Men B Vaccine Used in NHS UK for Infants
The NHS UK uses Bexsero® (4CMenB) for infant vaccination against meningococcal group B disease, administered at 2 months, 4 months, and 12 months of age, and this vaccine can be administered in any location with appropriate medical facilities and trained healthcare personnel. 1, 2
Vaccine Composition
Bexsero® is a multicomponent protein-based vaccine containing four major antigenic components 3, 4:
- fHbp (factor H binding protein) - recombinant surface-exposed protein
- NHBA (Neisserial Heparin Binding Antigen) - recombinant surface-exposed protein
- NadA (Neisserial adhesin A) - recombinant surface-exposed protein
- PorA P1.4 - contained within outer membrane vesicles (OMV) from New Zealand strain 3, 4
The vaccine specifically targets sub-capsular proteins rather than polysaccharide capsule antigens, which is fundamentally different from other meningococcal vaccines 3.
NHS UK Immunization Schedule
The UK implemented a reduced two-dose primary schedule starting September 1,2015 1, 2:
This differs from the standard three-dose primary schedule used in clinical trials, representing a pragmatic public health decision 1, 4.
Vaccine Uptake and Effectiveness
Uptake rates in England have been consistently high 2:
- 92.5% of children completed primary immunizations by first birthday
- 87.9% received all three doses by 2 years of age 2
Real-world effectiveness data from England (2015-2018) demonstrates substantial impact 2:
- 75% reduction in meningococcal group B disease incidence in vaccine-eligible cohorts
- Vaccine effectiveness: 52.7% after two primary doses, 59.1% after two primary doses plus booster
- An estimated 277 cases prevented over the first 3 years 2
Important Clinical Considerations
Fever Management
Prophylactic paracetamol is strongly recommended due to high rates of post-vaccination fever 1:
- Three doses of paracetamol should be given
- First dose administered as soon as possible after vaccination
- This is a unique requirement not typically needed with other infant vaccines 1
Strain Coverage Limitations
The vaccine provides 73-88% coverage against circulating meningococcal B strains in England 1. This means:
- Not all serogroup B strains are covered
- Breakthrough infections can occur with non-covered strains
- Continued surveillance is essential 1
Cross-Protection
Bexsero® may provide protection against non-B serogroups (particularly W and X) because it targets conserved sub-capsular proteins rather than capsule-specific antigens 3.
Administration Location
Bexsero® can be administered in any appropriate healthcare setting, including 1, 2:
- General practice surgeries
- Community health clinics
- Hospital settings
- Any location with trained healthcare personnel and appropriate facilities for vaccine storage and administration
The vaccine requires standard cold chain maintenance and should be administered intramuscularly, typically in the anterolateral thigh for infants 1.
Safety Profile
The vaccine shows a safety profile similar to other childhood vaccines, though with higher rates of certain reactions 4:
- Increased injection site pain/tenderness
- Elevated fever rates (hence the paracetamol recommendation)
- Most reactions are mild to moderate
- No significant increase in rare serious events like Kawasaki disease or juvenile arthritis 4
Duration of Protection
Protection after three doses appears sustained for at least 2 years, though the vaccine requires booster doses to maintain immunity in infants and young children 3, 2. The anamnestic response after the toddler booster suggests establishment of immunological memory 3.