An expert panel advising the United Kingdom on vaccine policy has recommended the use of a meningitis B vaccine to try to reduce the rising rate of gonorrhea. If adopted, the UK will be the first country to use the meningitis B vaccine for this purpose.
The Joint Committee on Vaccination and Immunization released a report on Friday that said the targeted use of a meningitis B vaccine – GSK’s Bexsero – in people at high risk of contracting gonorrhea should reduce the incidence. of infection that is more difficult to treat.
“The introduction of a MenB vaccination program to prevent gonorrhea in England will be a world first and should go a long way in reducing gonorrhea levels, which are currently at a record high,” said JCVI Chair Andrew Pollard in a statement.
The committee recommends that the meningitis B vaccine should be offered to gay, bisexual, and other men who have sex with men who are at high risk of contracting gonorrhea, because they currently have it or have previously been diagnosed with it, or who reported high. -risk of sexual behavior with multiple partners. Gonorrhea infection does not induce immunity; people who have recovered can be reinfected.
The decision to offer the vaccine to an individual should be based on a risk assessment by a professional sexual health clinic, the JCVI report. The report says there is no evidence whether vaccination while infected works, so it is recommended to stop vaccination until the infection is cured.
It also suggests other people at similar risk should be offered the vaccine. Those include transgender women, gender-diverse people assigned male at birth, and other people, regardless of gender, who are at high risk, including those with a recent history of bacterial STI, and sex workers.
Gonorrhea is the second most commonly diagnosed sexually transmitted infection in England, with around 80,000 diagnosed each year.
Neisseria gonorrhoeae, the bacteria responsible for the infection, has over the years developed resistance to almost all antibiotics used to treat it. The currently recommended therapy, ceftriaxone, is the last licensed antibiotic that reliably cures gonorrhea. But there are increasing reports of ceftriaxone-resistant infection cases.
“A vaccination program that affects … gonorrhea cases is a very welcome intervention to ensure that we are better prepared to face this growing threat,” said Katy Sinka, head of the program at sexually transmitted infections by the UK Health Security Agency. “We saw a rapid increase last year with more cases than ever before and with gonorrhea becoming more resistant to antibiotics, dealing with this infection is a serious concern.”
The JCVI also recommends routine use of the mpox vaccine among high-risk populations, a move that its US counterpart, the Advisory Committee on Immunization Practices, recommended last month. The UK’s department of health and social care will now study both recommendations. They must be approved before the JCVI advice can be implemented.
Bexsero protects against meningitis B, one of the serotypes of Neisseria meningitidis bacteria. It is closely related to Neisseria gonorrhoeae; the genetic sequences of the two are between 80% and 90% identical.
Theoretically, the similarity between the two bacteria suggests that the meningitis B vaccine may provide some protection against gonorrhea. And over the past decade or so, real-world evidence supporting the idea has been mounting.
Various studies conducted in many countries estimate that the vaccine is between 33% and 42% effective in protecting against gonorrhea.
But until now all the data supporting the use of the vaccine to protect against gonorrhea has been observational, meaning that researchers looked at gonorrhea rates in groups of people who received the vaccine for those purposes. to control meningitis. To get a clearer picture of whether and how well it is used to protect against gonorrhea, data from a randomized controlled trial comparing the rate of gonorrhea in those who have been vaccinated to similar people who have not been vaccinated is needed.
Scientists funded by the National Institutes of Health conducted such a study, enrolling 2,200 adults in the US, Thailand, and African sites. Jodie Dionne, an STI expert at the University of Alabama at Birmingham, is one of the trial site investigators and protocol co-chair. He told STAT that so far about 1,600 people have been enrolled. The trial is expected to reach full enrollment by mid-2024.
The trial will follow all participants for about 15 months after enrollment, so “we’re not on the precipice of having data available anytime soon.”
Asked about the JCVI recommendation, Dionne noted that Bexsero has a good safety profile, which is reassuring in terms of what could be off-label use of the vaccine. But he thinks making a decision like this without clinical trial data is “premature.”
“I think that waiting for clinical trial data is better if you can,” Dionne said. “I think for the average person, they are reassured if I can tell them as their doctor, that this vaccine has been studied in a clinical trial and shown to be effective. As opposed to, ‘Observational studies think that maybe it has an effect.’ That’s not very strong.”
If the vaccine protects against gonorrhea, it is not yet known how long the protection lasts, the JCVI report said. It also said it is important to inform people who get the vaccine that they are still at risk of infection.
“Although vaccination is expected to reduce the chance of contracting gonorrhea, it does not completely eliminate the possibility,” it said.