Research and analysis

Meningococcal ACWY (MenACWY) vaccine coverage for adolescents in England, academic year 2021 to 2022

Updated 24 April 2023

Applies to England

Main points

This report presents vaccine coverage data for the routine school-aged MenACWY immunisation programme in England for the 2021 to 2022 academic year. These results include MenACWY vaccine coverage estimates for children in years 9 and 10 (or the equivalent ages) measured up to the 31 August 2022.

The main findings of this report are that:

• MenACWY coverage for year 9 students during the 2021 to 2022 academic year was 69.2%, which is 7.1 percentage points lower than the year 9 cohort in 2020 to 2021 (Figure 1)
• MenACWY coverage for year 10 students during the 2021 to 2022 academic year was 79.6%, which is 1.2 percentage points lower than the year 10 cohort in 2020 to 2021 (Figure 1)
• coverage in year 10 students was 3.3 percentage points higher than in the 2020 to 2021 academic year when they were in year 9
• coverage in year 9 students was highest in East of England (76.4%) and lowest in South West South (59.2%)

Figure 1. MenACWY coverage in adolescents in school years 9 and 10 by academic year from 2015 to 2022

Introduction

An increase in meningococcal W (MenW) cases led to the Joint Committee on Vaccination and Immunisation (JCVI) advising that the routine adolescent meningococcal C (MenC) dose should be replaced with the quadrivalent MenACWY conjugate vaccine in 2014. In February 2015, JCVI further advised an emergency catch-up programme with the MenACWY vaccine for children in the higher school years.

In August 2015, a MenACWY catch-up programme began for all children aged 14 to 18 years and those aged under 25 years attending university for the first time (1, 2). The NHS MenACWY immunisation programme aimed to immunise all eligible cohorts through a series of school and GP catch-up campaigns.

The first of these MenACWY vaccination catch-up campaigns started in August 2015, targeting those born between 1 September 1996 and 31 August 1997. A second GP-based catch-up campaign started in April 2016, targeting those born between 1 September 1997 and 31 August 1998. The final catch-up campaign started in April 2017 for those born between 1 September 1998 and 31 August 1999. All these cohorts remain eligible for MenACWY vaccination up to their 25th birthday.

The routine school-based adolescent immunisation programme began in 2015. NHS England (NHSE) commissions school-aged providers to deliver this programme in schools across England. Adolescents who are home-schooled, those who attend a small minority of schools that do not offer the routine vaccination programmes, and those of eligible age but not in education should be offered their vaccinations in alternative settings, such as community clinics. The eligibility criteria and delivery models used for the MenACWY school-aged programme have changed over time and more details on these changes can be found in the Appendix.

Since March 2020, the coronavirus (COVID-19) pandemic has led to some disruption of school-based immunisation programme delivery and the impact has varied by region and local authority. The biggest impact was observed in the 2019 to 2020 academic year when all schools were closed in the first national lockdown (3). Throughout the 2020 to 2021 academic year, school attendance rates in England were lower than normal. In January 2021, schools were closed to all, except children of keyworkers and vulnerable children, with a phased reopening of secondary schools from March 2021. Staff absences in both schools and school age immunisation services (SAIS) also added to the disruption.

Vaccine coverage in 2020 to 2021 improved significantly but was still not back up to pre-pandemic levels. In the 2021 to 2022 academic year, school attendance rates in England remained lower than normal until the ‘Living with COVID-19’ guidance was implemented from February 2022 and all restrictions were lifted (4). In September 2021, the offer of COVID-19 vaccination was extended to all children aged 12 to 15 years and was delivered in secondary schools and other settings (5). In addition, the influenza immunisation programme was extended to all children in secondary schools (6). School-aged immunisation services were instrumental in supporting the delivery of all of these programmes under very challenging circumstances. It is likely that all of these factors combined impacted on the delivery of the routine adolescent immunisation programmes including the MenACWY programme.

Previous reports were published by Public Health England (PHE).

Methods

NHSE-commissioned school age immunisation providers collect school-level vaccine coverage data, which is then aggregated up to local authority and submitted to UK Health Security Agency (UKHSA) either directly by the providers or by NHSE Regional Public Health Commissioning Teams via the ImmForm website. Where possible, regional teams also include additional data for adolescents resident in the local authority but not linked to any school. Data providers may also submit data on vaccinations delivered through community clinics or GP practices and this can then be added to the school vaccination figures.

The numerator is defined by the number of adolescents in each cohort who had received a dose of the MenACWY vaccine by 31 August 2022. Providers must use updated data sources to identify all eligible children in the locality for the academic year. This can be calculated from school student records for all types of schools or units, plus children schooled at home, or Child Health Information Systems.

The denominator is defined by the total number of eligible adolescents in each cohort regardless of programme delivery. This means that adolescents in local authorities where NHSE commissioned school-aged providers did not run a MenACWY programme in year 9 or 10 are included in the coverage estimates.

Local authority level MenACWY vaccine coverage data up to 31 August 2022 was manually uploaded by data providers to the ImmForm website retrospectively, from 1 September 2022 to 1 October 2022. The target population for the programme is defined by school age cohorts born between 1 September 2006 and 31 August 2008 (Table 1). This means that it includes those adolescents in school years 9 and 10 in the 2021 to 2022 academic year. Coverage for the year 10 cohort was intended to capture both vaccines delivered during the 2020 to 2021 academic year (when the students were in year 9) and routine or catch-up vaccines delivered in 2021 to 2022.

Full details of the data collection process and definitions can be found in the user guide.

Table 1. MenACWY vaccination cohorts in the 2021 to 2022 academic year

School year in 2021 to 2022	Age in 2021 to 2022	Dates of birth
9 (routine)	13 to 14 years	1 September 2007 to 31 August 2008
10 (routine or catch-up)	14 to 15 years	1 September 2006 to 31 August 2007

Results

Programme delivery

The results showed that there was continued disruption to programme delivery in 2021 to 2022. The vast majority of providers were able to offer the MenACWY vaccine to all year 9 and/or year 10 students as needed, depending on delivery in 2020 to 2021. However, NHSE-commissioned providers covering 5 local authorities were unable to offer all children in year 9 and 10 the vaccinations they were eligible for in the 2021 to 2022 academic year. Catch-up vaccinations were also delivered to year 10 students in most areas.

Year 9 vaccine coverage

The main findings for the year 9 cohort were that:

• MenACWY coverage for year 9 students in 2021 to 2022 was 69.2%, which is 7.1 percentage points lower than year 9 students in the previous year (Table 2)
• coverage in year 9 students was highest in East of England (76.4%) and lowest in South West South (59.2%) (Figure 2)
• local authority level coverage ranged from 28.7% (Middlesbrough) to 93.3% (Hertfordshire) (this range excludes those who only offer the vaccine routinely in year 10)
• out of 150 local authorities, coverage in 76 (50.7%) was less than 70%, coverage in 42 (28.0%) was between 70% and 80%, coverage in 28 (18.7%) was between 80% and 90% and coverage in 4 (2.7%) was greater than 90%

Table 2. MenACWY coverage in years 9 and 10 from 2015 to 2022

Academic year	Year 9 MenACWY coverage (%)	Year 10 MenACWY coverage (%)
2015 to 2016	84.1 [Note 1]	77.2
2016 to 2017	83.6	82.5
2017 to 2018	86.2	84.6
2018 to 2019	88.0 [Note 1]	86.7
2019 to 2020	58.3	87.0
2020 to 2021	76.3	80.8
2021 to 2022	69.2	79.6

[Note 1] In 2015 to 2016, only half of the year 9 and 10 cohorts were eligible for the vaccine meaning these figures are not comparable to later years. Also, over time many local authorities have moved from routinely offering the vaccine in year 10 to offering it in year 9. During transitional years, some local authorities offered the vaccine routinely to both year 9 and 10. This transition meant that in 2018 to 2019, the year 9 data was incomplete meaning some local authorities were excluded from national coverage figures. Since almost all local authorities now offer the vaccine in year 9, the year 10 coverage figures in 2021 to 2022 are the year 9 coverage plus additional catch-up. These changes mean that national coverage figures are not directly comparable over time and explain why coverage in the year 10 cohort may appear to decrease when compared to previous years.

Figure 2. Year 9 MenACWY coverage by local team

Year 10 vaccine coverage

The main findings for the year 10 cohort in 2021 to 2022 were that:

• MenACWY coverage for year 10 students in 2021 to 2022 was 79.6%, which is 1.2 percentage points lower than year 10 students in the previous year (Table 2)
• coverage in year 10 students was 3.3 percentage points higher than in 2020 to 2021 when they were in year 9 (Table 2) suggesting ongoing catch-up activities
• coverage in year 10 students was highest in Hampshire, Isle of White and Thames Valley (86.6%) and lowest in South West South (69.6%) (Figure 3)
• local authority level coverage ranged from 48.2% (Hammersmith and Fulham) to 100% (Hertfordshire and West Berkshire)
• out of 150 local authorities, coverage in 30 (20.0%) was less than 70%, coverage in 46 (30.7%) was between 70% and 80%, coverage in 58 (38.7%) was between 80% and 90% and coverage in 16 (10.7%) was greater than 90%

Figure 3. Year 10 MenACWY coverage by local team

Discussion

MenACWY vaccine coverage for year 9 in 2021 to 2022 was 69.2%. This was lower than in 2020 to 2021 and not yet back to pre-pandemic levels. Coverage in the year 10 cohort was 79.6%, which is a small improvement on uptake recorded for this cohort in year 9 during the previous academic year, suggesting ongoing catch-up activity. When coverage was calculated for each local team, the estimates varied considerably.

The drop in year 9 coverage and high variation between geographies are likely due to the COVID-19 pandemic, which continued to disrupt programme delivery in schools. In 2021 to 2022, the additional burden of delivering the COVID-19 vaccination programme for adolescents and extending the flu programme to all secondary year students will also have had an impact on capacity to deliver the adolescent immunisation programmes in some areas. This disruption was reflected in the survey responses, which showed that 5 of the local authorities were unable to offer all students the vaccines they were eligible for in 2021 to 2022.

Some reasons given by providers for lower coverage were:

• lower attendance rates in schools during high COVID-19 incidence periods
• challenges due to the offer of COVID-19 vaccines for students aged 12 to 15 years in secondary schools in the 2021 to 2022 academic year
• reduced consent return rates in some areas
• reports of vaccine hesitancy in some areas
• increased workload due to flu vaccine administration during the autumn term

Validation work was carried out by UKHSA to assess data quality; however, several factors mean that it remains challenging to obtain accurate MenACWY coverage figures. For example, recording cohort denominators and numerators across multiple school years is challenging and requires teams to combine multiple data sources. It is also difficult to keep track of pupils when they move schools, which highlights the importance of accurate data sharing between teams.

The MenACWY vaccine is often given alongside the diphtheria, tetanus and inactivated poliomyelitis vaccine (Td/IPV). Because of this co-delivery, Td/IPV coverage is similar to MenACWY coverage. For both vaccines, it is crucial to continue catch-up in older cohorts who missed out due to COVID-19. This catch-up, alongside efforts to increase uptake in routine cohorts, remains critical to ensure the population remains protected.

Appendix

Eligibility

2015 to 2016

In the first academic year of the MenACWY schools vaccination programme, 2 groups of adolescents were offered the vaccine in schools. These groups included:

• approximately half of adolescents in years 9 and 10 as part of the routine programme
• adolescents in year 11 as part of the catch-up campaign

2016 to 2017

The MenACWY vaccine was offered to 2 groups as part of the routine programme. These groups included:

• approximately half of adolescents in years 10 and 11 (who were in years 9 and 10 in 2015 to 2016 and were not offered the vaccine)
• the vast majority of adolescents in year 9

The vaccine was also offered through GP practices to year 13 students and opportunistically to anyone born after 1 September 1996.

2017 to 2018

The transition to routinely offer the MenACWY vaccination programme to year 9 students was almost complete, with only a small number of NHSE commissioned school-aged immunisation providers still offering the routine programme to year 10 students (who were in year 9 in 2016 to 2017 and were not offered the vaccine).

2018 to 2019

NHS school-aged providers for 9 of the local authorities offering a year 10 programme in 2017 to 2018 transitioned to additionally offer the vaccine to year 9 students in 2018 to 2019.

2019 to 2020

Only a small number of NHSE commissioned school-aged immunisation providers covering 4 local authorities continued to offer the routine MenACWY programme to year 10 students routinely.

2020 to 2021

The routine offer of MenACWY vaccine to the year 9 cohort was implemented alongside catch-up for the year 10 cohort in the vast majority of local authorities.

References

1. PHE (2015). MenACWY vaccine introduction

2. JCVI (2014). Minute of the meeting on 1 October 2014

3. Department for Education (DfE) (2021). Attendance in education and early years settings during the coronavirus (COVID-19) pandemic (November)

4. DfE (2022). Attendance in education and early years settings during the coronavirus (COVID-19) pandemic (July)

5. Department of Health and Social Care (DHSC) (2021). Universal vaccination of children and young people aged 12 to 15 years against COVID-19

6. DHSC (2021). National flu immunisation programme 2021 to 2022 letter