A policy review of the introduction of the MenACWY vaccine in toddlers across multiple countries

Figures & data

Figure 1. Recommended age at MenACWY vaccination. * In Italy, vaccination in toddlers is strongly recommended by the national medical associations in the 2019 Calendario Vaccinale per la Vita; the recommendations have already been adopted in at least 8 of the 21 regions/autonomous provinces. Recently, the Italian authorities have also considered the introduction of an additional vaccination for children at 6 years of age. $ In Spain, toddler vaccination is present in only two regions, Castilla y León and Andalucía.

Figure 2. Standardized incidence (cases per 100,000) of IMD (all serogroups) by country [21,25,44].

Figure 3. Standardized incidence (cases per 100,000) of IMD cases due to serogroup W by country [21,25,44].

Table 1. Summary of reasons for the introduction of MenACWY vaccine in toddlers.

Country	Introduction of MenACWY vaccine in toddlers	Agencies making recommendation	Economic assessment	Main reasons for introduction of MenACWY vaccination in toddlers
Australia	2018	ATAGI & PBAC	Yes	Additional budget benefits (cost minimization) Non-inferiority to MenC component of Hib-MenC vaccine High safety and tolerability Increased coverage for additional serogroups [20]
Chile	2012 (pilot project) 2014 (national vaccination)	Ministerio de Salud de Chile	No	Dramatic increase in MenW cases, particularly in children below 5 years Serogroup W’s aggressive characteristics compared with other serotypes [22]
Netherlands	2018	Gezondheidsraad	Yes	Increase of MenW cases High safety and tolerability profile of the vaccine Maintenance of herd immunity (recommended despite cost-effectiveness higher than threshold) Cost-effectiveness ratio is not much higher compared to the usual reference value (€20,000 per QALY) [23]
Switzerland	2018	Bundesamt für Gesundheit	No	Increase of MenW cases Direct and indirect protection in age groups with high incidence (infants, toddlers, adolescents) [26]
Italy	2019* (Calendario Vaccinale per la Vita)	SIP, SITI, FIMP & FIMMG	No	Increase of MenW cases in Europe Increased serogroup coverage (ACWY instead of only C) [28]
Spain	2019 (Castilla y León) 2020 (Andalucía) 2021 (CAV-AEP recommendation)	AEPED & CAV-AEP	No	Increase of MenW and MenY Impact of MenACWY vaccination programs in some regions on the incidence of MenW and Y [42] Improving vaccination coverage (Andalucía, due to difficulty in vaccinating adolescents) [41]

*In Italy, the Calendario Vaccinale per la Vita published in 2019 included MenACWY vaccination in toddlers; this document is used by national and regional authorities for official recommendations.

Abbreviations: AEPED, Asociación Española de Pediatría; ATAGI, Australian Technical Advisory Group on Immunization; CAV-AEP, Comité Asesor de Vacunas de la Asociación Española de Pediatría; FIMMG, Federazione Italiana Medici di Famiglia; FIMP, Federazione Italiana Medici Pediatri; QALY, quality-adjusted life year; PBAC, Pharmaceutical Benefits Advisory Committee; SIP, Società Italiana di Pediatria; SITI, Società Italiana di Igiene, Medicina Preventiva e Sanità Pubblica.

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