Modeling the public health impact of different meningococcal vaccination strategies with 4CMenB and MenACWY versus the current toddler MenACWY National Immunization Program in Chile

Figures & data

Figure 1. Six vaccination strategies modeled. Overview of the vaccines included for infants and/or toddlers and/or adolescents in each vaccination strategy modeled and in the current National Immunization Program (NIP).

Figure 2. IMD incidence in Chile from 2009 to 2019 – by serogroup in the overall population, and in infants. IMD incidence can change unpredictably. The rapid increase in serogroup W (MenW) cases (from 2011) led to the introduction of MenACWY vaccination (from 2012 in the ‘W-135 Plan’ and from 2014 in the National Immunization Program [NIP]). IMD incidence rates are highest in infants. Abbreviations: MenACWY, quadrivalent meningococcal conjugate vaccine; MenB/MenW/MenC/MenY/MenZ/MenNT, serogroups B/W/C/Y/Z/NT IMD.

Figure 3. Predicted IMD cases (2013–2018) assuming no vaccination compared with observed cases (2013–2018) after vaccination programs were introduced in 2012. Prediction of invasive meningococcal disease (IMD) cases (2013–2018) based on observed cases (2008–2012) and assuming no vaccination program was introduced in 2012, compared with observed cases (2013–2018) following the implementation of vaccination strategies to control the outbreak.

Table 1. Vaccination parameters for 4CMenB and MenACWY

	4CMenB			MenACWY
	Infant and toddler			Toddler	Adolescent
Dosing	3 m	5 m	12 m	12 m	11 y
Vaccine effectiveness (%)	0	80.0^Citation39	82.8^Citation39	79.0^Citation40	79.0^Citation40
Average duration of protection (months)	33^Citation41	33^Citation41	38^Citation41	48^Citation42–44	187^Citation45
Carriage effect (%)	0			36.2 against MenACWY IMD^Citation20
Vaccine effectiveness potential cross-protection (%)	Calculated cross-protection against MenACWY IMD:			No cross-protection against MenB IMD
	Infant (3 m, 5 m) – 78.9
	Toddler (12 m) – 74.1
	Calculations use: 80 MenW IMD, 93.8 MenY IMD, 0 MenAC IMD^Citation17
Coverage (%)	99.0^a	99.0^a	96.0^b	96.0^b	89.9^c

Infant is <12 months, Toddler is ≥12 months old; Adolescent is ≥11 years old. Vaccine effectiveness for 4CMenB based on available data at time of analysis. Conservative assumption of 0% effectiveness after Dose 1 assumed. Vaccine cross-protection for 4CMenB calculated assuming potential cross-protection against MenW and MenY only.

^aBased on Chilean data for the hexavalent vaccine at similar ages.³⁸

^bBased on Chilean data for the measles, mumps, and rubella (MMR) vaccine at 12 months of age.³⁸

^cBased on Chilean data for the first dose of the human papillomavirus (HPV) vaccine at 11 years of age.³⁸

Abbreviations: 4CMenB, four-component meningococcal serogroup B vaccine; IMD, invasive meningococcal disease; MenACWY, quadrivalent meningococcal conjugate vaccine; MenACWY/MenAC/MenW/MenY IMD, serogroups A, C, W, Y/A, C/W, or Y IMD; m, months; y, years.

Figure 4. Percent reduction in IMD incidence after 5 years and 25 years – impact of introducing each strategy versus the current NIP. Percent reduction in IMD incidence with each vaccination strategy compared with the National Immunization Program (NIP) after 5 years and 25 years of vaccination. Abbreviations: IMD, invasive meningococcal disease; MenACWY, quadrivalent meningococcal conjugate vaccine; 4CMenB, four-component meningococcal serogroup B vaccine.

Figure 5. Percent change in IMD cases per year with vaccination strategies versus current NIP over 25 years, (a) for all ages and (b) for ages 0–4 years old. Percent change in invasive meningococcal disease (IMD) cases with each strategy compared with the current National Immunization Program (cNIP) over 25 years (a) for all ages, and (b) for ages 0–4 years.

Figure 6. Impact of vaccination strategies: cumulative IMD cases by age group, (a) after 5 years and (b) after 25 years. Impact of vaccination strategies on the cumulative number of invasive meningococcal disease (IMD) cases by age group compared with the current National Immunization Program (cNIP), (a) after 5 years of vaccination, and (b) after 25 years of vaccination. Abbreviations: 4CMenB, four-component meningococcal serogroup B vaccine; MenACWY, quadrivalent meningococcal conjugate vaccine.

Figure 7. Impact on long-term sequelae, IMD deaths and lost QALYs due to IMD with each strategy versus the current NIP, after (a) 5 years and (b) 25 years. The impact of each vaccination strategy (1–6) compared with the National Immunization Program (NIP) in Chile on invasive meningococcal disease (IMD)-related long-term (LT) physical, neurological, and psychological/behavioral sequelae; IMD deaths; and lost quality-adjusted life-years (QALYs) due to MenACWY, MenB, or “MenOther” IMD is presented after 5 years and after 25 years of vaccination.

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