JCVI recommends change to infant meningitis vaccines

The vaccine – known as Menitorix – has been part of the NHS routine immunisation schedule since 2006. It provides protection to infants and children from meningitis caused by two types of bacteria – Haemophilus influenzae type b (known as Hib) and meningococcal group C (known as MenC). 

The change has been prompted because the manufacturer of Menitorix, GSK, are to discontinue manufacturing the vaccine. The JCVI have therefore been considering how to replace this important vaccine for a number of years. 

They have recommended that the Hib part of the vaccination be given by providing an additional dose of the multivalent vaccine (6 in 1) at the age of 12 or 18 months. This will also protect children against diseases such as diphtheria, polio, tetanus, whooping cough and hepatitis B.

Herd immunity

However, the MenC part of the vaccine will not be replaced. Instead, the JCVI have suggested that herd immunity created by the successful uptake of the MenACWY vaccination in teenagers will be enough to protect infants and children.

This recommendation has been made following careful consideration and planning by the JCVI and the UK Health Security Agency. There is now very little disease caused by MenC and infants are being protected through herd immunity due to the success of the teenage MenACWY vaccine programme. The JCVI have also stressed that the change will be accompanied by close surveillance of disease incidence. 

No precise timeline for the change has been published although the JCVI statement suggests that the current schedule could continue until 2025, unless other changes are made to the schedule during this time.

Low rates of MenC

Responding to this change, CEO of Meningitis Now, Dr Tom Nutt said:

“This recommendation highlights what we can consider to be good news in that rates of meningitis caused by MenC are currently very low. It is also good news that the uptake of the MenACWY vaccination by teenagers is sufficiently high to afford protection from MenC to infants and children.

“However, the withdrawal of a vaccine that has demonstrably protected so many lives since 2006 will be a source of worry for many people and especially parents. Any change that lessens the direct protection afforded by vaccines will naturally be a cause for concern.

“At Meningitis Now, we are reassured by the evidence produced by the JCVI in support of this change. It does appear that herd immunity will be sufficient to protect infants and children.

“We will, however, keep this recommendation under close scrutiny and review. We plan to share all our concerns with the JCVI, including the views of all the Meningitis Now family. 

“And – of course – the recommendation underlines the importance of people taking up all vaccinations when offered them through the NHS. This is especially the case for teenagers being offered the MenACWY vaccination at school. By having this vaccination you not only protect yourself; you also save the lives of others.”  

Meningitis Now has also been working closely with Meningitis Research Foundation in our response to this proposed change. A spokesperson from MRF, Liz Rodgers, Head of Research, said:

“The evidence highlighted by the JCVI suggests that, due to the success of vaccination programmes in reducing invasive meningococcal A, C, W and Y disease in the UK, an infant MenC containing dose may no longer be required. With protection against MenC and MenW for babies reliant on the teenage MenACWY school-based vaccination programmes (a programme which was significantly impacted by the pandemic), achieving and maintaining high vaccine uptake rates will be more important than ever. Public health authorities maintaining strong surveillance of disease cases and vaccine uptake rates, and making such data publicly available, will remain essential. We welcome continued collaboration with UKHSA on awareness-raising initiatives, including for those who may have missed receiving their vaccine because of COVID-19 restrictions.”

Our chief executive, Dr Tom Nutt, has now written to the JCVI to express concern about the potential change, in particular that it is premature and could place lives at risk.

In the letter he says: “As you know, Meningitis Now has fought for four decades for the development and introduction of vaccines that can prevent meningitis and therefore save lives. It is therefore of significant concern to see the JCVI recommend the withdrawal of the MenC vaccine Menitorix from the NHS immunisation schedule on a timescale that is potentially ahead of 2025 when the vaccine will be discontinued.

“We recognise that the proposed change has been long-planned given changes to the manufacture of Menitorix. We also recognise the NHS immunisation schedule is never fixed and that change is constantly required to respond to shifts in the landscape of disease and the changing availability, efficacy and cost-effectiveness of vaccines.

“We therefore welcome the proposed changes to bring forward the second dose of the measles, mumps and rubella (MMR) vaccine from 3 years 4 months to 18 months of age. We are also pleased to note that, within the suite of changes proposed, protection from Hib will be sustained through the introduction of an additional dose of the hexavalent vaccine at 18 months.

Concerned proposals are premature

“We are, however, concerned that proposals to remove the MenC vaccination from the infant schedule are premature and could place lives at risk. We would therefore request that the JCVI gives specific consideration to our concerns as set out below.

1. Epidemiological modelling commissioned and reviewed by the JCVI has formed a critical part of the evidence used to inform this decision. The modelling suggests that indirect protection against MenC in infants will be sustained as a result of the teenage MenACWY programme and is therefore an adequate alternative to direct protection.
   
   We ask for more transparency regarding the evidence used for the modelling, including publication and peer-review of the model. This will help us to fully understand the decisions made, and to be able to communicate this clearly and with confidence to our supporters and a wider audience.
   
   
2. Cases of MenC disease are currently very low. However, meningococcal disease is unpredictable, with the possibility of new strains emerging over time. The long-term impact of the Covid-19 pandemic on meningococcal disease is not yet clear.
   
   We ask the JCVI to give assurance that changes to the MenC schedule do not take place before 2025 when stocks of Menitorix are expected to run out. This will allow time to monitor meningococcal disease and any new emerging risks.
   
   We also ask the JCVI to schedule a review of the decision to remove direct protection against MenC, in the year prior to the proposed withdrawal of Menitorix.
   
   
3. Good uptake of the MenACWY vaccine is vital to ensure effective herd protection. Vaccine uptake within the MenACWY schools programme has been significantly impacted during the Covid-19 pandemic. Although uptake of MenACWY is increasing again, it is not yet back to pre-pandemic rates and remains worryingly low in some regions. There is also a concerning trend of falling vaccination rates across the whole of the childhood schedule as reported in Childhood Vaccination Coverage Statistics – 2020-21. 
   
   We would welcome hearing what measures will be taken to ensure high vaccine uptake of MenACWY in teenagers (and all childhood vaccines), especially in localities and communities where take-up is sub-optimal. Meningitis Now would actively support, and contribute to, the efforts of JCVI and UKHSA to ensure that vaccine take-up is maximised wherever, and however, possible.

“I would be grateful to hear the response of the JCVI to our concerns.”

Read the JCVI statement here.

What do you think about the recommendation? We would welcome hearing your thoughts and views; email us with your comments to info@meningitisnow.org using the subject header 'JCVI'.