Regional Inequity in 4CMenB Vaccination Rates in Austria & Correlation With Unemployment: A Retrospective Ecological Study

OBJECTIVES: Despite a recent decline in invasive meningococcal disease (IMD) cases, serogroup B (MenB) remains the most reported IMD serogroup in Europe. The four-component MenB vaccine (4CMenB) protects against MenB. MenB vaccination is recommended in Austria for those aged <25 years, but is not included in the National Immunization Program. As MenB vaccination is not funded, access may vary by region and socioeconomic status. This study investigated 4CMenB vaccination rate per births and its association with unemployment in Austria.

METHODS: In this retrospective, ecological correlation analysis, 4CMenB uptake was estimated from an IQVIA pharmacy panel, representing ~13% of pharmacies, covering an estimated 40% of the birth cohort. Unemployment data were sourced from the Austrian Labor Market Service. 4CMenB vaccination rate was estimated as total doses distributed from March 2022–February 2023, divided by doses required for newborns in the catchment population (40% of 2022 births). Correlation between 4CMenB vaccination rates and 2022 unemployment rates was assessed using Spearman’s coefficient.

RESULTS: Base case (2022 births) Austrian 4CMenB vaccination rate was 18.7%, for a fraction of the population. The highest vaccination rates were observed in Kärnten and Burgenland, while the lowest were observed in Oberösterreich and Steiermark. Base case analysis at district and municipality levels showed that unemployment rates correlated negatively and significantly (r=–0.43; p<0.001) with 4CMenB vaccination rates. This correlation remained significant when excluding regions with partial reimbursement (Voralberg, Salzburg & Burgenland) at both district and municipality levels (r=–0.53; p<0.01 and r=–0.48; p<0.01, respectively).

CONCLUSIONS: Despite limitations in database coverage and uncertainties in vaccination rates, this analysis shows that 4CMenB vaccination rate in Austria is negatively correlated with unemployment, a socioeconomic factor with high disparity across different regions in Austria. Reimbursement of 4CMenB could reduce the inequity seen in vaccination rates.