title: Meningococcal serogroup B strain coverage of the multicomponent 4CMenB vaccine with corresponding regional distribution and clinical characteristics in England, Wales, and Northern Ireland, 2007-08 and 2014-15: a qualitative and quantitative assessment.
abstract: The UK introduced 4CMenB-a multicomponent vaccine against serogroup B meningococcal disease-into the national infant immunisation programme in September, 2015. The Meningococcal Antigen Typing System (MATS) was used to estimate coverage by 4CMenB of invasive meningococcal group B isolates obtained during 2007-08 in England and Wales (MATS coverage). We aimed to repeat the MATS survey for invasive meningococcal group B isolates obtained during 2014-15, before 4CMenB introduction; compare strain coverage between 2007-08 and 2014-15; and investigate associations between MATS coverage, age, region, and disease outcomes.
  
  
  
  Invasive serogroup B meningococcal isolates from cases in England, Wales, and Northern Ireland during 2014-15 were assayed using MATS and compared with 2007-08 data. MATS coverage was assessed by geographical region and age group. Clinical characteristics, risk factors, and outcomes were assessed according to MATS coverage for 2014-15 English cases.
  
  
  
  In 2014-15, 165 of 251 (66%; 95% CI 52-80) meningococcal group B isolates were estimated by MATS to be covered by 4CMenB, compared with 391 of 535 (73%; 95% CI 57-87) in 2007-08. The proportion of MATS-positive isolates with one vaccine antigen increased from 23% (122 of 535) in 2007-08 to 31% (78 of 251) in 2014-15, whereas the proportion with more than one antigen fell from 50% (269 of 535) to 35% (87 of 251). This effect reflected changes in circulating strains, particularly ST-269 clonal complex strains. MATS coverage increased with age, varied by geographical region, and was associated with more severe disease.
  
  
  
  In 2014-15, two-thirds of meningococcal group B isolates were predicted to be covered by 4CMenB. Temporal changes in MATS coverage underscore the need for continued monitoring of antigen expression and diversity, particularly in countries with 4CMenB programmes.
  
  
  
  Public Health England, GlaxoSmithKline.
authors.affiliation: Immunisation Department, Public Health England, London, UK. Electronic address: sydel.parikh@phe.gov.uk.
authors.forename: Sydel R
authors.initials: SR
authors.lastname: Parikh
authors.affiliation: Meningococcal Reference Unit, Public Health England, Manchester, UK.
authors.forename: Lynne
authors.initials: L
authors.lastname: Newbold
authors.affiliation: Meningococcal Reference Unit, Public Health England, Manchester, UK.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Slater
authors.affiliation: GlaxoSmithKline Vaccines, Siena, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Stella
authors.affiliation: Médecins Sans Frontières, Nukus, Uzbekistan.
authors.forename: Monica
authors.initials: M
authors.lastname: Moschioni
authors.affiliation: Meningococcal Reference Unit, Public Health England, Manchester, UK.
authors.forename: Jay
authors.initials: J
authors.lastname: Lucidarme
authors.affiliation: GlaxoSmithKline Vaccines, Siena, Italy.
authors.forename: Rosita
authors.initials: R
authors.lastname: De Paola
authors.affiliation: GlaxoSmithKline Vaccines, Siena, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Giuliani
authors.affiliation: GlaxoSmithKline Vaccines, Siena, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Serino
authors.affiliation: Meningococcal Reference Unit, Public Health England, Manchester, UK.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Gray
authors.affiliation: Meningococcal Reference Unit, Public Health England, Manchester, UK.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Clark
authors.affiliation: Meningococcal Reference Unit, Public Health England, Manchester, UK.
authors.forename: Jamie
authors.initials: J
authors.lastname: Findlow
authors.affiliation: GlaxoSmithKline Vaccines, Siena, Italy.
authors.forename: Mariagrazia
authors.initials: M
authors.lastname: Pizza
authors.affiliation: Immunisation Department, Public Health England, London, UK.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Ramsay
authors.affiliation: Immunisation Department, Public Health England, London, UK; St George's University of London, London, UK.
authors.forename: Shamez N
authors.initials: SN
authors.lastname: Ladhani
authors.affiliation: Meningococcal Reference Unit, Public Health England, Manchester, UK.
authors.forename: Ray
authors.initials: R
authors.lastname: Borrow
mesh_terms: D000942:Antigens, Bacterial / Q000097:blood / Q000276:immunology; D002675:Child, Preschool; D004739:England; D006801:Humans; D017589:Immunization Programs; D007115:Immunization Schedule; D007223:Infant; D008589:Meningococcal Infections / Q000517:prevention & control*; D022401:Meningococcal Vaccines / Q000008:administration & dosage* / Q000276:immunology; D038541:Neisseria meningitidis, Serogroup B / Q000276:immunology / Q000302:isolation & purification*; D009660:Northern Ireland; D014852:Wales
chemical_list: C570015:4CMenB vaccine; D000942:Antigens, Bacterial; D022401:Meningococcal Vaccines