Prevalence of Meningococcal Carriage by Serogroup in Adolescents and Young Adults: A Global Systematic Literature Review and Meta-Analysis
Author(s)
Zeki Kocaata, PhD1, Lucian Gaianu, MSc1, Laura Taddei, MSc1, Ifeanyi Ubamadu, MSc2, Thatiana de Jesus Pereira Pinto, PhD1, Hiral Anil Shah, BSc, MSc, PhD3, Pavo Marijic, PhD4, Patrice Carter, PhD5, Matthew Turner, PhD5, Andrew Easton, MSc5.
1GSK, Wavre, Belgium, 2GSK, London, United Kingdom, 3GSK, St Albans, United Kingdom, 4Manager Market Access, GSK, Munich, Germany, 5Health Economics & Outcomes Research Ltd, Cardiff, United Kingdom.
1GSK, Wavre, Belgium, 2GSK, London, United Kingdom, 3GSK, St Albans, United Kingdom, 4Manager Market Access, GSK, Munich, Germany, 5Health Economics & Outcomes Research Ltd, Cardiff, United Kingdom.
OBJECTIVES: Neisseria meningitidis causes severe and fatal invasive meningococcal disease (IMD). Adolescents are the main carriers, with social behaviours facilitating transmission to the community. Objectives were to assess meningococcal carriage prevalence by serogroup, age, and region to inform vaccination strategy optimization.
METHODS: A systematic literature review (Medline, Embase, public health websites; 2000-April 2024) and meta-analysis (MA) was conducted. Hierarchical mixed-effects logistic regression models estimated age-specific carriage prevalence by IMD serogroup separately, controlling for population, swab type, direct plating, bias risk, and publication time as fixed effects, with country and study as nested random effects.
RESULTS: Among 203 studies included (all ages), 60 were in adolescents and 71 in young adults (YA), with serogroup data across six continents, and wide sample sizes (15-34,489) and timeframe ranges (1996-2022). Global carriage prevalence increased non-linearly with age: starting with the lowest rates (<0.91%) in infants and reaching a peak in adolescents/YA (highest carriage prevalence of 6.52% [95% confidence interval: 3.21-12.77%] in 20-year-olds), gradually declining in older adults. Similarly, serogroup B carriage was lowest (<0.12%) in infants, reached a peak (1.41% [95% CI: 0.58-3.39%]) in 17-year-olds, then gradually declined in adults. Despite considerable variations in carriage by age and region, the MA consistently found highest carriage rates were in adolescents/YA, for serogroup B, and in Europe. Higher carriage in adolescents/YA likely reflects their social mixing behavior and crowded living conditions, however, limited evidence on these drivers was identified.
CONCLUSIONS: Meningococcal carriage is highest in adolescents/YA and seems driven by serogroup B, putting this subpopulation at increased risk of serogroup B invasive disease. While infant vaccination protects infants/young children against IMD, there is an unmet need for meningococcal B vaccination as standard-of-care for adolescents/YA. Understanding carriage prevalence and risk factors is essential to inform public health interventions and mitigate transmission from adolescents/YA to at-risk populations.
METHODS: A systematic literature review (Medline, Embase, public health websites; 2000-April 2024) and meta-analysis (MA) was conducted. Hierarchical mixed-effects logistic regression models estimated age-specific carriage prevalence by IMD serogroup separately, controlling for population, swab type, direct plating, bias risk, and publication time as fixed effects, with country and study as nested random effects.
RESULTS: Among 203 studies included (all ages), 60 were in adolescents and 71 in young adults (YA), with serogroup data across six continents, and wide sample sizes (15-34,489) and timeframe ranges (1996-2022). Global carriage prevalence increased non-linearly with age: starting with the lowest rates (<0.91%) in infants and reaching a peak in adolescents/YA (highest carriage prevalence of 6.52% [95% confidence interval: 3.21-12.77%] in 20-year-olds), gradually declining in older adults. Similarly, serogroup B carriage was lowest (<0.12%) in infants, reached a peak (1.41% [95% CI: 0.58-3.39%]) in 17-year-olds, then gradually declined in adults. Despite considerable variations in carriage by age and region, the MA consistently found highest carriage rates were in adolescents/YA, for serogroup B, and in Europe. Higher carriage in adolescents/YA likely reflects their social mixing behavior and crowded living conditions, however, limited evidence on these drivers was identified.
CONCLUSIONS: Meningococcal carriage is highest in adolescents/YA and seems driven by serogroup B, putting this subpopulation at increased risk of serogroup B invasive disease. While infant vaccination protects infants/young children against IMD, there is an unmet need for meningococcal B vaccination as standard-of-care for adolescents/YA. Understanding carriage prevalence and risk factors is essential to inform public health interventions and mitigate transmission from adolescents/YA to at-risk populations.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EPH189
Topic
Epidemiology & Public Health, Organizational Practices, Study Approaches
Topic Subcategory
Public Health
Disease
Infectious Disease (non-vaccine), Vaccines