Meningococcal serogroup B vaccination series initiation in the United States: A real-world claims data analysis

Figures & data

Figure 1. Plain Language Summary.

Figure 2. MenB vaccine series initiation, overall and by age, sex, residence density, and race (only available in the Medicaid cohort) in the (a) commercial 16–18 years, (b) commercial 19–23 years, (c) Medicaid 16–18 years, and (d) Medicaid 19–23 years.

MenB, meningococcal serogroup B.

Figure 3. Time to MenB vaccine series initiation since the date of each person’s first eligibility for the (a) commercial and (b) Medicaid populations^a.

^aIndividuals were censored after the earliest of the end of continuous enrollment, 19^th (16–18-year-old age group) or 24^th birthday (19–23-year-old age group), or end of study period.

MenB, meningococcal serogroup B.

Table 1. Cox regression models for probability of MenB vaccine series initiation^a.

	Commercial, HR (95% CI)		Medicaid, HR (95% CI)
	16–18 years	19–23 years	16–18 years	19–23 years
Age at index date (ref. 16 years)
17 years	0.96* (0.95–0.98)	NA	0.57* (0.56–0.59)	NA
18 years	0.69* (0.68–0.71)	NA	0.31* (0.30–0.33)	NA
Age at index date (ref. 19 years)
20 years	NA	0.56* (0.54–0.58)	NA	0.63* (0.56–0.70)
21 years	NA	0.28* (0.27–0.29)	NA	0.51* (0.44–0.58)
22 years	NA	0.13* (0.12–0.14)	NA	0.41* (0.35–0.48)
23 years	NA	0.06* (0.05–0.07)	NA	0.26* (0.20–0.35)
Female (ref. male)	1.11* (1.10–1.11)	1.20* (1.18–1.22)	1.12* (1.11–1.14)	1.07* (1.00–1.14)
Race (ref. White)
Black	NA	NA	1.15* (1.14–1.17)	1.30* (1.21–1.40)
Hispanic	NA	NA	1.26* (1.23–1.28)	1.69* (1.50–1.90)
Other	NA	NA	1.53* (1.49–1.56)	1.50* (1.25–1.81)
Unknown	NA	NA	1.17* (1.14–1.20)	1.93* (1.74–2.13)
Region (ref. New England)
Middle Atlantic	1.32* (1.30–1.35)	0.70* (0.68–0.73)	NA	NA
East North Central	0.95* (0.93–0.97)	0.49* (0.47–0.50)	NA	NA
West North Central	0.83* (0.81–0.85)	0.34* (0.32–0.36)	NA	NA
South Atlantic	0.92* (0.90–0.94)	0.34* (0.33–0.35)	NA	NA
East South Central	0.65* (0.64–0.67)	0.21* (0.20–0.22)	NA	NA
West South Central	0.65* (0.64–0.67)	0.16* (0.15–0.17)	NA	NA
Mountain	0.61* (0.59–0.62)	0.21* (0.20–0.22)	NA	NA
Pacific	0.67* (0.65–0.69)	0.41* (0.39–0.43)	NA	NA
Other	0.87* (0.82–0.92)	0.50* (0.44–0.57)	NA	NA
Rural (ref. urban/unknown)	0.65* (0.64–0.66)	0.57* (0.55–0.60)	0.74* (0.73–0.75)	0.47* (0.43–0.52)
Baseline^b vaccination (ref. not)
MenACWY	1.01 (0.99–1.02)	0.89* (0.83–0.95)	0.85* (0.83–0.88)	0.99 (0.77–1.28)
Influenza	1.67* (1.65–1.69)	1.94* (1.88–2.00)	1.82* (1.79–1.85)	2.86* (2.57–3.19)
Other^c	1.09* (1.07–1.10)	1.23* (1.18–1.29)	1.04* (1.02–1.07)	1.35* (1.17–1.55)
Baseline^b HIV infection (ref. not)	0.69 (0.52–0.91)	0.73 (0.49–1.08)	0.75 (0.53–1.06)	0.66 (0.25–1.75)

*p < .001.

^aModel controlled for all covariates listed above plus index month and baseline health care expenditures, number of preventive care office visits, and number of vaccine administration office visits. Please note that MenACWY at any time during the study period was not included in the final model as earlier models became distorted due to the high proportion of MenACWY vaccine co-administrations on the date of MenB vaccination, which affected the other covariates.

^b6 months before index (excluding the index date).

^cIncluding adenovirus, anthrax, Bacillus Calmette–Guérin, cholera, hepatitis A, hepatitis B, HPV, pneumococcus, rabies, rotavirus, typhoid, DTP, measles-mumps-rubella, polio, varicella, yellow fever, plague, Japanese encephalitis, Haemophilus influenzae B, DTP/Haemophilus influenzae B, DTP/polio, MenCY/Haemophilus influenzae B vaccinations.

CI, confidence interval; DTP, diphtheria-tetanus-pertussis; HIV, human immunodeficiency virus; HPV, human papillomavirus; HR, hazard ratio; MenACWY, meningococcal serogroups A, C, W, Y; MenB, meningococcal serogroup B; MenCY, meningococcal serogroups C, Y; NA, not applicable (age) or not available (race for Commercial or region for Medicaid); ref., referent group.

Table 2. MenB vaccination characteristics among those who received MenB vaccination.

	Commercial		Medicaid
	Age 16–18 years n = 240,602	Age 19–23 years n = 42,141	Age 16–18 years n = 132,381	Age 19–23 years n = 3,804
MenB vaccine type (all doses)^a n (%)
MenB-4C	152,646 (63.4)	27,197 (64.5)	104,725 (79.1)	3,252 (85.5)
MenB-FHbp	89,700 (37.3)	15,301 (36.3)	28,590 (21.6)	560 (14.7)
Age at first MenB vaccination, n (%)
16 years	89,869 (37.4)	NA	65,816 (49.7)	NA
17 years	83,946 (34.9)	NA	46,194 (34.9)	NA
18 years	66,787 (27.8)	NA	20,371 (15.4)	NA
19 years	NA	19,677 (46.7)	NA	1,849 (48.6)
20 years	NA	11,376 (27.0)	NA	900 (23.7)
21 years	NA	6,234 (14.8)	NA	452 (11.9)
22 years	NA	3,227 (7.7)	NA	324 (8.5)
23 years	NA	1,627 (3.9)	NA	279 (7.3)
Month of first MenB vaccination, n (%)
January	13,795 (5.7)	4,216 (10.0)	7,726 (5.8)	286 (7.5)
February	13,152 (5.5)	1,424 (3.4)	7,791 (5.9)	250 (6.6)
March	11,080 (4.6)	2,256 (5.4)	7,995 (6.0)	258 (6.8)
April	11,824 (4.9)	1,534 (3.6)	8,557 (6.5)	249 (6.5)
May	17,696 (7.4)	3,615 (8.6)	9,625 (7.3)	342 (9.0)
June	32,711 (13.6)	4,576 (10.9)	12,314 (9.3)	359 (9.4)
July	41,258 (17.1)	6,066 (14.4)	16,159 (12.2)	417 (11.0)
August	43,722 (18.2)	8,689 (20.6)	20,833 (15.7)	474 (12.5)
September	15,370 (6.4)	2,074 (4.9)	12,467 (9.4)	307 (8.1)
October	15,449 (6.4)	2,154 (5.1)	12,897 (9.7)	348 (9.1)
November	13,537 (5.6)	2,617 (6.2)	9,227 (7.0)	302 (7.9)
December	11,008 (4.6)	2,920 (6.9)	6,790 (5.1)	212 (5.6)
Year of first MenB vaccination, n (%)
2017	69,417 (28.9)	14,601 (34.6)	38,884 (29.4)	1,253 (32.9)
2018	76,725 (31.9)	13,620 (32.3)	43,790 (33.1)	1,227 (32.3)
2019	87,811 (36.5)	13,029 (30.9)	49,707 (37.5)	1,324 (34.8)
2020	6,649 (2.8)	891 (2.1)	NA	NA
Vaccination setting of first MenB vaccination, n (%)
Office	235,364 (97.8)	39,588 (93.9)	100,184 (75.7)	3,102 (81.5)
Pharmacy	1,576 (0.7)	1,616 (3.8)	187 (0.1)	86 (2.3)
Emergency room	5 (0.0)	0 (0.0)	5 (0.0)	1 (0.0)
Other outpatient	3,657 (1.5)	937 (2.2)	32,005 (24.2)	615 (16.2)
Type of visit for first MenB vaccination, n (%)
Preventive care/well-child	191,910 (79.8)	27,665 (65.6)	105,385 (79.6)	2,270 (59.7)
Vaccine-only	27,702 (11.5)	7,000 (16.6)	12,487 (9.4)	324 (8.5)
Other	20,990 (8.7)	7,476 (17.7)	14,509 (11.0)	1,210 (31.8)
Provider type of first MenB vaccination, n (%)
Pediatrician	173,673 (72.2)	21,594 (51.2)	50,651 (38.3)	667 (17.5)
Family medicine	27,326 (11.4)	9,673 (23.0)	6,194 (4.7)	216 (5.7)
Internal medicine	5,785 (2.4)	2,220 (5.3)	1,142 (0.9)	54 (1.4)
Pharmacist	1,699 (0.7)	1,738 (4.1)	188 (0.1)	86 (2.3)
Obstetrician/gynecologist	258 (0.1)	79 (0.2)	655 (0.5)	24 (0.6)
Other^b	21,399 (8.9)	4,538 (10.8)	39,134 (29.6)	804 (21.1)
Unknown	10,462 (4.3)	2,299 (5.5)	34,417 (26.0)	1,953 (51.3)
Co-administration of first MenB dose with other vaccinations, n (%)
MenACWY	128,486 (53.4)	4,724 (11.2)	86,756 (65.5)	469 (12.3)
Influenza	36,418 (15.1)	6,101 (14.5)	22,668 (17.1)	816 (21.5)
Other^c	63,128 (26.2)	13,740 (32.6)	32,930 (24.9)	1,323 (34.8)

^aData for MenB vaccine type are numbers of individuals who received any dose(s) of MenB-4C and any dose(s) of MenB-FHbp vaccines. The sums add to more than the numbers of individuals as some received both vaccines.

^bIncluding nurse practitioner/physician assistant, other physician, or other professional (non-physician).

^cIncluding adenovirus, anthrax, Bacillus Calmette–Guérin, cholera, hepatitis A, hepatitis B, HPV, pneumococcus, rabies, rotavirus, typhoid, DTP, measles-mumps-rubella, polio, varicella, yellow fever, plague, Japanese encephalitis, Haemophilus influenzae B, DTP/Haemophilus influenzae B, DTP/polio, MenCY/Haemophilus influenzae B vaccinations.

DTP, diphtheria-tetanus-pertussis; HPV, human papillomavirus; MenACWY, meningococcal serogroups A, C, W, Y; MenB, meningococcal serogroup B; MenB-4C, meningococcal serogroup B 4-component; MenB-FHbp, meningococcal serogroup B factor H binding protein; MenCY, meningococcal serogroups C, Y; n, number of individuals; NA, not applicable.