One disease, two vaccines: challenges in prevention of meningococcal disease

Invasive meningococcal disease (IMD) is a serious disease. IMD incidence in Australia has increased in recent years through the emergence of serogroups W and Y, although serogroup B still causes around half of all cases. However, demonstrating cost-effectiveness for nationally funded meningococcal ACWY and B vaccine programs remains challenging, as authors of a new perspective piece published in the Medical Journal of Australia discuss.

According to the authors, from NCIRS, cost-effectiveness and equity are important considerations when incorporating vaccines into immunisation programs. Because of the low incidence of IMD, with relatively small numbers of deaths and trends in serogroup incidence difficult to predict, accurate assessment of the cost-effectiveness of both MenACWY and MenB vaccines has been challenging. Other uncertainties such as duration of protection and the magnitude of any herd protection effect, particularly for MenB vaccines, along with the high cost of MenB vaccines, add to the complexity of adding these vaccines to the National Immunisation Program (NIP).

In 2018, MenACWY vaccine Nimenrix replaced MenC vaccine on the NIP at 12 months of age, and it was also added to the NIP for use in a single birth cohort of adolescents aged between 14 and 16 years from early 2019. Also, the prospect of funding both MenACWY and MenB vaccines for people with certain high-risk medical conditions, and MenB vaccine for Aboriginal and Torres Strait Islander infants, is currently being actively considered by the Australian government. 

These expanded programs should be effective over time in protecting those most at risk, but gaps remain and the disease continues to challenge. Authors urge clinicians to remain aware and discuss vaccination options against both MenB and MenACWY disease with their patients.

Read more here.