June 29, 2022
By Christopher J. Graber, MD, MPH, FIDSA
As Neisseria gonorrhoeae continues to frequently acquire antimicrobial resistance and persist in the community despite ongoing public health measures, more strategies are needed to improve our response to this pathogen. Recently, it was discovered that meningococcal B vaccines (which have outer membrane vesicle-based antigens similar to that of N. gonorrhoeae) might provide some protection against N. gonorrhoeae infections and complications.
In a study recently published in Clinical Infectious Diseases, authors utilized the Southern California Kaiser Permanente database to match 6,641 teen and young adult recipients of meningitis B vaccine to 26,471 who had only received meningitis ACWY vaccine by age, sex, and year of vaccination to examine rates of gonorrhea acquisition subsequent to vaccine receipt, comparing gonorrhea incidence to chlamydia incidence. While the meningitis B vaccine cohort was different demographically (higher income/education/health care utilization, more non-Hispanic White or Asian/Pacific Islander and fewer Hispanic) and clinically (fewer prior year HIV diagnoses, STI infections, HIV pre-exposure prophylaxis use, and male reporting male sexual partners) from the ACWY cohort, the meningitis B cohort had a similar rate of chlamydia acquisition (12.4 and 15.2 cases per 1,000 person-years) but a lower rate of gonorrhea acquisition (2.0 versus 5.2 cases per 1,000 person years). In a multivariable analysis that adjusted for the above factors and other potential confounders, the hazard ratio for incident gonorrhea was 0.54 (95% confidence interval [CI], 0.34-0.86) for meningitis B vaccine recipients, compared to 0.98 (95% CI, 0.82-1.17) for chlamydia.
This work provides support for further exploration of the role of meningitis B vaccination as a tool in gonorrhea prevention; a randomized trial (ClinicalTrials.gov identifier: NCT04350138) is currently recruiting patients.