Meningococcal vaccines in China

Joint consensus on reducing the burden of invasive meningococcal disease in the Asia-Pacific region

Invasive meningococcal disease (IMD) imposes a heavy burden of mortality and life-long sequelae on infected individuals and has devastating impacts on their family members. International data show that meningococcal vaccination programs have reduced IMD incidence and changed the serogroup distribution of the disease. Furthermore, newer data show that although the public health measures in response to the coronavirus disease 2019 (COVID-19) pandemic temporarily reduced the incidence of IMD, there has been a resurgence in the years since. In the Asia-Pacific (APAC) region, many countries do not include meningococcal vaccines in their routine vaccination programs, and approaches to IMD surveillance are inconsistent. This review summarizes recent data and consensus statements from a group of experts from selected APAC countries on the burden of IMD in the region, evidence for vaccination, and how barriers to IMD vaccination may be addressed.

Epidemiological characteristics and disease burden of bacterial meningitis in hospitalized children in China: a 6-year nationwide retrospective study

Bacterial meningitis is a severe infectious disease. Study of bacterial meningitis of children in recent years are limited. It is unclear whether there have been any changes in the epidemiological characteristics of bacterial meningitis during the years of the COVID-19 pandemic. The purpose of this study was to describe a large, nationwide study of bacterial meningitis in China. We analyzed data of hospitalized patients with bacterial meningitis from 30 hospitals in China from 2016-2021. A total of 16566 episodes of bacterial meningitis were included, of which 13614 episodes (82.18%) occurred in children age under 5-years old. The admission proportion of bacterial meningitis to total hospitalization decreased from 0.24% to 0.16% after COVID -19 pandemic (under COVID -Zero Strategy) (P < .0001). The risk of at least one complication was 26.45% (4382/16566). The three most common complications were hydrocephalus (2351, 14.19%), subdural effusions or empyema (1438, 8.68%), and seizures (794, 4.79%). Ninety-one (0.55%) patients died in hospital. Risks of complications and mortality (0.55%) were related to age under 5 years old (P < .0001). The median length of stay and inpatient expenditures for children with bacterial meningitis were 16 days and 2,697.38 USD.ConclusionsBacterial meningitis mostly occurred in children aged < 5 y. The percentage of 30 tertiary hospitalized children with bacterial meningitis apparently decreased after the COVID-19 pandemic. Ninety-one (0.55%) patients died in the hospital.

Cost-effectiveness analysis of vaccination strategies against meningococcal disease for children under nine years of age in China

Meningococcal vaccination strategies in China are intricate, including multiple vaccines targeting different serogroups. The current National Immunization Program (NIP) includes two polysaccharide vaccines for serogroups A and C (MPV-A and MPV-AC), covering limited serogroups and requiring adaptation. This study aims to evaluate the cost-effectiveness of replacing the current strategy with alternative strategies utilizing non-NIP vaccines to inform policy decisions. From a societal perspective, a decision tree-Markov model was constructed to simulate the economic and health consequences of meningococcal disease in a 2019 birth cohort with four vaccination strategies. Epidemiology, vaccine efficacy, cost, and other parameters were derived from previous studies. We conducted sensitivity analyses to assess the robustness of the findings and explored prices for non-NIP vaccines that enable cost-effective strategies. Compared to the current strategy, alternative strategies using quadrivalent polysaccharide vaccine (MPV-4), bivalent conjugate vaccine (MCV-AC), and quadrivalent conjugate vaccine (MCV-4) could avoid 91, 286, and 455 more meningococcal cases. The ICERs were estimated at approximately $250 thousand/QALY, $450 thousand/QALY, and $1.5 million/QALY, all exceeding the threshold of three times GDP per capita. The alternative strategies were not cost-effective. However, if vaccine prices were reduced to $3.9 for MPV-4, $9.9 for MCV-AC, and $12 for MCV-4, the corresponding strategy would be cost-effective. The current meningococcal vaccination strategy in China could effectively prevent the disease at a low cost, but with limited serogroup coverage. Strategies using MPV-4, MCV-AC, or MCV-4 could increase health benefits at a substantial cost, and might become cost-effective if vaccine prices decrease.

Long-Term Patterns of Meningitis Mortality: A Continual Downward Trend and a Vulnerable Infant Population - China, 1987-2021

What is already known about this topic?

Meningitis, a life-threatening disease, presents a significant public health challenge. Its rate of progress in burden reduction notably lags behind other diseases that can be prevented through vaccination.

What is added by this report?

This research explored the changes in the mortality rate of meningitis in China over a span of 35 years. The study further identified the effects of age, period, and cohort on the mortality trends.

What are the implications for public health practice?

In the context of minimal disparities between urban and rural settings, it is crucial to focus on and implement targeted prevention programs for meningitis within the infant population.

A phase II, single-center, randomized, double-blind, parallel control clinical study evaluating the immunogenicity and safety of a two-dose schedule of serogroups ACYW meningococcal polysaccharide conjugate vaccine

BACKGROUND

This was a single-center, randomized, double-blind, parallel control study evaluating the immunogenicity and safety of a two-dose schedule of serogroups ACYW meningococcal polysaccharide conjugate vaccine with tetanus toxoid (TT) conjugate protein, in infants and toddlers of 3-35 months old.

METHOD

720 participants were stratified according to the age of 3-5 months old, 6-11 months old, and 12-35 months old and randomly assigned with an equal ratio to two different dose groups, i.e., 40- and 20-μg doses. Blood samples were taken from all participants before the first vaccination and 30 days after the full-course vaccination to detect the serogroups ACYW meningococcal antibodies. All adverse events occurred within 30 days after vaccination of each dose, and serious adverse events occurred within six months after full-course vaccination were collected for safety evaluation. This study was registered at the China drug trial registration with the identifier CTR 20182031.

RESULTS

After 30 days of full-course vaccination, 92.78 % (95 % CI: 85.70 %-100.00 %) showed the immune response against all serogroups in both high-dose and low-dose groups by rabbit serum bactericidal antibody assay (rSBA) and the geometric mean titer (GMT) of all serogroups showed a high level (74.6-505.8, 95 % CI: 56.4-615.7). However, no significant difference between different dose groups was observed (P > 0.05). The common local and systemic adverse events in both groups were redness (3 %-7%), and fever (26 %-65 %), respectively. In addition, the grade 3 adverse event related to the vaccine was fever (1.67 %-12.50 %). No serious adverse event was reported to be associate with the vaccination.

CONCLUSION

The serogroups ACYW meningococcal polysaccharide conjugate vaccine was safe and effective in the population aged 3-35 months. The vaccine efficacy and safety of the 20-μg dose group were not less than that of the 40-μg dose group.