Oscar Herrera-Restrepo

Invasive meningococcal disease (IMD) is an uncommon but serious infectious disease caused by Neisseria meningitidis that may result in death or long-term sequelae.1,2 In the overall population of t...

1. Invasive meningococcal disease (IMD) is a severe infectious disease that can result in extreme acute morbidity and case fatality rates as high as 15–20%, even with appropriate treatment [1,2]. O...

Invasive meningococcal disease (IMD) is a vaccine-preventable, serious disease. In 2023-2024, the United States (US) Advisory Committee on Immunization Practices (ACIP) proposed revisions to the adolescent meningococcal vaccine schedule. This survey aimed to understand healthcare professionals' (HCPs') perspectives on these revisions and the potential role of the meningococcal serogroups A, B, C, W, Y (MenABCWY) vaccine. An online survey was conducted in May - June 2025 among US HCPs who regularly recommend meningococcal vaccines for 16-23-year-old patients. Responses were analyzed descriptively. Of 302 HCPs, 73.2% felt the MenABCWY vaccine provides significant value to the meningococcal vaccination program, and almost half preferred a two-dose MenABCWY schedule over the ACIP recommendation, wherein a MenABCWY dose is followed by a MenB dose. Most HCPs indicated concern with removing MenACWY vaccination for 11-12-year-olds (84.8%). Comparatively, fewer were concerned about changing the MenB vaccine recommendation from shared clinical decision-making to risk-based (60.6%) and administering the second MenB dose closer to college entry (48.7%). While HCPs were receptive to revisions that simplify the vaccine schedule, this was not without concerns. The adolescent vaccination platform is essential to ensure continued protection against IMD; any changes will require clear, evidence-based guidance.

Background: Invasive meningococcal disease (IMD) is associated with high case-fatality rates and severe long-term sequelae. In the United States (US), IMD incidence rate (IR) is highest among infants aged <1 year, with most cases occurring in infants aged <6 months. This study estimated IMD incidence in commercially and Medicaid-insured infants, toddlers, and children aged <11 years. Methods: This retrospective claims analysis utilized real-world data (01 January 2005 to 31 December 2022) from the MarketScan® Commercial and Multi-State Medicaid Research Databases of infants (aged <1 year), toddlers (aged 1–4 years), and children (aged 5–10 years). IMD incidence, time at risk for IMD, IR, and IR ratio (IRR) were evaluated overall and by demographic/clinical characteristics. Results: Within the commercially and Medicaid-insured cohorts, 21 and 115 infants, 34 and 80 toddlers, and 36 and 37 children with IMD were identified, respectively. Overall IMD IRs in infants, toddlers, and children were 0.45, 0.17, and 0.11 per 100 000 person-years (PY; commercially insured) and 1.97, 0.45, and 0.18 per 100 000 PY (Medicaid-insured), respectively. Incidence rates were highest in infants aged <4 months (1.03 and 4.65 per 100 000 PY for infants aged 2 to <3 months [commercially insured] and 1 to <2 months [Medicaid-insured], respectively). Significantly elevated IRRs were observed among infants and children with specific demographic and clinical characteristics, including residence in rural counties, immunocompromised status, and complement component deficiency. Conclusions: IMD incidence is low in the United States, but varies by age, insurance type, and demographic/clinical characteristics. Timely preventative interventions, such as early vaccination, may reduce the incidence, risk, and associated burden of IMD.

Background In 2025, invasive meningococcal disease (IMD) vaccination in United States (US) adolescents consisted of two standard of care (SoC) schedules: Q-Q-B-B (routine MenACWY [Q] at ages 11 and 16 years; MenB [B] under shared clinical decision-making [SCDM] at age 16 years and 6 months later) or Q-P-B (routine MenACWY at ages 11 and 16 years; MenABCWY [P] at age 16 years and MenB under SCDM 6 months later). We assessed public health impact (PHI) and cost-effectiveness (CE) of intervention strategies on the basis of potential implementation options and revisions to the adolescent meningococcal vaccine schedule proposed in June 2024 by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices. Methods A model utilizing epidemiological and economic inputs compared projected outcomes for 27 intervention strategies (distinguished by vaccine type [Q, P, and/or B], recommendation type [routine, risk-based], and dosing interval for MenB-containing vaccines [0,6-month , 0,24-month]) versus no vaccination or SoC over 15 years (2025–2039). Discounted outcomes (societal perspective) included IMD cases, deaths, and quality-adjusted life-year losses averted; total direct and indirect costs; and incremental CE ratios. Results Retaining routine MenACWY at age 11−12 years and including routine or risk-based MenB-containing vaccines at age 16 years improved PHI versus SoC, particularly with 0,6-month dosing interval for MenB-containing vaccines. Five strategies incorporating MenABCWY improved PHI and were cost-saving versus SoC: Q-Q-B-B. Conclusions Adolescent meningococcal vaccine schedule revisions retaining routine MenACWY and incorporating risk-based or routine MenABCWY may increase PHI in a cost-effective manner, minimizing the humanistic and economic burden of IMD. Graphical Abstract

Several vaccines are recommended for 16-23-year-olds in the United States, but coverage varies widely across these vaccines. Previous studies have indicated that routine healthcare visits are associated with vaccination uptake. This study aimed to describe healthcare visit patterns among 16-23-year-olds to identify challenges and inform opportunities to reach adolescents and young adults for vaccination. A descriptive, retrospective database analysis was conducted of commercially insured and Medicaid-insured 16-23-year-olds from 2019-2022 using IQVIA's PharMetrics® Plus claims database and open-source Longitudinal Prescription/Medical claims databases. The proportion of 16-23-year-olds with healthcare provider (HCP) visits, visit types, provider types involved, visits including vaccination, and specific vaccines delivered were analyzed. In 2022, 68.2% of commercially insured 16-23-year-olds had ≥1 HCP visit. Most commercially insured and Medicaid-insured individuals with ≥1 HCP visit had sick visits (72.9-80.6%). The proportion of individuals with preventative visits was lower as age increased (commercially insured: 73.2% at 16, 67.4% at 18, 56.3% at 19, and 45.3% at 23 years). Lower proportions of individuals with preventative visits with increasing age were also seen among Medicaid-insured individuals, ranging from 53.7% at 16 years to 28.0% at 23 years. Among 16-18-year-olds with ≥1 HCP or pharmacy visit in 2022, 52.6% in the commercial cohort and 33.0% in the Medicaid cohort had visits that involved vaccination; for 19-23-year-olds, these proportions were 34.5% and 25.6%, respectively. Vaccination rates by vaccine type were largely aligned with the ages specified by recommendations, but nonetheless were low. Approximately one-third of commercially insured 16-23-year-olds did not have an annual HCP visit, and among commercially insured and Medicaid-insured individuals who did have visits, a substantial proportion did not have preventative visits; this proportion was higher with increasing age. The proportions of visits with vaccination were particularly low for 19-23-year-olds. Targeted interventions to promote routine visits, including framing these as opportunities for immunization, may help to increase vaccination uptake; based on the findings of this analysis, these efforts should consider age-specific shifts in health-seeking behaviors.

In the United States (US), meningococcal serogroup B (MenB) vaccination is currently recommended under shared clinical decision-making for 16-23-year-olds to prevent invasive meningococcal disease; the MenB vaccine may be co-administered with other vaccines recommended for this age group. A retrospective analysis of two US health insurance claims databases was conducted to estimate the proportion of commercially insured and Medicaid-insured 16-23-year-olds with potential missed opportunities for MenB vaccine series initiation via co-administration. Potential missed opportunities were defined as visits with healthcare providers during which other recommended vaccines (MenACWY, Tdap, HPV, influenza, and/or COVID-19) were administered, but not the initial MenB vaccine dose. In 2022, 74.5% of commercially insured and 67.1% of Medicaid-insured 16-23-year-olds had potential missed opportunities for MenB vaccination initiation via co-administration. The proportion of missed opportunities was higher among 19-23-year-olds (versus 16-18-year-olds) and lower for visits with pediatricians (versus internists or general practitioners/family physicians). The most frequently co-administered vaccine was the MenACWY vaccine. Many 16-23-year-olds had potential missed opportunities for MenB series initiation via co-administration. Increasing awareness of the opportunity to initiate the MenB series via co-administration may improve meningococcal vaccination coverage in the United States.

In the United States, while meningococcal vaccines are available and recommended for adolescents and young adults, coverage remains low and disparities persist. We evaluated meningococcal serogroups A, C, W, Y (MenACWY) and B (MenB) vaccine uptake, completion, and compliance using a cross-sectional analysis of National Immunization Survey-Teen (NIS-Teen) data (2015-2021) and a cohort analysis of commercial claims data (2010-2021). Regression models were used to identify factors associated with vaccine uptake. Included in the NIS-Teen MenACWY and MenB analyses were 138,952 and 177,077 patients, respectively. Included in the claims MenACWY and MenB analyses were 953,905 and 818,424 patients, respectively. In 2021, MenACWY uptake was 86.4% (95% confidence interval [CI]: 83.6-88.8%) among ≤13-year-olds (NIS-Teen) and 63.2% (62.8-63.5%) among 11-12-year-olds (claims). MenB was 33.7% (30.5-37.1%) among ≤17-year-olds (NIS-Teen), 41.6% (41.2-42.0%) among 16-18-year-olds (claims), and 15.0% (14.7-15.4%) among 19-23-year-olds (claims). The states with the lowest and highest MenB uptake by ≤17-year-olds in 2021 (NIS-Teen) were Minnesota (10.1% [3.9-23.6%]) and North Dakota (69.9% [52.1-83.2%]). Factors associated with MenACWY uptake included living in a state with a vaccine mandate, Black or Hispanic race (versus White), and well-child visit attendance. Factors associated with MenB uptake included having Medicaid (versus private insurance) and Hispanic race (versus White). The findings suggest that meningococcal vaccination coverage disparities persist across vaccines, age, geography, and race and ethnicity. Higher MenACWY (versus MenB) coverage suggests the benefit of routine recommendations. Annual well-child visits and simplified vaccination schedules could reduce vaccination access barriers.

Background and Objective Invasive meningococcal disease (IMD) is an uncommon but serious disease associated with a risk of death and severe long-term sequelae, impacting both patients and their caregivers. Productivity losses due to IMD have not previously been comprehensively evaluated in the USA. This study evaluated both market and non-market productivity losses to better estimate the economic burden of IMD in the USA. Methods An economic model estimated lifetime market (labour) and non-market (unpaid household, caring and voluntary services) productivity losses due to acute IMD, premature death due to IMD, reduced life expectancy in IMD survivors and IMD-related sequelae for patients 16 years of age or older and their caregivers based on IMD cases diagnosed in the USA in 2021 (due to data availability). Time use data were used to characterise IMD-incurred disruptions as market or non-market productivity losses. Time lost during the acute phase (assumed equal for patients and caregivers) was estimated based on hospital length-of-stay data. Time lost due to premature death from acute IMD or reduced remaining life expectancy (only calculated for patients) was estimated by subtracting the age at IMD acquisition or life expectancy of IMD survivors from average life expectancy. Time lost due to IMD-related sequelae was estimated based on sequelae event rates. Time lost was multiplied by earnings per hour (derived from median salary) to estimate productivity losses. Assumptions about sequelae impact on productivity were derived from the literature and expert clinical opinion. Scenario and sensitivity analyses assessed the impact of different inputs and assumptions on the results. Costs were inflated to 2023 US dollars. Results Lifetime productivity losses for IMD cases diagnosed in the USA in 2021 (N = 121) totalled $87.4 million ($722,458 per case) for patients 16 years of age and older and their caregivers, with market and non-market losses accounting for approximately 72% and 28%, respectively. Premature death, reduced life expectancy and long-term sequelae were responsible for the majority of total productivity losses for patients and caregivers ($87.1 million); the acute phase accounted for $314,850. Results were most sensitive to the ratio of total benefits, median salary, case-fatality rates and specific sequelae included. Conclusions Despite being an uncommon disease, the high mortality rate and severe long-term consequences of IMD result in a substantial economic impact. Comprehensive market and non-market productivity losses for both patients and caregivers should be considered when evaluating and communicating the true burden of IMD.