Select Committee on Health Appendices to the Minutes of Evidence

Attachment 9



  Until this year around 250 people died from meningococcal disease in England and Wales each year, the majority (over 60 per cent) of these deaths are in young people under the age of 20. The disease peaks each year in the winter months, with the rise starting around November and reaching a peak in early January. As well as the tragic loss of young lives these cases raise considerable fear and anxiety in the public, especially when they involve outbreaks.


  In the UK there are two main types of meningococcus, serogroups B and C. In recent years a third of all meningococcal cases have been due to group C, and in those aged 10 years and over, more than half the cases are due to C. Because C disease is more severe than B, more than half the deaths, around 150 each year, are due to C. The first "conjugate" vaccines against group C went into clinical trial in the US in 1992, and in 1994, with funding from the Department of Health, the PHLS embarked on a programme to accelerate their introduction in the UK. In a co-ordinated series of trials involving infants, pre-schoolers, school children and university students, the new conjugate vaccines were found to be safe, to produce protective antibody levels in almost all recipients and, unlike the existing "plain" C vaccines, to induce immunological memory—the basis of long lasting protection. Potentially therefore they could prevent many deaths over successive years, particularly if introduced with a catch up programme for all pre-school and school aged children.


  In view of the winter peak in cases and deaths, and with the prospect of licensure of the first conjugate vaccines in autumn 1999, a decision was taken to introduce them into the national immunisation programme in a phased manner. The programme began in November 1999 with immunisation of the highest risk groups, infants and adolescents, with extension to other age groups as more supplies became available during 2000. The implementation strategy was led by the Department of Health with reliance on PHLS to monitor both the process (ie vaccine coverage by age) and outcome. The latter required PHLS to establish enhanced surveillance to monitor the impact on meningococcal disease and to establish the efficacy and safety of the vaccine under conditions of routine use. High quality post licensure surveillance data is particularly important for this vaccine as the UK is the first country to use it. At considerable speed, the PHLS and collaborators, notably those of the Institute of Child Health (London), developed a detailed surveillance plan and protocol for the investigation of vaccine failures. Such a surveillance programme requires considerable co-ordination as the contributors include paediatricians who may see children with meningococcal disease, NHS and PHLS microbiologists who receive specimens from suspected cases, consultants in communicable disease control as well as the national reference and surveillance centres of the PHLS


  Preliminary findings indicate that the vaccine has been highly successful. Cases in the two targeted age groups have dramatically fallen compared with previous years, with so far only one vaccine failure identified. In the first three months of 2000 there were only 10 cases of meningococcal disease in one and two-year-olds compared to an expected 37 based on previous years' figures. For 15 to 17-year-olds the number observed was 16 compared to the 70 that were expected.


  Communicable Disease Surveillance Centre. Meningococcal disease falls in vaccine recipients. CDR Weekly 2000; 10: 133,6.

  Prepared by Drs Liz Miller CDSC and Ed Kaczmarski (PHLS Meningococcal Reference Laboratory).

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Prepared 28 March 2001