B Part of It School Leaver Study: A Repeat Cross-Sectional Study to Assess the Impact of Increasing Coverage with Meningococcal B (4CMenB) Vaccine on Carriage of Neisseria meningitidis

Mark McMillan, Ann P. Koehler, Andrew Lawrence, Thomas R. Sullivan, Jana Bednarz, Jenny M. MacLennan, Martin C.J. Maiden, Shamez N. Ladhani, Mary E. Ramsay, Caroline Trotter, Ray Borrow, Adam Finn, Charlene M. Kahler, Jane Whelan, Kumaran Vadivelu, Peter C. Richmond, Helen S. Marshall

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Background: Recombinant protein-based vaccines targeting serogroup B meningococci protect against invasive disease but impacts on carriage are uncertain. This study assessed carriage prevalence of disease-associated meningococci in 2018-2020 as the proportion of vaccinated adolescents increased following introduction of a school-based 4CMenB immunization program. Methods: Eligible participants who completed high school (aged 17-25) in South Australia in the previous year had an oropharyngeal swab taken and completed a risk factor questionnaire. Disease-associated meningococci (genogroups A, B, C, W, X, Y) were detected by meningococcal and genogroup-specific polymerase chain reaction. Results: The analysis included 4104 participants in 2018, 2690 in 2019, and 1338 in 2020. The proportion vaccinated with 4CMenB increased from 43% in 2018, to 78% in 2019, and 76% in 2020. Carriage prevalence of disease-associated meningococci in 2018 was 225/4104 (5.5%). There was little difference between carriage prevalence in 2019 (134/2690, 5.0%; adjusted odds ratio [aOR], 0.82; 95% confidence interval [CI],. 64-1.05) and 2020 (68/1338, 5.1%; aOR, 0.82; 95% CI,. 57-1.17) compared to 2018. Conclusions: Increased 4CMenB uptake in adolescents was not associated with decline in carriage of disease-associated meningococci. 4CMenB immunization programs should focus on direct (individual) protection for groups at greatest risk of disease. Clinical Trials Registration: NCT03419533.

Original languageEnglish
Pages (from-to)637-649
Number of pages13
JournalJournal of Infectious Diseases
Issue number4
Publication statusPublished or Issued - 15 Feb 2022


  • 4CMenB
  • Carriage
  • Herd protection
  • Meningococcal
  • Neisseria meningitidis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Infectious Diseases

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