Efficacy of Meningococcal Vaccine and Barriers to Vaccination

• Published in: JAMA : the journal of the American Medical Association Vol. 279; no. 6; pp. 435 - 439
• Main Authors: Rosenstein, Nancy, Levine, Orin, Taylor, Jeffery P, Evans, Deborah, Plikaytis, Brian D, Wenger, Jay D, Perkins, Bradley A
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Medical Association 11-02-1998
• Subjects: Adolescent; Adult; Bacteria; Bacterial Vaccines - administration & dosage; Bacterial Vaccines - immunology; Biological and medical sciences; Case-Control Studies; Child; Child, Preschool; Disease Outbreaks - prevention & control; Epidemiology. Vaccinations; Female; General aspects; Humans; Infectious diseases; Male; Medical sciences; Meningitis; Meningococcal Infections - prevention & control; Meningococcal Vaccines; Neisseria meningitidis - classification; Neisseria meningitidis - immunology; Proportional Hazards Models; Risk Factors; Serotyping; Texas - epidemiology; United States - epidemiology; Vaccination - statistics & numerical data; Vaccines; Infection; Human; Prevention; Immunoprophylaxis; Evaluation; Barrier function; Vaccination; Bacteriosis; Population; Effectiveness factor; Meningococcal disease
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.279.6.435

CONTEXT.— Use of the quadrivalent meningococcal vaccine for control of outbreaks
has increased in recent years, but the efficacy of meningococcal vaccine during
mass vaccination campaigns in US civilian populations has not been assessed. OBJECTIVES.— To evaluate the efficacy of the quadrivalent meningococcal vaccine against
serogroup C meningococcal disease in a community outbreak setting and to evaluate
potentially modifiable barriers to vaccination in an area with persistent
meningococcal disease following immunization. DESIGN.— Matched case-control study of vaccine efficacy using cases of serogroup
C meningococcal disease in persons eligible for vaccination during mass vaccination
campaigns. Control patients were matched by neighborhood and age. The control
group was used to identify possible barriers to vaccination. SETTING.— Gregg County, Texas, population 106076, from 1993 to 1995. PARTICIPANTS.— A total of 17 case patients with serogroup C meningococcal disease eligible
for vaccine and 84 control patients. MAIN OUTCOME MEASURES.— Vaccine efficacy and risk factors associated with nonvaccination. RESULTS.— Vaccine efficacy among 2- to 29-year-olds was 85% (95% confidence interval,
27%-97%) and did not change in bivariate analyses with other risk factors
that were significant in univariate analysis. Among control patients, older
age was strongly associated with nonvaccination; vaccination rates for 2-
to 4-year-olds, 5- to 18-year-olds, and 19- to 29-year-olds were 67%, 48%,
and 20%, respectively (χ2for linear trend, P=.01). CONCLUSIONS.— The meningococcal polysaccharide vaccine was effective against serogroup
C meningococcal disease in this community outbreak. Although specific barriers
to vaccination were not identified, older age was a risk factor for nonvaccination
in the target population of 2- to 29-year-olds. In future outbreaks, emphasis
should be placed on achieving high vaccination coverage, with special efforts
to vaccinate young adults.