Peer-reviewed article
Meningococcal B Immunisation in Adults and Potential Broader Immunisation Strategies: A Narrative Review
George C. Kassianos, Osamah Barasheed, Victoria Abbing‐Karahagopian, Mansour Khalaf, Serdar Öztürk et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This review examines meningococcal B vaccines in adults and their potential for broader use beyond high-risk groups. While meningococcal B disease is most common in young children, about 20% or more of cases now occur in adults across Europe, Australia, and the United States. Clinical studies show that two meningococcal B vaccines generate strong immune responses in most adults, but evidence is limited, especially for older adults, and questions remain about how long protection lasts.
Key points
- A substantial proportion of meningococcal B cases (20% or more) now occurs in the adult population in Europe, Australia, and the United States
- The 4CMenB vaccine generates protective antibody titres in up to 98-100% of adults after a 2-dose schedule
- MenB-FHbp vaccine shows protective immune responses in 70-95% of recipients following a 3-dose schedule
- Most countries recommend MenB vaccination only for high-risk adults, not routine general adult use
- Data on duration of protection in adults remain unclear, particularly for adults over 50 years
Limitations
This is a narrative review that synthesises existing evidence rather than new research data. The review identifies significant gaps in knowledge about long-term protection duration and effectiveness in older adults, limiting what can be concluded about whether broader adult immunisation policies should be implemented.
Abstract
Recombinant vaccines against invasive meningococcal disease due to Neisseria meningitidis serogroup B (MenB) have shown substantial impact in reducing MenB disease in targeted populations. 4CMenB targets four key N. meningitidis protein antigens; human factor H binding protein (fHbp), Neisserial heparin binding antigen (NHBA), Neisseria adhesin A (NadA) and the porin A protein (PorA P1.4), with one or more of these expressed by most pathogenic MenB strains, while MenB-FHbp targets two distinct fHbp variants. While many countries recommend MenB immunisation in adults considered at high risk due to underlying medical conditions or immunosuppression, there are no recommendations for routine use in the general adult population. We reviewed the burden of MenB in adults, where, while incidence rates remain low (and far lower than in young children < 5 years of age at greatest risk), a substantial proportion of MenB cases (20% or more) is now observed in the adult population; evident in Europe, Australia, and in the United States. We also reviewed immunogenicity data in adults from clinical studies conducted during MenB vaccine development and subsequent post-licensure studies. A 2-dose schedule of 4CMenB generates hSBA titres ≥ 1:4 towards all four key vaccine target antigens in up to 98-100% of subjects. For MenB-FHbp, a ≥ fourfold rise in hSBA titres against the four primary representative test strains was observed in 70-95% of recipients following a 3-dose schedule. While this suggests potential benefits for MenB immunisation if used in adult populations, data are limited (especially for adults > 50 years) and key aspects relating to duration of protection remain unclear. Although a broader adult MenB immunisation policy could provide greater protection of the adult population, additional data are required to support policy decision-making.