Optimizing the timing of 4CMenB vaccination in adolescents and young adults based on immune persistence and booster response data

ABSTRACT

Introduction: Meningococcal disease has an incidence peak spread over several years during adolescence and young adulthood in the United States. Meningococcal serogroup B (MenB) vaccines have been introduced relatively recently and may help protect individuals in these age groups. Currently there is insufficient long-term experience to determine the duration of disease protection after any MenB vaccine. Understanding antibody persistence after primary vaccination and responses to booster can help inform MenB vaccination strategies and optimize disease prevention.

Areas covered: Four studies in adolescents/young adults vaccinated with meningococcal B vaccine 4CMenB were reviewed with the aim to compare findings across studies and draw key learnings. The studies varied by geographic location, population characteristics, and timing of antibody measurement relative to primary vaccination.

Expert opinion: Antibody persistence data for 4CMenB are substantial, extending 7.5 years post-primary vaccination. Vaccination at age 16–18 years may help protect adolescents throughout their highest age-based risk period. Similar robust responses to a single booster dose were observed 4 and 7.5 years after primary vaccination. In outbreak settings it is beneficial to have received prior vaccination; residual circulating antibodies may provide protection, and a single dose induces booster responses within 7 days, which is quicker than administration of a 2-dose series to vaccine-naïve individuals.

KEYWORDS:

• 4cmenb
• antibody persistence
• booster
• adolescent
• young adult
• Neisseria meningitidis
• vaccine
• serogroup B

Acknowledgements

The authors thank Daniela Toneatto for critically reviewing this manuscript. Writing assistance was provided by Joanne Wolter (Independent medical writer on behalf of GSK) and editorial and coordination assistance was provided by XPE Pharma & Science on behalf of GSK.

Article highlights

• MenB vaccines are relatively new. Healthcare providers and policy makers may not be familiar with the breadth of emerging data relating to antibody persistence and booster responses.

• The available adolescent persistence dataset for 4CMenB is substantial and extends from 11 months up to 7.5 years. The percentage of adolescents and young adults with seroprotective antibodies to at least one meningococcal B vaccine antigen was high (84%–94%) at 2, 4 and 7.5 years after vaccination.

• Whilst it is not yet fully understood how antibody persistence data might relate to long-term disease prevention, the available data can be used to help inform decision making on the most appropriate timing of adolescent vaccination.

• Estimates of protection based on immunogenicity data do not take into account the potential cooperativity between antibodies induced by different vaccine components, and may be conservative.

• Vaccination at 16–18 years of age in the US (or shortly ahead of the incidence peak in other countries should this be different) may help protect adolescents throughout the highest age-based risk period.

• Persisting antibodies and a robust anamnestic response that is higher than responses to the 2-dose primary series suggest that in an outbreak setting it is beneficial to have received prior vaccination.

• Emerging information on vaccine impact and effectiveness, carriage, and cross-protection against other N. meningitidis serogroups, will contribute to refining vaccination strategies in coming years.

Declaration of interest

P S Watson, P Novy and R Bekkat-Berkani are employed by the GSK group of companies and hold shares in the GSK group of companies. F Strubbe and A Banzhoff are employed by the GSK group of companies.

Reviewer disclosures

A reviewer on this manuscript has disclosed that they perform contract research on behalf of Public Health England for GSK group of companies. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Data availability statement

All data have been previously published in peer-reviewed manuscripts or congress abstracts or are available at https://clinicaltrials.gov.

Geolocation information

The studies referred to in this review were conducted in the United States, Poland, Chile, United Kingdom, Canada and Australia.

Trademarks

Bexsero is a trademark of the GSK group of companies.

Additional information

Funding

GlaxoSmithKline Biologicals SA funded all costs associated with the development and the publishing of the present manuscript.