The impact of introducing meningococcal C/ACWY booster vaccination among adolescents in Germany: a dynamic transmission modelling study

BackgroundIn Germany, primary vaccination against invasive meningococcal disease (IMD) serogroup C aims to reduce the highest burden of IMD in infants aged 12-23 month. Due to another IMD-peak in adolescents, we modelled the potential impact of introducing adolescent boosters with conjugate meningococcal C or ACWY (MenC/MenACWY) vaccines. MethodsWe built an age- and serogroup-structured dynamic-transmission model for Germany, which we calibrated to national surveillance data in 2005-2019. We simulated five vaccination scenarios of either continuing with the current MenC primary vaccination (scenario 1), or additionally introducing MenC or MenACWY boosters at age 13 years (scenarios 2-3) or 16 years (scenarios 4-5). We performed comprehensive sensitivity analyses, including on the protection against carriage and serotype replacement. ResultsThe calibrated model projected for scenario 1 an annual mean of 243 (95%-uncertainty interval: 220-258) expected IMD cases over a 10-year period. Introducing the MenC booster prevented an estimated 5 (3.9-6.7) and the MenACWY booster 8 (6.7-9.1) IMD cases per year on average (scenario 2 and 3). The number-needed-to-vaccinate (NNVs) to prevent one IMD case were 140,000 (100,000-180,000) and 91,000 (76,000-100,000), respectively. To prevent one sequela or death, NNVs were higher (i.e., less efficient). Results were broadly similar for scenarios 4-5. Simulations suggested relevant serotype replacement starting eight-to-ten years after introducing the MenACWY booster. ConclusionsIntroducing adolescent MenC or MenACWY boosters marginally reduces the expected IMD burden in Germany. Effectiveness and efficiency of evaluated strategies depend on future incidence. The magnitude of future serotype replacement for the MenACWY vaccine is highly uncertain.