MRF Meningitis Symposium 2018

Second time round, with no signs of the beast from the east, and we were off to a good start!

After a warm welcome from Chief Executive Vinny Smith, the first session began with Lucy Anning, a member of Meningitis Research Foundation giving a poignant insight in to her own experience with pneumococcal meningitis. A former intensive care nurse herself, Lucy explained how she first began to experience dreadful ear ache whilst on shift at hospital. Lucy described how quickly her condition deteriorated, and just hours later she was back in same hospital, in the same ward, but this time as a patient. Lucy’s insight into her experience with the disease was an inspiring start the day and we would like to extend our thanks to Lucy for sharing her story with us all.

Dr Jeremy Carr then updated us on the progress of ‘Be on the TEAM’ a nationwide study designed to evaluate the impact of MenB immunisation on meningococcal carriage. Jeremy started by taking us back to September 2015 which saw the routine introduction of Bexsero® for the under ones. This was shortly followed by a petition calling to extend the vaccine to all children. But to find the best way to protect the whole population, the vaccine’s impact on meningococcal carriage needs to be understood– hence Be on the TEAM. Tasked with recruiting 24,000 year 12 students, the study will investigate whether immunisation with Bexsero® or Trumenba® influences meningococcal carriage by comparing throat swabs taken pre vaccination to those collected a year later. With nearly 5,000 teenagers already recruited, the team are off to an excellent start.  

Dr Vanessa Saliba gave a great overview of the current issues with variability in vaccine uptake, highlighting that despite high immunisation rates nationally, disparities do still exist.  Using the infant rotavirus vaccination programme as an example, Vanessa explained that London has the lowest coverage of all regions, with deprivation and ethnicity contributing to inequalities in uptake. Interestingly even when London figures are adjusted for deprivation and ethnic mix, not all of the differences disappear - suggesting that something else is at play here. In terms of what works well, Vanessa described how school based approaches are the most equitable way of delivering adolescent programmes.

Prof Nick Andrews then delivered a thought provoking talk on pneumococcal disease and the potential impact of a reduced immunisation schedule. Nick acknowledged that whilst invasive disease caused by PCV7 and PCV13 serotypes is now rare, serotype replacement has increased more than expected. Whilst these replacing serotypes appear to be more invasive than before, they are associated with less severe disease. Nick then took us through evidence surrounding the contemporary issue of whether a reduced schedule could maintain good disease control.

The morning ended with Prof Ray Borrow providing a thorough update on the epidemiology of meningococcal disease and impact of routine immunisation programmes in the UK, all in just half an hour. MenB cases in infants have continued to decline since the routine introduction of Bexsero® with the vaccine also appearing to offer some cross protection against cases of MenW cc11. Ray then eloquently addressed the decision to remove the 3 month MenC dose, and we learnt that there has been an increase in cases of MenC in a particular area on England – which is being closely monitored by Public Health England.

After lunch, Dr Gemma Lasseter took us through public preferences surrounding vaccine decision making. Gemma gave a great description of QALYs, explaining that the assumption that all QALYs are equal is not one that the public necessarily agrees with. In fact research revealed a general consensus from the public that policy makers should prioritise vaccinations depending on certain characteristics such as disease severity, incidence, age, carer impact and social groups. It was also found that some people experience peace of mind benefits from vaccination.

Rob Dawson and Claire Wright of Meningitis Research Foundation continued the discussion on cost-effectiveness, delivering a topical update on the transparency in vaccine decision making. The duo gave a great overview of the CEMIPP consultation process, explaining how some changes in the rules could improve vaccine access.  However they warned that one rule about how much the government are willing to spend on health threatened to restrict the vaccine budget and could ultimately make it harder for all kinds of health interventions to be made available on the NHS.

We then changed direction with Prof James Stuart addressing the progress and challenges in the prevention of meningitis in the African meningitis belt. James gave a great overview of epidemic disease in the belt. He explained the profound impact of the MenAfriVac campaigns, with cases of MenA being reduced by 99%, but stressed the need for routine introduction of the vaccine. We learnt that pneumococcal meningitis remains a risk, having a high burden outside of epidemics. Priorities for the belt include ensuring better vaccine supply during outbreaks, and developing affordable meningococcal conjugate vaccines.

Dr Andrew Riordan ended the day with an excellent talk on the complexities in the early recognition and treatment of meningitis and septicaemia. Starting off with a decision rule for swans! Andrew highlighted the complex balancing act of ensuring that no children with serious infection are missed whilst remaining compliant with ever stringent rules on antibiotic stewardship.