Laboratory confirmed cases of invasive meningococcal infection in England: January to March 2021
Updated 25 January 2022
Applies to England
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In England, the national Public Health England (PHE) Meningococcal Reference Unit (MRU) confirmed 18 cases of invasive meningococcal disease (IMD) between January and March 2021. IMD cases were 89% lower during these 3 months compared to 169 cases in the equivalent period in 2020 (table 1). This low number of confirmed cases 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.
The age distribution of meningococcal capsular groups causing IMD is summarised in table 2, with capsular group B (MenB) accounting for 67% (12 of 18) of all cases, followed by MenY (n=4, 22%), and 1 case each of MenW and MenC.
There were 12 MenB cases confirmed between January and March 2021, 90% lower than the equivalent period in 2020 (116 cases). MenW cases were 96% lower (1 case) than the number of cases confirmed in the same time period in 2020 (24 cases). In this quarter of 2021, 1 case was confirmed with MenC disease compared to 10 cases in the equivalent period in 2020. There were 4 confirmed cases of MenY during this quarter of 2021, a 76% reduction compared to the previous year (17 cases) (table 1). There were no reported cases for capsular groups A, X or Z/E, or of ungrouped or ungroupable capsular group, during the reporting period in 2021.
Between January and March 2021, MenB was responsible for 6 cases of IMD in children aged less than 5 years of age. MenB also accounted for 71%, (5 of 7) of cases in individuals aged between 5 and 64 years and for 1 of 5 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 91.8% for 2 doses at 12 months of age and 88.5% for the booster dose by 24 months old (evaluated between January and March 2021). The 2-dose infant MenB schedule has been shown to be highly effective in preventing MenB disease in infants.
Of the 4 MenW cases confirmed between January and March 2021, all cases were reported in adults aged 65 years or older.
There was only 1 reported case of MenW for this period, in a 20 to 24 year old. The earlier increase in MenW cases, which had 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. The 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 2019 to 2020 school year and evaluated up to the end of March 2021 was:
- 53.8% – year 9 in 2019 to 2020
- 87.0% – 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 institutions.
Table 1: Invasive meningococcal disease in England by capsular group and laboratory testing method: January to March, 2020 and 2021
| Capsular groups* | Culture and PCR (2020) | Culture and PCR (2021) | Culture only (2020) | Culture only (2021) | PCR only (2020) | PCR only (2021) | Total (2020) | Total (2021) |
|---|---|---|---|---|---|---|---|---|
| B | 23 | 1 | 33 | 5 | 60 | 6 | 116 | 12 |
| C | 1 | 0 | 6 | 1 | 3 | 0 | 10 | 1 |
| W | 1 | 0 | 19 | 0 | 4 | 1 | 24 | 1 |
| Y | 3 | 1 | 12 | 3 | 2 | 0 | 17 | 4 |
| Other** | 0 | 0 | 1 | 0 | 1 | 0 | 2 | 0 |
| Total | 28 | 2 | 71 | 5 | 70 | 7 | 169 | 18 |
*No cases of group A or Z were confirmed during the periods summarised in the table.
**‘Other’ includes group E 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: January to March 2021
| Age groups | Capsular group B | Capsular group C | Capsular group W | Capsular group Y | Total number | Total percentage |
|---|---|---|---|---|---|---|
| <1 year | 3 | 0 | 0 | 0 | 3 | 16.7% |
| 1 to 4 years | 3 | 0 | 0 | 0 | 3 | 16.7% |
| 5 to 9 years | 1 | 0 | 0 | 0 | 1 | 5.6% |
| 10 to 14 years | 0 | 0 | 0 | 0 | 0 | 0.0% |
| 15 to 19 years | 1 | 0 | 0 | 0 | 1 | 5.6% |
| 20 to 24 years | 0 | 1 | 1 | 0 | 2 | 11.1% |
| 25 to 44 years | 2 | 0 | 0 | 0 | 2 | 11.1% |
| 45 to 64 years | 1 | 0 | 0 | 0 | 1 | 5.6% |
| 65+ years | 1 | 0 | 0 | 4 | 5 | 27.8% |
| Total | 12 | 1 | 1 | 4 | 18 | – |
*No cases of group A or E/Z, or of ungrouped or ungroupable capsular group, were confirmed during the periods summarised in the table.