Public health impact and cost-effectiveness of introducing MenACWY vaccination strategies in Germany.

BACKGROUND

The invasive meningococcal disease (IMD) routine immunization recommendation in Germany is a meningococcal serogroup C (MenC) conjugate vaccine for toddlers aged 12 months with a catch-up for unimmunized up to 17 years. However, there are no recommendations for routine meningococcal serogroups A, C, W, Y (MenACWY) vaccination or for adolescent vaccinations; this differs from other European countries. This analysis aimed to understand the benefits of implementing adolescent MenACWY vaccination in Germany.

METHODS

A static population-cohort model evaluating IMD burden and related health outcomes (e.g., cases, cases with long-term sequelae, deaths) was developed to compare any two meningococcal vaccination strategies. We compared hypothetical vaccination strategies that included different approaches to adolescent vaccination in Germany, such as vaccinating at 13-year olds versus 16-year olds and vaccinating with MenC versus MenACWY. Additional strategies considered the benefit that could be provided by switching the current MenC vaccine recommendation in toddlers to MenACWY.

RESULTS

All strategies that included MenACWY vaccine were effective in decreasing the number of cases, preventing mortality and offered good value for money. The greatest benefit was observed in individuals vaccinated with MenACWY at 12 months and 16 years of age (2,978 IMD cases averted; 563 IMD deaths prevented). Compared with the current strategy of MenC vaccination at 12 months of age, two-dose strategies that included MenACWY reported incremental cost-effectiveness ratios <€13,205 per quality-adjusted life year. Adolescent strategies of MenC or MenACWY vaccine at 16 years old (with no vaccination at 12 months) dominated current vaccination strategies. Adolescent vaccination at 16 years old versus 13 years old offered slightly better value for money.

CONCLUSIONS

With recent increases in IMD cases and outbreaks occurring globally following the COVID-19 pandemic, there is a greater urgency to proactively implement a MenACWY vaccine recommendation to protect adolescents in Germany. This recommendation would provide direct protection to a group at increased risk and offer indirect protection to other population groups. Implementation of a school-based immunization program could increase vaccine uptake and overcome hurdles in adolescent vaccination.