Laboratory confirmed cases of invasive meningococcal infection in England: April to June 2022
Updated 1 June 2023
Applies to England
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In England, the national UK Health Security Agency (UKHSA) Meningococcal Reference Unit (MRU) confirmed 55 cases of invasive meningococcal disease (IMD) between April and June 2022. IMD cases reported during these 3 months were triple the number of cases in the equivalent period in 2021 when 17 cases were reported (table 1) and double the 29 cases reported in 2020. However, IMD cases in April and June 2022 were 55% lower than in the same, pre-pandemic, period in 2019 when 122 cases were reported. This relatively low number of confirmed meningococcal cases between April and June 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 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 From July 2021, COVID-19 containment measures were withdrawn in England and overall case numbers have slowly increased.
The age distribution of meningococcal capsular groups causing IMD is summarised in table 2, with capsular group B (MenB) accounting for 87% (48 of 55) of all cases, followed by 2 capsular group W (MenW) cases and 2 ungrouped/ungroupable cases.
There were 48 MenB cases confirmed between April and June 2022, three-fold higher than in the equivalent period in 2021 (15 cases) and double the then 22 cases reported in the same quarter of 2020. MenB cases in this quarter were 29% lower than the equivalent period in 2019 when 68 cases were reported.
Two MenW cases were reported in this quarter compared to 0, 4 and 32 cases in the equivalent periods in 2021, 2020 and 2019 respectively. One case of capsular group C (MenC) was reported in this quarter compared to 0, 2 and 9 cases reported for the same quarter in 2021, 2020 and 2019 respectively. One case of capsular group Y (MenY) was reported in this quarter in 2022 compared to 2 cases in 2021, none in 2020 and 12 in 2019.
Between April and June 2022, 1 case of capsular group A (MenA) was reported, with the 2 previous MenA cases in England reported in 2014 and 2011. There were no reported cases for other capsular groups.
Between April and June 2022, MenB was responsible for 38 out of 39 IMD cases in individuals aged under 25 years of age and 63% (10 of 16 cases) of cases aged 25 years and over (table 2). Forty-four percent of all cases of invasive meningococcal disease and 48% of all MenB cases arose in young people aged 15 to 24 years during this time.
Both MenW cases and the MenC case confirmed between April and June 2022 were reported in adults aged 45 and older. The MenY and MenA cases were reported in adults aged 65 years and older.
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 92.0% for 2 doses at 12 months of age and 88.6% for the booster dose by 24 months – evaluated between January and March 2022 (1). The 2-dose infant MenB schedule has been shown to be highly effective in preventing MenB disease in infants (2).
The earlier increase in MenW cases, which had been previously reported, 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% (year 9), and 80.9% (year 10) (3). Local arrangements are being made to catchup 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: April to June 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 | 3 | 7 | 3 | 10 | 9 | 31 | 15 | 48 |
| C | – | – | – | 1 | – | – | – | 1 |
| W | – | – | – | 2 | – | – | – | 2 |
| Y | – | – | 1 | 1 | 1 | – | 2 | 1 |
| Other** | – | – | – | – | – | 3 | – | 3 |
| Total | 3 | 7 | 4 | 14 | 10 | 34 | 17 | 55 |
*No cases of group E, X or Z were confirmed during the periods summarised in the table.
**‘Other’ includes group A and ungrouped or ungroupable. ‘Ungroupable’ refers to invasive clinical meningococcal isolates that were non-groupable, while ‘ungrouped’ cases refer 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 2022
| Age groups | Capsular group B | Capsular group C | Capsular group W | Capsular group Y | Capsular group Other** | Total number | Total percentage |
|---|---|---|---|---|---|---|---|
| <1 year | 6 | – | – | – | – | 6 | 10.9% |
| 1 to 4 years | 6 | – | – | – | – | 6 | 10.9% |
| 5 to 9 years | – | – | – | – | – | – | 0.0% |
| 10 to 14 years | 3 | – | – | – | – | 3 | 5.5% |
| 15 to 19 years | 14 | – | – | – | 1 | 15 | 27.3% |
| 20 to 24 years | 9 | – | – | – | – | 9 | 16.4% |
| 25 to 44 years | 3 | – | – | – | 1 | 4 | 7.3% |
| 45 to 64 years | 2 | 1 | 1 | – | – | 4 | 7.3% |
| 65+ years | 5 | – | 1 | 1 | 1 | 8 | 14.5% |
| Total | 48 | 1 | 2 | 1 | 3 | 55 | – |
*No cases of group E, X or Z were confirmed during the period summarised in the table.
**‘Other’ includes group A and ungrouped or ungroupable. ‘Ungroupable’ refers to invasive clinical meningococcal isolates that were non-groupable, while ‘ungrouped’ cases refer to culture-negative but PCR screen (ctrA) positive and negative for the 4 genogroups (B, C, W and Y) routinely tested for.
References
1. Health Protection Report volume 16 issue 6 (28 June 2022) ‘Quarterly vaccination coverage statistics for children aged up to five years in the UK (COVER programme)’
2. Parikh SR and others (2016) ‘Effectiveness and impact of a reduced infant schedule of 4CMenB vaccine against group B meningococcal disease in England: a national observational cohort study’, The Lancet: volume 388 issue 10061
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