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Original Investigation
July 20, 2020

Incidence of Meningococcal Disease Before and After Implementation of Quadrivalent Meningococcal Conjugate Vaccine in the United States

Author Affiliations
  • 1Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
  • 2Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
  • 3Assessment Branch, Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
  • 4National Center for Immunization and Respiratory Diseases Office of the Director, Centers for Disease Control and Prevention, Atlanta, Georgia
JAMA Pediatr. Published online July 20, 2020. doi:10.1001/jamapediatrics.2020.1990
Key Points

Question  What is the association between the quadrivalent meningococcal conjugate vaccination program in adolescents and incidence of meningococcal disease in the United States?

Findings  The incidence of meningococcal disease was declining prior to introduction of the vaccine. However, in this cohort study of surveillance data, the rates of decline in incidence of meningococcal disease due to serogroups C, W, and Y accelerated nearly 2-fold to 3-fold in vaccinated age groups, with greater rates of decline in states with high quadrivalent meningococcal conjugate vaccine coverage.

Meaning  Although the quadrivalent meningococcal conjugate vaccine alone cannot explain the decline of the incidence of meningococcal disease in the United States, these data suggest an association between vaccination and declining disease rates in adolescents.

Abstract

Importance  In 2005, the US Advisory Committee on Immunization Practices recommended routine quadrivalent meningococcal conjugate (MenACWY) vaccine for all adolescents aged 11 to 12 years, and in 2010, a booster dose for adolescents aged 16 years. Measuring the association between MenACWY vaccination and the incidence of meningococcal disease in adolescents is critical for evaluating the adolescent vaccination program and informing future vaccine policy.

Objective  To describe the association between MenACWY vaccination and the incidence of meningococcal disease in US adolescents.

Design, Setting, and Participants  In this cohort study, analysis of surveillance data included all confirmed and probable cases of Neisseria meningitidis reported to the National Notifiable Diseases Surveillance System from January 1, 2000, to December 31, 2017. Statistical analysis was conducted from October 1, 2018, to August 31, 2019.

Exposures  Routine MenACWY vaccination among US adolescents.

Main Outcomes and Measures  Poisson segmented regression analysis was used to model the annual incidence of meningococcal disease among adolescents aged 11 to 15 years and 16 to 22 years before the introduction of the MenACWY vaccine (2000-2005), after the primary dose recommendation (2006-2010), and after the booster dose recommendation (2011-2017); 95% CIs were used to determine significant differences between time periods.

Results  The national incidence of meningococcal disease declined from 0.61 cases per 100 000 population during the prevaccine period (2000-2005) to 0.15 cases per 100 000 population during the post–booster dose period (2011-2017). The greatest percentage decline was observed for serogroup C, W, and Y combined (CWY) among adolescents aged 11 to 15 years and 16 to 22 years in the periods after vaccine introduction. Incidence of serogroup CWY meningococcal disease among adolescents aged 11 to 15 years decreased by 16.3% (95% CI, 12.1%-20.3%) annually during the prevaccine period and 27.8% (95% CI, 20.6%-34.4%) during the post–primary dose period (P = .02); among adolescents aged 16 to 22 years, the incidence decreased by 10.6% (95% CI, 6.8%-14.3%) annually in the post–primary dose period and 35.6% (95% CI, 29.3%-41.0%) annually in the post–booster dose period (P < .001). An estimated 222 cases of meningococcal disease due to serogroup CWY among adolescents were averted through vaccination during the evaluation period.

Conclusions and Relevance  After introduction of a primary and booster MenACWY dose, the rates of decline in incidence of meningococcal disease due to serogroup C, W, or Y accelerated nearly 2-fold to 3-fold in vaccinated adolescent age groups. Although the MenACWY vaccine alone cannot explain the decline of meningococcal disease in the United States, these data suggest that MenACWY vaccination is associated with reduced disease rates in adolescents.

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