Laboratory confirmed cases of invasive meningococcal infection in England: July to September 2020
Updated 25 January 2022
Applies to England
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In England, the national Public Health England (PHE) Meningococcal Reference Unit (MRU) confirmed 26 cases of invasive meningococcal disease (IMD) between July and September 2020. IMD cases were 67% lower during these 3 months compared to 78 cases in the equivalent period in 2019 (table 1). This relatively low number of confirmed cases was observed across all capsular groups.
The COVID-19 pandemic and the implementation of social distancing measures and lockdown across the UK from 23 March 2020 has had a significant impact on the spread and detection of other infections, including IMD.
The age distribution of meningococcal capsular groups causing IMD is summarised in table 2, with capsular group B (MenB) accounting for 77% (20 out of 26) of all cases, followed by MenC (n=3, 12%), 1 case of MenW and 2 ungrouped or ungroupable cases. There were no confirmed IMD cases in children and teenagers aged between 10 and 19 years.
There were 20 MenB cases confirmed between July and September 2020, 62% lower than the equivalent period in 2019 (53 cases). MenW cases were 94% lower (1 case) than the number of cases confirmed in the same time period in 2019 (13 cases). In this quarter, the number of cases confirmed with MenC disease was 40% lower (3 cases) in 2020 than the equivalent period in 2019 (5 cases) and there were no MenY cases confirmed in this period in 2020, while, in 2019 4 cases were reported (table 1). Two ungrouped or ungroupable cases were reported in this quarter. There were no reported cases for capsular groups A, X and Z/E during the reporting period.
Between July and September 2020, MenB was responsible for the majority of IMD cases in children aged less than 5 years of age (7 out of 9, 78%), with one confirmed case of MenW and one MenC also in this age group.
MenB also accounted for more than two-thirds of cases in individuals aged between 5 and 64 years (71%) and for all of cases in adults aged 65 years or more (table 2).
The introduction of a routine national MenB immunisation programme for infants was announced in June 2015 with immunisation of infants starting from 1 September 2015.
Vaccine coverage estimates for infant MenB immunisation across England was 92.5% for 2 doses at 12 months of age and 89.5% for the booster dose by 24 months of age (evaluated between July to September 2020). The 2-dose infant MenB schedule has been shown to be highly effective in preventing MenB disease in infants.
Two of the 3 MenC cases confirmed between July and September 2020, were in adults aged between 25 to 64 years. One child aged less than 1 year of age was confirmed with MenC disease. There were no confirmed cases in young people aged between 1 and 24 years.
The earlier increase in MenW cases, which has been previously reported, led to the introduction of MenACWY conjugate vaccine to the national immunisation programme in England (see Meningococcal ACWY conjugate vaccination and Meningococcal ACWY vaccination programme).
Targeted catch-up with MenACWY vaccine began in August 2015 at which time it also replaced the existing time-limited MenC ‘freshers’ vaccination programme. MenC vaccine was also directly substituted with MenACWY vaccine in the routine adolescent school programme (school year 9 or 10) from autumn 2015.
Coverage for the first cohorts to be routinely offered MenACWY vaccine in schools from September 2015 and evaluated up to the end August 2019 was 88.0% (Year 9 in 2018 to 2019) and 86.7% (Year 10).
The impact of the MenACWY teenage and the MenB infant vaccination programmes continues to be monitored. Early assessment of the infant MenB programme and MenACWY vaccination in the 2015 school leaver cohort have been published.
All teenage cohorts remain eligible for opportunistic MenACWY vaccination until their 25th birthday and it is important that these young people continue to be encouraged to be immunised, particularly if they are entering higher education.
Table 1: Invasive meningococcal disease in England by capsular group and laboratory testing method: July to September 2019 and 2020
| Capsular groups* | Culture and PCR (2019) | Culture and PCR (2020) | Culture only (2019) | Culture only (2020) | PCR only (2019) | PCR only (2020) | Total (2019) | Total (2020) |
|---|---|---|---|---|---|---|---|---|
| B | 16 | 5 | 10 | 5 | 27 | 10 | 53 | 20 |
| C | 2 | 0 | 2 | 1 | 1 | 2 | 5 | 3 |
| W | 1 | 0 | 11 | 0 | 1 | 1 | 13 | 1 |
| Y | 0 | 0 | 4 | 0 | 0 | 0 | 4 | 0 |
| Other** | 1 | 0 | 2 | 1 | 0 | 1 | 3 | 2 |
| Total | 20 | 5 | 29 | 7 | 29 | 14 | 78 | 26 |
*No cases of group A, Z/E were confirmed during the periods summarised in the table. **Other includes group X and ungrouped or ungroupable (ungroupable refers to invasive clinical meningococcal isolates that were non-groupable, while ungrouped cases refers to culture-negative but PCR screen (ctrA) positive and negative for the 4 genogroups [B, C, W and Y] routinely tested for)
Table 2. Invasive meningococcal disease in England by capsular group and age group at diagnosis: July to September 2020
| Age groups | Capsular group B | Capsular group C | Capsular group W | Other | Total number | Total percentage |
|---|---|---|---|---|---|---|
| <1 year | 5 | 1 | 1 | 0 | 7 | 26.9% |
| 1 to 4 years | 2 | 0 | 0 | 0 | 2 | 7.7% |
| 5 to 9 years | 5 | 0 | 0 | 0 | 5 | 19.2% |
| 10 to 14 years | 0 | 0 | 0 | 0 | 0 | - |
| 15 to 19 years | 0 | 0 | 0 | 0 | 0 | - |
| 20 to 24 years | 0 | 0 | 0 | 1 | 1 | 3.8% |
| 25 to 44 years | 1 | 1 | 0 | 1 | 3 | 11.5% |
| 45 to 64 years | 4 | 1 | 0 | 0 | 5 | 19.2% |
| 65+ years | 3 | 0 | 0 | 0 | 3 | 11.5% |
| Total | 20 | 3 | 1 | 2 | 26 |