Article
作者: Finn, Adam ; Turner, David P J ; Baxter, David ; Raman, Mala ; Whittaker, Elizabeth ; MacLennan, Jenny M ; Carr, Jeremy P ; Morales-Aza, Begonia ; Faust, Saul N ; Trotter, Caroline ; Christensen, Hannah ; Snape, Matthew D ; Clark, Stephen A ; Gowda, Rohit ; Borrow, Ray ; Maiden, Martin C ; Orr, David ; Fidler, Katy ; Zipitis, Christos S ; Lekshmi, Aiswarya ; Khajuria, Sujata ; Bray, James E ; Pollard, Andrew J ; Bratcher, Holly B ; Davis, Kimberly ; Harrison, Odile B ; Plested, Emma ; Bartolf, Angela ; Cameron, J Claire ; Rodrigues, Charlene M C ; Camara, Susana ; Aley, Parvinder K ; Oliver, Jennifer ; Cunningham, Richard ; Heath, Paul T ; Williams, Christopher J ; Smith, Andrew ; Hughes, Stephen
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.