigel Crawford

• Kristine Macartney

• Jean Li-Kim-Moy

• Helen Quinn

• Peter McIntyre

• National Notifiable Diseases Surveillance System

• Communicable Diseases Network of Australia

• Australian Government Department of Health

• Australian Technical Advisory Group on Immunisation

and its Meningococcal Working Party

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