helen campbell @ mrf's meningitis & septicaemia in children & adults 2017
TRANSCRIPT
Impact and challenges of the
MenACWY vaccination programme in
England
MRF conference November 2017 Helen Campbell Shamez Ladhani, Sonia Ribeiro, Sydel Parikh, Ray Borrow, Steve Gray, Jay Lucidarme, Nick Andrews, Mary Ramsay, Michael Edelstein, Joanne Yarwood, Angela Edwards, Louise Letley [email protected] Public Health England, Immunisation Team
1. Context of the programme
2. Programme challenges
3. Acceptance of the programme
4. Impact of the programme
MenACWY vaccination in England
Group W invasive meningococcal disease
by epidemiological year, England
3 Group W IMD
0
20
40
60
80
100
120
140
160
180
200
To
tal co
nfi
rmed
case n
um
bers
Epidemiological year
JCVI recommendations: February 2015
• Strategy in Chile of vaccinating children <5y, only
impacted on vaccinated age group (Abad et al Epidemiol.
Infect, 2014)
• Evidence that Bexsero (new infant programme) protects
against the circulating W strain*
• Strategy was to target carriers with conjugate ACWY
vaccine – 14-18 year olds plus new university freshers
*Ladhani et al. Emerging Infectious Diseases www.cdc.gov/eid • Vol. 22, No. 2, Feb 2016
MenACWY vaccination
programme roll-out
Birth cohort 2014/15
year - age
Academic year
2014/15 2015/16 2016/17 2017/18 2018/19
01/09/2003-31/08/2004 Y6 – 10/11 Y9 ACWY Y9 ACWY
01/09/2002-31/08/2003 Y7 - 11/12 Y9 ACWY
01/09/2001-31/08/2002 Y8 - 12/13 Y9 ACWY Y10 ACWY
01/09/2000-31/08/2001 Y9 - 13/14 Y10 ACWY Y11 ACWY
01/09/1999-31/08/2000 Y10 - 14/15 Y10 MenC Y11 ACWY
01/09/1998-31/08/1999 Y11 - 15/16 Y13 ACWY
01/09/1997-31/08/1998 Y12 - 16/17 Y13 ACWY
01/09/1996-31/08/1997 Y13 – 17/18 Y13 ACWY
Routine schedule MenC
Routine schedule ACWY
School based catch-up ACWY
Primary care catch-up cohorts
Key
5
1. Context of the programme
2. Programme Challenges
3. Acceptance of the programme
4. Impact of the programme
MenACWY vaccination in England
Programme challenges 1. Short interval from decision to implementation
2. Getting MenACWY vaccine into school leavers
a) The immunisers
b) The immunised
1. Context of the programme
2. Programme challenges
3. Acceptance of the programme
4. Impact of the programme
MenACWY vaccination in England
MenACWY vaccine coverage
General practice,
17-18Y
Coverage
(end Aug 17)
2015 school leaver 39.7%
2016 school leaver 35.5%
2017 school leaver 29.5%
At school, 13-15Y 77-84%
At school 16Y 71.8%
11 Campbell et al. EID 2016
1. Context of the programme
2. Programme Challenges
3. Acceptance of the programme
4. Impact of the programme
MenACWY vaccination in England
0
50
100
150
200
250
0%
5%
10%
15%
20%
25%
30%
35%
To
tal
ca
se
s o
f la
bo
rato
ry
co
nfi
rmed
IM
D
% o
f all I
MD
case
s
W cases
% W of all IMD
MenW IMD by epidemiological year,
England only
13 Vaccine Update
Confirmed MenW cases by age and epidemiological
year, England
14 MenB disease and vaccination programme in England 14 MenB disease and vaccination programme in England 14 invasive meningococcal disease
Observed cases and projected MenW cases based on
trend lines fitted to the pre-vaccination period and
extrapolated to 2015/16 for the school-leaver cohort
15 Meningococcal disease
Type IRR (95% CI)
W 0.31 (0.12-0.82)
Y 0.40 (0.05-3.35)
B 1.67 (0.93-2.99)
15 Campbell et al EID 2016
>20 MenW cases in vaccine eligible cohorts and none of these have been vaccinated under the MenACWY programme.
Summary
• Increase in MenW cases from 2009 in England.
• Introduction of a MenACWY vaccination programme
from Aug 2015 targeting teenagers.
• Roll out of the programme has caused some
confusion and older teenagers can be difficult to
motivate but they clearly recognise the importance of
vaccination.
• MenW cases continued to increase overall in 2016/17
with falls in in those aged 15-24 years and <1year.
• Early data suggested a 69% reduction in the first year
in the first targeted vaccination group
• There have been falls in university associated cases
• MenW levels are lower at the beginning of 2017/18
than the previous 3 years – across all age groups