Invasive serogroup B meningococci in England following three years of 4CMenB vaccination – First real-world data

Jay Lucidarme*, Xilian Bai, Aiswarya Lekshmi, Stephen A. Clark, Laura Willerton, Sonia Ribeiro, Helen Campbell, Laura Serino, Rosita De Paola, Ann Holland, Jennifer Louth, Mary E. Ramsay, Shamez N. Ladhani, Ray Borrow

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)
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Objectives: In 2015 the UK became the first country to implement the meningococcal B (MenB) vaccine, 4CMenB, into the national infant program. 4CMenB is expected to cover meningococci expressing sufficient levels of cross-reactive proteins. This study presents clonal complex, 4CMenB antigen genotyping, and 4CMenB coverage data for all English invasive MenB isolates from 2014/15 (1 year pre-vaccine) through 2017/18 and compares data from vaccinated and unvaccinated ≤3 year olds. 

Methods: Vaccine coverage of all invasive MenB isolates from 2014/15 to 2017/18 (n = 784) was analysed using the Meningococcal Antigen Typing System. Genotyping utilised the Meningococcus Genome Library. 

Results: Among ≤3 year olds, proportionally fewer cases in vaccinees (1, 2 or 3 doses) were associated with well-covered strains e.g. cc41/44 (20.5% versus 36.4%; P<0.01) and antigens e.g. PorA P1.4 (7.2% versus 17.3%; P = 0.02) or fHbp variant 1 peptides (44.6% vs 69.1%; P<0.01). Conversely, proportionally more cases in vaccinees were associated with poorly-covered strains e.g. cc213 (22.9% versus 9.6%; P<0.01) and antigens e.g. variant 2 or 3 fHbp peptides (54.2% versus 30.9%; P<0.01). 

Conclusions: 4CMenB reduces disease due to strains with cross-reactive antigen variants. No increase in absolute numbers of cases due to poorly covered strains was observed in the study period.

Original languageEnglish
Pages (from-to)136-144
Number of pages9
JournalJournal of Infection
Issue number2
Early online date25 Nov 2021
Publication statusPublished - Feb 2022

Bibliographical note

Funding Information: Material and funding for the MATS assay used in this study
were provided by GlaxoSmithKline Biologicals SA. GlaxoSmithKline Biologicals SA was provided the opportunity to review a preliminary version of the manuscript for factual accuracy, but the authors are solely responsible for final content and interpretation. The authors received no financial support or other forms of compensation related to the development of the manuscript.

JL, XB, AL, SAC, LW, AH, JLo and RB perform contract research on behalf of Public Health England for GlaxoSmithKline, Pfizer, and Sanofi Pasteur. SNL performs contract research for vaccine manufacturers (including GSK, Pfizer, and Sanofi Pasteur) on behalf of St George’s University of London and Public Health England but receives no personal remuneration. LS and RDP are employed by the GSK group of companies. LS holds shares in the GSK group of companies. SR, HC and MER have no interests to declare. The immunization and Countermeasures Division at PHE has provided GSK, Pfizer, and Sanofi Pasteur with postmarketing surveillance reports on meningococcal, Haemophilus influenzae, and pneumococcal infections, which the companies are required to submit to the UK Licensing Authority in compliance with their Risk Management Strategy. A cost recovery charge is made for these reports.

This publication made use of the Neisseria Multi Locus Sequence Typing website ( sited at the University of Oxford. The development of this site has been funded by the Wellcome Trust and the European Union.31 It also made use of the Meningitis Research Foundation Meningococcus Genome Library ( developed by Public Health England, the Wellcome Trust Sanger Institute and the University of Oxford as a collaboration. The project is part funded by Meningitis Research Foundation.

The authors would like to thank Paul Charter for his support with the IMD surveillance and all those who have contributed from PHE HPTs and General Practice.

Open Access: This is an open access article under the CC BY license (

Publisher Copyright: Crown Copyright © 2021 Published by Elsevier Ltd on behalf of The British Infection Association.

Citation: Lucidarme, Jay, et al. "Invasive serogroup B meningococci in England following three years of 4CMenB vaccination–First real-world data." Journal of Infection (2021).



  • 4CMenB
  • England
  • MATS
  • Meningococcal antigen typing system
  • Meningococcal disease
  • Serogroup B
  • Vaccine coverage


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