Last year we responded to the UK’s Joint Committee on Vaccination and Immunisation (JCVI) recommended changes to the routine immunisation schedule for children in the UK.
This was an important update for meningitis, as it addressed the withdrawal of Menitorix, the vaccine currently given to infants at 12 months to protect against Hib meningitis and Meningococcal Group C disease (commonly known as MenC).
Stocks of Menitorix in the UK are anticipated to run out in 2025, meaning recommendations are made now by the JCVI, so they can be adopted and implemented by the UK’s Departments of Health, in England, Wales, Scotland and Northern Ireland.
Since publishing our formal response we’ve had a number of questions from supporters, parents, carers, and journalists. So, we thought we’d gather these individual replies and share them, to help people stay informed on this important potential development to the vaccines available to children in the UK.
Claire Wright, Head of Evidence and Policy, Meningitis Research Foundation
What do you think about the plans to not replace the MenC element of the vaccine for young children? Are you surprised by this choice?
Seeing meningitis vaccines dropped from the infant routine immunisation schedule is always a concern. Behind every case number is an individual or family whose lives have been changed, sometimes tragically forever.
The change in vaccination schedule is not a huge surprise however. The schedule for MenC vaccine has changed a lot in response to the changing patterns of disease and as more has been learnt about how vaccines work since the MenC vaccine was first introduced in 1999.
Are you concerned about the impact that could have on rates of meningitis among children?
Removing the MenC containing vaccine for children at aged one means that young children will not be directly protected from MenC. Instead, they will be indirectly protected by the UK’s teenage MenACWY vaccination programme. The teenage MenACWY programme reduces transmission of the harmful bacteria amongst the wider population, reducing the risk of vulnerable babies being exposed – commonly called herd protection. However, when unimmunised children leave the protective UK environment and travel to countries where herd protection is not established, they may be at higher risk of contracting MenC.
At the moment there is very little MenC circulating in the UK, so the modelling used by the JCVI predicts that the increase in cases after removing the vaccine will be small. However, meningococcal disease is unpredictable. We have already seen an unexpected rapid resurgence of MenB disease in adolescents, which has followed an unusual seasonal pattern and indicates that the effects of the easing of COVID-19 restrictions on meningococcal disease is far from predictable (this unpredictability of infectious diseases post-lockdown is also being seen in other areas like Strep A and measles). In the run-up to vaccine supplies running out in 2025, and as the effects of COVID-19 restrictions diminish, it will be essential to closely monitor disease levels to check that the current modelling predictions are valid.
It will be important for teenage MenACWY vaccine uptake rates to be as high as possible to maintain the best levels of herd protection across the UK. COVID disruptions have had a long-lasting impact on schools-based immunisation programmes. 1 in 4 teenagers did not take up their MenACWY vaccine at school during the academic year 2020-21. Vaccine coverage data for MenACWY uptake in schools during the academic year 2021-22 is not yet available, but recently released data on HPV vaccine coverage shows that, for HPV vaccine, uptake rates continue to be lower than pre-pandemic levels. Any decline in teenage MenACWY vaccination rates is worrying and must be tackled through public health campaigning and targeted interventions.
What kind of illness and outcomes can infection with MenC have on children?
Meningitis is so feared by parents because it strikes healthy children without warning, is difficult to distinguish from milder illnesses like flu in the early stages, and can be fatal within 24 hours.
One in ten people who contract the disease will die and one in five survivors will be left with life-altering disabilities such as limb loss, deafness, epilepsy and brain damage.
For those that do survive with life-altering disabilities, there is also a wider ripple effect across their families, with significant long-term caring needs and costs becoming a part of daily life.
It is an awful, yet largely vaccine-preventable, infection.
What impact has the vaccination programme had on rates of MenC?
Thanks to the UK’s world-class childhood immunisation programme, we now only see a handful of MenC cases each year in the UK. This is incredible progress against a disease which in the late 1990s, before a vaccine had been introduced, affected nearly 1,000 people annually across England and Wales. However, it also means that clinicians are becoming increasingly unfamiliar with identifying and treating cases, which leads to poorer outcomes and highlights the importance of maintaining high level of protection against meningitis.
What would you like to see happen now?
The decision to remove MenC protection in infants was a missed opportunity to provide even broader protection against meningococcal disease alongside the MenACWY vaccine, maintaining resilience against the future introduction of virulent strains and protecting UK infants at home and abroad.
However, given the current low levels of meningococcal disease in young children, our most pressing concern is the resurgence of group B meningococcal disease (MenB) in teenagers and young adults. In the first quarter of 2022, MenB accounted for 90% of all meningococcal disease cases in England, with approximately half of these cases in young adults (aged 15 -24). MenB vaccine is available privately, which means protection is only an option for those who can afford it. Rather than removing public funds from the prevention of meningococcal disease, we would like to see renewed efforts towards providing protection for those who are currently most at risk i.e. young adults.
We will continue to work with the UK Health Security Agency (UKHSA) on sustained awareness-raising among teenagers, young adults and parents on the symptoms of meningitis and the preventative vaccines available to all age groups.
We also call for continued monitoring and transparency by UKHSA on vaccination coverage data and case incidence nationally and regionally (by local authority), releasing this publicly for analysis and enquiry to inform targeted public health interventions, including awareness-raising campaigning. We would like the recommendations on removing the infant dose of MenC to stay under review and be informed by this data, with rapid publication enabling ourselves and others to understand how the disease pattern is evolving for all strains of meningitis. We believe in being evidence-based and this should continue to inform public health decisions on meningitis, to see whether the modelling predictions are borne out in the real world.
Our response to the JCVI’s recommended changes (September 2022)
Joint Committee on Vaccination and Immunisation (JCVI) interim statement on the immunisation schedule for children (August 2022)