Laboratory confirmed cases of invasive meningococcal infection in England: January to March 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 57 cases of invasive meningococcal disease (IMD) between January and March 2022. IMD cases reported during these 3 months were triple the number of cases in the equivalent period in 2021 when 18 cases were reported (table 1). However, IMD cases in January and March 2021 were 66% lower than in the same period in 2020 when 169 cases were reported. This relatively 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 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 From July 2021, COVID-19 containment measures were withdrawn in England and overall case numbers have slowly increased.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 89% (51 of 57) of all cases, followed by capsular group W (MenW) (n=5, 9%).
There were 51 MenB cases confirmed between January and March 2022, 4-fold higher than in the equivalent period in 2021 (12 cases) and 56% fewer than in 2020 (116 cases). Five MenW cases were reported in this quarter compared to 1 and 24 cases in the equivalent periods in 2021 and 2020 respectively. No cases of capsular group C (MenC) were reported in this quarter, compared to one case reported for the same period in 2021. No cases of capsular group Y (MenY) were reported in this quarter in 2022, compared to 4 cases in 2021 (table 1).
There were no reported cases for capsular groups A, E, X, or Z.
Between January and March 2022, MenB was responsible for all IMD cases in individuals under 25 years of age (42 cases) and 60% of cases (9 of 15) aged 25 years and over (table 2).
Of the 5 MenW cases confirmed between January and March 2022, 1 case was reported in an adult aged between 25 and 44 years, and 3 cases in adults aged 65 or 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 for catch-up for the cohorts who missed vaccination at school.
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: January to March 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 | 1 | 12 | 5 | 15 | 6 | 24 | 12 | 51 |
| C | 0 | 0 | 1 | 0 | 0 | 0 | 1 | 0 |
| W | 0 | 1 | 0 | 3 | 1 | 1 | 1 | 5 |
| Y | 1 | 0 | 3 | 0 | 0 | 0 | 4 | 0 |
| Other** | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 1 |
| Total | 2 | 13 | 9 | 19 | 7 | 25 | 18 | 57 |
*No cases of group A, E, X or Z were confirmed during the periods summarised in the table.
**Other 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 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: January to March 2022
| Age groups | Capsular group B | Capsular group W | Capsular group Other** | Total number | Total percentage |
|---|---|---|---|---|---|
| <1 year | 9 | – | – | 9 | 15.8% |
| 1 to 4 years | 5 | – | – | 5 | 8.8% |
| 5 to 9 years | 2 | – | – | 2 | 3.5% |
| 10 to 14 years | 1 | – | – | 1 | 1.8% |
| 15 to 19 years | 19 | – | – | 19 | 33.3% |
| 20 to 24 years | 6 | – | – | 6 | 10.5% |
| 25 to 44 years | 3 | 1 | 1 | 5 | 8.8% |
| 45 to 64 years | 4 | 1 | – | 5 | 8.8% |
| 65+ years | 2 | 3 | – | 5 | 8.8% |
| Total | 51 | 5 | 1 | 57 | – |
*No cases of group A, E, X or Z were confirmed during the period summarised in the table.
**Other 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 four 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