Laboratory confirmed cases of invasive meningococcal infection in England: July to September 2022
Updated 25 April 2024
Applies to England
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In England, the national UK Health Security Agency (UKHSA) Meningococcal Reference Unit (MRU) confirmed 43 cases of invasive meningococcal disease (IMD) between July and September 2022 (table 1) compared to 28 and 26 cases of IMD in the equivalent periods in 2021 and 2020, respectively. However, IMD cases in July to September 2022 were 46% lower than in the same pre-pandemic period in 2019 when 79 cases were reported. This relatively low number of confirmed meningococcal cases between July to September 2022 was observed across all capsular groups.
The coronavirus (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. From July 2021, COVID-19 containment measures were withdrawn in England and overall case numbers have gradually increased.
The age distribution of meningococcal capsular groups causing IMD is summarised in table 2, with capsular group B (MenB) accounting for 88% (38 of 43) of all cases, followed by 1 capsular group W (MenW) case, 1 capsular group Y (MenY) case and 1 ungrouped/ungroupable case.
There were 38 MenB cases confirmed between July and September 2022, compared to 23 and 20 cases in 2021 and 2020, respectively. MenB cases in this quarter were 28% lower than the equivalent period in 2019 when 53 cases were reported.
Two MenC cases were reported in this quarter compared to 0, 3 and 6 cases in the equivalent periods in 2021, 2020 and 2019, respectively. One case of capsular MenW was reported in this quarter compared to 3, 1 and 13 cases reported for the same quarter in 2021, 2020 and 2019, respectively. One case of MenY was reported in this quarter in 2022 compared to 1 case in 2021, 0 in 2020 and 4 in 2019. No cases of group A, E, X or Z were confirmed in this quarter in 2022.
Between July and September 2022, MenB was responsible for 23 of the 25 IMD cases in individuals aged under 25 years of age and 83% (15 of 18) of cases aged 25 years and over (table 2). Thirty per cent percent of all cases of invasive meningococcal disease and 32% of all MenB cases arose in young people aged 15 to 24 years during this time.
Both MenC cases confirmed between July and September 2022 were reported in adults aged 65 years and older. The MenW case was reported in an infant under one year of age and the MenY case in an adult aged between 45 and 64.
Vaccination
The introduction of a routine national MenB immunisation programme for infants began with the immunisation of infants from 1 September 2015. Vaccine coverage estimates for infant MenB immunisation across England was 91.9% for 2 doses at 12 months of age and 88.1% for the booster dose by 24 months – evaluated between July and September 202 (1). The 2-dose infant MenB schedule has been shown to be highly effective in preventing MenB disease in infants and toddlers (2).
The earlier increase in MenW cases, which had been reported in 2015, led to the introduction of MenACWY conjugate vaccine in England. 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 young people routinely offered MenACWY vaccine in the 2020 to 2021 school year and evaluated up to the end of August 2021 was 76.5%, in school year 9, and 80.9% for year 10 (3). Local arrangements are being made for catch-up for the cohorts who missed vaccination at school during periods when COVID-19 control measures were in place.
The impact of the MenACWY teenage and the MenB infant vaccination programmes continues to be monitored. Early assessments of the infant MenB programme (2,4), and MenACWY vaccination in the 2015 school leaver cohort, have been published (5,6).
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. This is particularly important if they are entering higher education institutions where their risk of disease is known to be substantially higher than that of their peers(7).
Table 1. Invasive meningococcal disease in England by capsular group and laboratory testing method: July to September only, 2021 and 2022
| Capsular groups* | Culture and PCR (2021) | Culture and PCR (2022) | Culture only (2021) | Culture only (2022) | PCR only (2021) | PCR only (2022) | Total (2021) | Total (2022) |
|---|---|---|---|---|---|---|---|---|
| B | 5 | 8 | 8 | 9 | 10 | 21 | 23 | 38 |
| C | 0 | 0 | 0 | 1 | 0 | 1 | 0 | 2 |
| W | 0 | 1 | 2 | 0 | 1 | 0 | 3 | 1 |
| Y | 0 | 0 | 0 | 0 | 1 | 1 | 1 | 1 |
| Other** | 0 | 0 | 0 | 0 | 1 | 1 | 1 | 1 |
| Total | 5 | 9 | 10 | 10 | 13 | 24 | 28 | 43 |
*No cases of group A, E, X or Z were confirmed during the periods summarised in the table.
**‘Other’ includes 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 four 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 2022
| Age groups | Capsular group B | Capsular group C | Capsular group W | Capsular group Y | Capsular group Other** | Total number | Total percentage |
|---|---|---|---|---|---|---|---|
| <1 year | 4 | 0 | 1 | 0 | 0 | 5 | 11.6% |
| 1 to 4 years | 4 | 0 | 0 | 0 | 0 | 4 | 9.3% |
| 5 to 9 years | 0 | 0 | 0 | 0 | 0 | 0 | – |
| 10 to 14 years | 3 | 0 | 0 | 0 | 0 | 3 | 7.0% |
| 15 to 19 years | 7 | 0 | 0 | 0 | 1 | 8 | 18.6% |
| 20 to 24 years | 5 | 0 | 0 | 0 | 0 | 5 | 11.6% |
| 25 to 44 years | 4 | 0 | 0 | 0 | 0 | 4 | 9.3% |
| 45 to 64 years | 5 | 0 | 0 | 1 | 0 | 6 | 14.0% |
| 65+ years | 6 | 2 | 0 | 0 | 0 | 8 | 18.6% |
| Total | 38 | 2 | 1 | 1 | 1 | 43 | – |
*No cases of group A, E, X or Z were confirmed during the periods summarised in the table.
**‘Other’ includes 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 four genogroups [B, C, W and Y] routinely tested for).
References
1. Health Protection Report volume 16 issue 13 (20 December 2022) ‘Quarterly vaccination coverage statistics for children aged up to 5 years in the UK (COVER programme)’.
2. Ladhani S and others (2020) ‘Vaccination of Infants with Meningococcal Group B Vaccine (4CMenB) in England’, the New England Journal of Medicine: volume 382 number 4.
3. Health Protection Report volume 16 issue 2 (8 February 2022) ‘Meningococcal ACWY (MenACWY) vaccine coverage for the NHS adolescent vaccination programme in England, academic year 2020 to 2021’.
4. Health Protection Report volume 10 issue 37 (28 October 2016) ‘Impact of MenB vaccination programme in England’.
5. Campbell H and others (2017) ‘Emergency Meningococcal ACWY Vaccination Program for Teenagers to Control Group W Meningococcal Disease, England, 2015 to 2016’, Emerging Infectious Disease, volume 23 number 7.
6. Campbell H and others (2022). ‘Impact of an adolescent meningococcal ACWY immunisation programme to control a national outbreak of group W meningococcal disease in England: a national surveillance and modelling study’, Lancet Child Adolescent Health: volume 6 issue 2.
7. Mandal S and others (2017). ‘Risk of invasive meningococcal disease in university students in England and optimal strategies for protection using MenACWY vaccine’, Vaccine: volume 35 issue 43.