Laboratory confirmed cases of invasive meningococcal infection in England: October to December 2021
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 65 cases of invasive meningococcal disease (IMD) between October and December 2021. IMD cases reported during these 3 months were more than triple the number of cases in the equivalent period in 2020 when 19 cases were reported (table 1). However, IMD cases in this quarter were 65% lower than in the same period in 2019 when 185 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 has 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 From July 2021, COVID-19 containment measures were withdrawn in England.
The age distribution of meningococcal capsular groups causing IMD is summarised in table 2, with capsular group B (MenB) accounting for 88% (57 of 65) of all cases, followed by capsular group W (MenW) (n=3, 5%).
There were 57 MenB cases confirmed between October and December 2021, four-fold higher than in the equivalent period in 2020 (14 cases) and 50% fewer than in 2019 (115 cases). Three MenW cases were reported in this quarter compared to 1 case in the equivalent period in 2020. One case of capsular group E was reported in this quarter. No cases of capsular group C (MenC) were reported in this quarter compared to 1 case reported for the same period in 2020. No cases of capsular group Y (MenY) were reported in this quarter in 2021, nor in 2020 (table 1).
There were no reported cases for capsular groups A, X or Z/E.
Between October and December 2021, MenB was responsible for 13 of the 14 IMD cases in children aged less than 5 years of age. MenB accounted for the majority of cases (26 of 29) in individuals aged between 15 to 19 years and for the majority of cases in adults aged 45 years and older (7 of 9 cases) (table 2).
Of the 3 MenW cases confirmed between October and December 2021, 1 case was reported in an adult aged between 20 and 24 years of age, and 2 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 88.1% for the booster dose by 24 months – evaluated between October and December 2021 (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 reported in 2015, led to the introduction of MenACWY conjugate vaccine to the national immunisation programme 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.
Table 1. Invasive meningococcal disease in England by capsular group and laboratory testing method: October to December, 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 | 3 | 16 | 5 | 16 | 6 | 25 | 14 | 57 |
| C | 0 | 0 | 1 | 0 | 0 | 0 | 1 | 0 |
| W | 0 | 0 | 3 | 3 | 0 | 0 | 3 | 3 |
| Other** | 0 | 1 | 1 | 2 | 0 | 2 | 1 | 5 |
| Total | 3 | 17 | 10 | 21 | 6 | 27 | 19 | 65 |
*No cases of group A, X, Y 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: October to December 2021
| Age groups | Capsular group B | Capsular group W | Capsular group Other** | Total number | Total percentage |
|---|---|---|---|---|---|
| <1 year | 11 | 0 | 0 | 11 | 16.9% |
| 1 to 4 years | 2 | 0 | 1 | 3 | 4.6% |
| 5 to 9 years | 1 | 0 | 0 | 1 | 1.5% |
| 10 to 14 years | 1 | 0 | 0 | 1 | 1.5% |
| 15 to 19 years | 26 | 0 | 3 | 29 | 44.6% |
| 20 to 24 years | 5 | 1 | 0 | 6 | 9.2% |
| 25 to 44 years | 4 | 0 | 1 | 5 | 7.7% |
| 45 to 64 years | 5 | 0 | 0 | 5 | 7.7% |
| 65+ years | 2 | 2 | 0 | 4 | 6.2% |
| Total | 57 | 3 | 5 | 65 | – |
*No cases of group A, E, X 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).
References
1. Health Protection Report volume 16 issue 4 (29 March 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