Abstract
Introduction
Diagnoses of gonorrhoea in England rose by 26% between 2018 and 2019. Recent evidence that a vaccine against meningococcal B disease currently offered to infants in the UK (4CMenB) could additionally protect (with 31% efficacy) against gonorrhoea has led to renewed hope for a vaccine. A Phase 2 proof-of-concept trial of 4CMenB vaccination against gonorrhoea in adults is currently underway.
Objectives
To investigate the potential public health impact of adolescent gonorrhoea vaccination in England, considering different implementation strategies.
Methods
We developed a deterministic transmission-dynamic model of gonorrhoea infection among heterosexual 13–64-year-olds stratified by age, sex and sexual activity. We explored the impact of a National Immunisation Programme (NIP) among 14-year-olds for a vaccine with 31% efficacy, 6 years’ duration of protection, and 85% uptake. We also explored how impact might change for varying efficacy (20–50%) and uptake (75–95%), the addition of a catch-up programme, the use of boosters, and varying duration of protection.
Results
An NIP against gonorrhoea could lead to 50,000 (95% credible interval, CrI 31,000-80,000) and 849,000 (95%CrI 476,000-1,568,000) gonorrhoea infections being averted over 10 and 70 years, respectively, in England, for a vaccine with 31% efficacy and 85% uptake. This is equivalent to 25% (95%CrI 17–33%) of heterosexual infections being averted over 70 years. Vaccine impact is predicted to increase over time and be greatest among 13–18-year-olds (39% of infections 95%CrI 31–49% averted) over 70 years. Varying vaccine efficacy and duration of protection had a noticeable effect on impact. Catch-up and booster vaccination increased the short- and long-term impact, respectively.
Conclusions
A partially-effective vaccine against gonorrhoea infection, delivered to 14-year-olds alongside the MenACWY vaccine, could have an important population impact on gonorrhoea. Catch-up and booster vaccination could be considered alongside cohort vaccination to increase impact.
Diagnoses of gonorrhoea in England rose by 26% between 2018 and 2019. Recent evidence that a vaccine against meningococcal B disease currently offered to infants in the UK (4CMenB) could additionally protect (with 31% efficacy) against gonorrhoea has led to renewed hope for a vaccine. A Phase 2 proof-of-concept trial of 4CMenB vaccination against gonorrhoea in adults is currently underway.
Objectives
To investigate the potential public health impact of adolescent gonorrhoea vaccination in England, considering different implementation strategies.
Methods
We developed a deterministic transmission-dynamic model of gonorrhoea infection among heterosexual 13–64-year-olds stratified by age, sex and sexual activity. We explored the impact of a National Immunisation Programme (NIP) among 14-year-olds for a vaccine with 31% efficacy, 6 years’ duration of protection, and 85% uptake. We also explored how impact might change for varying efficacy (20–50%) and uptake (75–95%), the addition of a catch-up programme, the use of boosters, and varying duration of protection.
Results
An NIP against gonorrhoea could lead to 50,000 (95% credible interval, CrI 31,000-80,000) and 849,000 (95%CrI 476,000-1,568,000) gonorrhoea infections being averted over 10 and 70 years, respectively, in England, for a vaccine with 31% efficacy and 85% uptake. This is equivalent to 25% (95%CrI 17–33%) of heterosexual infections being averted over 70 years. Vaccine impact is predicted to increase over time and be greatest among 13–18-year-olds (39% of infections 95%CrI 31–49% averted) over 70 years. Varying vaccine efficacy and duration of protection had a noticeable effect on impact. Catch-up and booster vaccination increased the short- and long-term impact, respectively.
Conclusions
A partially-effective vaccine against gonorrhoea infection, delivered to 14-year-olds alongside the MenACWY vaccine, could have an important population impact on gonorrhoea. Catch-up and booster vaccination could be considered alongside cohort vaccination to increase impact.
| Original language | English |
|---|---|
| Article number | 1 |
| Journal | BMC Public Health |
| Volume | 23 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 10 Jan 2023 |
Bibliographical note
Funding Information:This work was supported by GlaxoSmithKline Biologicals SA. KJL reports grants from WHO paid to her employer outside the submitted work; NB is a freelance consultant for GSK and therefore received consulting fees during the conduct of the study; EB was an employee of GSK during the course of this study and holds shares in GSK; JS was an employee of GSK during the course of this study and holds shares in GSK; KMET reports that since the completion of this work she has changed position and has received payment to her current employer (Aquarius Population Health) for expert consultation in related projects including participation in an expert advisory board for GSK; HC reports honoraria from Sanofi-Pasteur, and consultancy fees from IMS Health and AstraZeneca all paid to her employer, and outside of the submitted work; RB does not declare any competing interests.
Funding Information:
KJL, KMET and HC are members of the NIHR Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol. The authors thank Martin Homer (University of Bristol) and Kinga Meszaros (GSK) for their insightful comments on the manuscript, Holly Mitchell (UK Health Security Agency) for providing gonorrhoea diagnosis data by single year of age, and Catherine Mercer (UCL) for providing bespoke data analyses for Natsal-3. Bexsero is a trademark owned by or licensed to GSK.
Funding Information:
This work was supported by GlaxoSmithKline Biologicals SA. KJL had full access to all data in the study and had final responsibility for the decision to submit for publication. HC is also funded by an NIHR Career Development Fellowship (CDF-2018-11-ST2–015). The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated, the NHS, the NIHR, the Department of Health and Social Care or the UK Health Security Agency (UKHSA).
Publisher Copyright:
© 2022, The Author(s).
Access to Document
- Full-text PDF (final published version)
This is the final published version of the article (version of record). It first appeared online via BMC at https://doi.org/10.1186/s12889-022-14670-z . Please refer to any applicable terms of use of the publisher.