Vaccination of infants with meningococcal group B vaccine (4CMenB) in England

Shamez Ladhani*, Nicholas Andrews, Sydel Parikh, Helen Campbell, Joanne White, Michael Edelstein, Xilian Bai, Jay Lucidarme, Raymond Borrow, Mary Ramsay

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

99 Citations (Scopus)


In September 2015, the United Kingdom introduced the multicomponent meningococcal group B vaccine (4CMenB, Bexsero) into its publicly funded national immunization program at a reduced two-dose priming schedule for infants, with a 12-month booster. METHODS Using data from enhanced national surveillance of invasive meningococcal disease in England, we evaluated the effect of vaccination on the incidence of meningococcal group B disease during the first 3 years of the program. The effect of vaccination was assessed by comparing the observed incidence of disease with the expected incidence based on the incidence during the 4-year prevaccination period in equivalent cohorts and with the use of disease trends in cohorts of children younger than 5 years of age who were not eligible to receive the vaccine. Vaccine effectiveness was estimated with the use of the indirect screening method. RESULTS 4CMenB uptake in England remained consistently high; data from the first 3 months of 2018 showed that 92.5% of children had completed the primary immunizations by their first birthday and 87.9% had received all three doses by 2 years. From September 2015 through August 2018, the incidence of meningococcal group B disease in England (average annual birth cohort, approximately 650,000 infants) was significantly lower in vaccine-eligible cohorts than the expected incidence (63 observed cases as compared with 253 expected cases; incidence rate ratio, 0.25; 95% confidence interval [CI], 0.19 to 0.36), with a 75% reduction in age groups that were fully eligible for vaccination. The adjusted vaccine effectiveness against meningococcal group B disease was 52.7% (95% CI, −33.5 to 83.2) with a two-dose priming schedule for infants and 59.1% (95% CI, −31.1 to 87.2) with a two-dose priming schedule plus a booster at 1 year). Over the 3-year period, there were 169 cases of meningococcal group B disease in the vaccine-eligible cohorts, and an estimated 277 cases (95% CI, 236 to 323) were prevented. CONCLUSIONS The 4CMenB program was associated with continued positive effect against meningococcal group B disease in children in England, and protection after three doses of the vaccine was sustained for at least 2 years.

Original languageEnglish
Pages (from-to)309-317
Number of pages9
JournalNew England Journal of Medicine
Issue number4
Publication statusPublished - 23 Jan 2020

Bibliographical note

Funding Information: Supported by Public Health England.

Open Access: Free to read, but No Open Access licence.

Publisher Copyright: © 2020 Massachusetts Medical Society.

Citation: Ladhani, Shamez N., et al. "Vaccination of infants with meningococcal group B vaccine (4CMenB) in England." New England Journal of Medicine 382.4 (2020): 309-317.

DOI: 10.1056/NEJMoa1901229


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