4CMenB Vaccination to Prevent Meningococcal B Disease in Vietnam: Expert Review and Opinion

Abstract

An advisory board meeting was held with experts in Vietnam (Hanoi, August 2022), to review the evidence on invasive meningococcal disease (IMD) epidemiology, clinical management, and meningococcal vaccines to reach a consensus on recommendations for meningococcal vaccination in Vietnam. IMD is a severe disease, with the highest burden in infants and children. IMD presents as meningitis and/or meningococcemia and can progress extremely rapidly. Almost 90% of deaths in children occur within the first 24 h, and disabling sequelae (e.g., limb amputations and neurological damage) occur in up to 20% of survivors. IMD patients are often hospitalized late, due to mild and nonspecific early symptoms and misdiagnosis. Difficulties related to diagnosis and antibiotic misuse mean that the number of reported IMD cases in Vietnam is likely to be underestimated. Serogroup B IMD is predominant in many regions of the world, including Vietnam, where 82% of IMD cases were due to serogroup B (surveillance data from 2012 to 2021). Four component meningococcal B vaccine (4CMenB) is used in many countries (and is part of the pediatric National Immunization Program in 13 countries), with infant vaccination starting from two months of age, and a 2 + 1 dosing schedule. Experts recommend 4CMenB vaccination as soon as possible in Vietnam, starting from two months of age, with a 2 + 1 dosing schedule, and at least completing one dose before 6 months of age.

Keywords: 4CMenB; Infant; Invasive meningococcal disease; Vaccination; Vietnam.

Fig. 1

IMD incidence by age group in Europe [European Centre for Disease Prevention and Control (ECDC) 2018 and 2021] [5, 7]. The incidence of IMD per 100,000 population by age group in 2018 and 2021 is shown. y year

Fig. 2

Distribution of IMD cases in children by age group in Türkiye (2015–2018) [8]. The distribution of IMD cases by age group in under 18 s is shown. IMD invasive meningococcal disease; y year

Fig. 3

IMD incidence by age group in Vietnamese children (prospective surveillance 2000–2002) [11]. The incidence per 100,000 population of IMD in children under 5 years is shown. IMD invasive meningococcal disease; m month; y year

Fig. 4

Number of yearly IMD cases and deaths (2012–2021) for Vietnam and South Vietnam, reported by the National Surveillance System and Communicable Diseases Surveillance System in South Vietnam. The annual number of IMD cases and deaths in Vietnam and South Vietnam from 2012 to 2021 is shown. IMD invasive meningococcal disease

Fig. 5

IMD cases in the USA (2020) [3] and Canada (2015–2019) [12] by serogroup. The serogroup distribution of IMD cases in the USA (2020) and Canada (2015–2019) is shown. IMD invasive meningococcal disease; NG nongroupable; USA United States of America; N number; Other includes other or unknown serogroup cases, including 1 serogroup E case in the USA

Fig. 6

a Serogroup distribution of IMD cases in Europe (ECDC 1999–2021) [7]; b IMD cases and deaths by serogroup in Europe (ECDC 2021) [7]. ECDC European Centre for Disease Prevention and Control; IMD invasive meningococcal disease; NG nongroupable

Fig. 7

IMD serogroups in Vietnam over time (1966–2012) and serogroup distribution (2012–2021). The prevalent IMD serogroups in Vietnam from 1966 to 2012 and the serogroup distribution of IMD cases from 2012 to 2021 are shown. IMD invasive meningococcal disease

Fig. 8

Case study—serogroup B IMD disease progression. The IMD disease progression in a case study is shown. FiO₂ fraction of inspired oxygen; IMD invasive meningococcal disease; LR lactate ringer; min minute; NCPAP nasal continuous positive airway pressure; SpO₂ peripheral capillary oxygen saturation

Fig. 9

4CMenB dosing regimens in National Immunization Programs [33]. An overview of four-component meningococcal B vaccine (4CMenB) schedules used in National Immunization Programs around the world is shown. 4CMenB four component meningococcal B vaccine; UK United Kingdom; USA United States of America