Main points

This report presents vaccine coverage data for the routine school-aged Meningococcal ACWY (MenACWY) immunisation programme in England for the 2023/24 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 2024.

MenACWY vaccine coverage is presented for England at national, NHS commissioning region, and local authority (LA) level.

The main findings of this report are that:

• MenACWY coverage for year 9 students during the 2023/24 academic year was 72.1%, which is 3.5 percentage points higher than the year 9 cohort in 2022/23
• MenACWY coverage for year 10 students during the 2023/24 was 73.0%, which is 0.4 percentage points lower than the year 10 cohort in 2022/23
• MenACWY coverage in year 10 students was 4.4 percentage points higher than in the 2022/23 academic year when they were in year 9
• MenACWY coverage in year 9 students was lowest in London (64.1%) and highest in the East of England (79.3%)
• MenACWY coverage in year 10 students was lowest in London (64.1%) and highest in the South East (79.9%)

Table 1. MenACWY vaccination cohorts in the 2023/24 academic year

School year in 2023/24	Age in 2023/24	Dates of birth
9 (routine)	13 to 14 years	1 September 2009 to 31 August 2010
10 (routine or catch-up)	14 to 15 years	1 September 2008 to 31 August 2009

Results

Figure 1. MenACWY coverage in adolescents in school years 9 and 10 by academic year from 2015 to 2024

Figure 1 shows the MenACWY vaccine coverage for year 9 and year 10 students in England from 2015 to 2024. This data is also presented in text form in Table 2. MenACWY coverage for year 9 students during the 2023/24 academic year was 72.1%, which is 3.5 percentage points higher than the year 9 cohort in 2022/23. For year 10 students, coverage was 73.0% in the 2023/24 academic year, which is 0.4 percentage points lower than the year 10 cohort in the previous year.

Table 2. MenACWY coverage in years 9 and 10 from 2015 to 2024 [Note 1]

Academic year	Year 9 MenACWY coverage (%)	Year 10 MenACWY coverage (%)
2015 to 2016	84.1	77.2
2016 to 2017	83.6	82.5
2017 to 2018	86.2	84.6
2018 to 2019	88.0	86.7
2019 to 2020	58.3	87.0
2020 to 2021	76.3	80.8
2021 to 2022	69.2	79.6
2022 to 2023	68.6	73.4
2023 to 2024	72.1	73.0

Note 1. In 2015/16, 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 LAs have moved from routinely offering the vaccine in year 10 to offering it in year 9. During transitional years, some LAs offered the vaccine routinely to both year 9 and 10. This transition meant that in 2018/19, the year 9 data was incomplete meaning some LAs were excluded from national coverage figures. Since almost all LAs now offer the vaccine in year 9, the year 10 coverage figures from 2021/22 onwards 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.

Year 9 vaccine coverage

The main findings for the year 9 cohort were that:

• MenACWY coverage for year 9 students in 2023 to 2024 was 72.1%, which is 3.5 percentage points higher than year 9 students in the previous year
• MenACWY coverage in year 9 students was lowest in London (64.1%) and highest in the East of England (79.3%)
• LA level coverage ranged from 31.4% (Brent) to 91.8% (West Berkshire) (this range excludes those who only offer the vaccine routinely in year 10)
• out of 150 LAs, coverage in 53 (35.3%) was less than 70%, coverage in 57 (38.0%) was between 70% and 80%, coverage in 37 (24.7%) was between 80% and 90%, and coverage in 3 (2.0%) was greater than 90%

Figure 2. Year 9 MenACWY coverage by NHS commissioning region

Figure 2 shows the distribution of MenACWY vaccine coverage in school year 9 by NHS commissioning region. The boxes indicate the inter-quartile range (IQR), the range between the first and third quartiles, among constituent LAs in each NHS commissioning region. The median (second quartile) is indicated by the horizontal white line within each box. Vertical black lines indicate the range of coverage values among LAs that fall within 1.5 times the IQR above the third quartile or below the first quartile. LAs with coverage outside this range are considered outliers and indicated by a black dot.

MenACWY coverage in year 9 students was lowest in London (64.1%) and highest in the East of England (79.3%)

Figure 3 shows the geographical distribution of MenACWY vaccine coverage at the LA level for year 9 students in England. Coverage within LAs ranged from 31.4% in Brent to 91.8% in West Berkshire (this range excludes LAs who only offer the vaccine routinely in year 10).

Figure 3. Map of year 9 MenACWY coverage by LA [Note 2]

Note 2. Bolton and Wigan LAs only routinely offered MenACWY vaccination in school year 10 in the 2023/24 academic year, and so in this map of year 9 coverage they are greyed out.

Figure 3 shows the geographical distribution of MenACWY vaccine coverage at the LA level for year 9 students in England. Coverage within LAs ranged from 31.4% in Brent to 91.8% in West Berkshire (this range excludes LAs who only offer the vaccine routinely in year 10).

Year 10 vaccine coverage

The main findings for the year 10 cohort were that:

• MenACWY coverage for year 10 students in 2023 to 2024 was 73.0%, which is 0.4 percentage points lower than year 10 students in the previous year
• MenACWY coverage in year 10 students was 4.4 percentage points higher than in 2022 to 2023 when they were in year 9 suggesting ongoing catch up activities in year 10
• MenACWY coverage in year 10 students was lowest in London (64.1%) highest in the South East (79.9%)
• LA level coverage ranged from 31.9% (Brent) to 97.7% (Rochdale)
• out of 150 LAs, coverage in 60 (40.0%) was less than 70%, coverage in 48 (32.0%) was between 70% and 80%, coverage in 37 (24.7%) was between 80% and 90%, and coverage in 5 (3.3%) was greater than 90%

Figure 4. Year 10 MenACWY coverage by NHS commissioning region

Figure 4 shows the distribution of MenACWY vaccine coverage in school year 10 by NHS commissioning region. The boxes indicate the inter-quartile range (IQR), the range between the first and third quartiles, among constituent LAs in each NHS commissioning region. The median (second quartile) is indicated by the horizontal white line within each box. Vertical black lines indicate the range of coverage values among LAs that fall within 1.5 times the IQR above the third quartile or below the first quartile. LAs with coverage outside this range are considered outliers and indicated by a black dot.

MenACWY coverage in year 10 students was lowest in London (64.1%) and highest in the South East (79.9%)

Figure 5. Map of year 10 MenACWY coverage by local authority

Figure 5 shows the geographical distribution of MenACWY vaccine coverage at the LA level for year 10 students in England. Coverage within LAs ranged from 31.9% in Brent to 97.7% in Rochdale.

Discussion

MenACWY vaccine coverage for year 9 in 2023/24 was 72.1%. This is higher than coverage in 2022/23 and not yet back to pre-pandemic levels. Coverage in the year 10 cohort was 73.0%, 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 NHS commissioning region, the estimates varied considerably.

Background information

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. 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 at the end of this report.

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 LA. The biggest impact was observed in the 2019/20 academic year when all schools were closed in the first national lockdown. Throughout the 2020/21 academic year, school attendance rates in England were lower than normal. In January 2021, schools were closed to all, except children of key workers and vulnerable children, with a phased reopening of secondary schools from March 2021. Staff absences in both schools and school age immunisation services also added to the disruption.

Vaccine coverage in 2020/21 improved significantly but was still not back up to pre-pandemic levels. In the 2021/22 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. 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. In addition, the influenza immunisation programme was extended to all children in secondary schools. 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.

Prior to the academic year 2020/21, vaccine coverage 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 LA-level and submitted to 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 LA 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 2024. 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 LAs where NHSE commissioned school-aged providers did not run a MenACWY programme in year 9 or 10 are included in the coverage estimates.

LA-level MenACWY vaccine coverage data up to 31 August 2024 was manually uploaded by data providers to the ImmForm website retrospectively, from 1 September 2024 to 1 October 2024. The target population for the programme is defined by school age cohorts born between 1 September 2008 and 31 August 2010 (Table 1). This means that it includes those adolescents in school years 9 and 10 in the 2023/24 academic year. Coverage for the year 10 cohort was intended to capture both vaccines delivered during the 2022/23 academic year (when the students were in year 9) and routine or catch-up vaccines delivered in 2023/24.

For this report, the Isles of Scilly LA is merged with Cornwall LA due to small numbers.

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

Programme delivery

The JCVI recommends that the MenACWY vaccine is offered to students in year 9 or 10; however, the routine delivery schedule varies by LA depending on local requirements and resources. In the 2023/24 academic year, MenACWY was routinely offered to year 9 in 112 LAs, year 10 in 2 LAs, both year 9 and 10 in 27 LAs and an alternative schedule was used in 9 LAs. Out of the 150 LAs, 2 were unable to offer the vaccine to all eligible students in year 9 and 10.

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 2015/16 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 2016/17 and were not offered the vaccine).

2018 to 2019

NHS school-aged providers for 9 of the LAs offering a year 10 programme in 2017/18 transitioned to additionally offer the vaccine to year 9 students in 2018/19.

2019 to 2020

Only a small number of NHSE commissioned school-aged immunisation providers covering 4 LAs 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 LAs.