Chad Wells, PhD, discusses how to improve MenACWY completion rates for vulnerable populations

According to Chad Wells, PhD, postdoctoral research associate at the Yale School of Public Health, the quadrivalent meningococcal conjugate vaccination program (MenACWY) has been a cornerstone of adolescent public health.

Research indicates that from 2001 to 2021, the incidence of invasive meningococcal disease (IMD) among individuals aged 11 to 23 years would have been at least 59% higher without this vaccination program. While the initial dose coverage for adolescents aged 13 to 17 years is high at approximately 90.1% as of 2024, a significant “booster gap” persists for the second dose, typically administered at aged 16 years. Wells notes that this dropout rate is particularly concerning for older adolescents and young adults entering high-risk environments such as college dormitories, where immunity may have waned.

The data reveal that although IMD incidence has declined across all groups, Black individuals aged 16 to 23 years continue to experience a greater incidence of disease compared with other ethnicities. This is largely attributed to lower booster completion rates. Wells highlights that access to care and consistent communication is the primary driver for improving these rates, especially among patients from lower-income and lower maternal education backgrounds.

Wells warns against shifting to a single-dose schedule at aged 16 years. His prior studies show that such a shift would lead to a drastic increase in both IMD cases and deaths across the population. Even pushing the first dose back to aged 15 years with a booster at aged 16 or 17 years was found to shift the disease burden back toward populations aged 11 to 15 years. Maintaining the current 2-dose scheme is essential for preserving herd immunity.

To close the booster gap and address socioeconomic disparities, several strategies are recommended, as follows:

• Strong provider recommendation: This remains the single most effective predictor of vaccine uptake.
• Pentavalent vaccines (MenABCWY): Using newly approved vaccines that cover serogroups A, B, C, W, and Y in fewer injections reduces the “shot burden” and improves completion during a single visit.
• Effective communication: Moving beyond general outreach to direct doctor-patient communication about the specific risks of meningococcal disease is vital.
• Targeted systems: Implementing reminder systems specifically for the booster at aged 16 years can help ensure equitable access, particularly in rural and underserved urban areas where provider recommendations are statistically less frequent.

No relevant disclosures.

Reference

Shin T, Wells CR, Shoukat A, et al. Quadrivalent conjugate vaccine and invasive meningococcal disease in US adolescents and young adults. JAMA Netw Open. 2024;7(11):e2443551. doi:10.1001/jamanetworkopen.2024.43551