An expert panel has urged the Government to introduce routine targeted vaccinations for gonorrhoea, alongside advising on a routine vaccination programme against mpox for people at highest risk.
Both programmes should be offered on an "opportunistic basis" through specialist sexual health services in England, the Joint Committee on Vaccination and Immunisation (JCVI) recommended.
Vaccination against gonorrhoea should use the 4CMenB (Bexsero, GSK) vaccine, as Neisseria meningitidis and Neisseria gonorrhoeae were closely genetically related, with evidence showing that MenB vaccine provides some cross-protection against gonorrhoea, the Committee said.
The 4CMenB vaccine is currently used in the routine childhood vaccination programme.
Possible World First
Professor Andrew Pollard, chair of the JCVI, said: "Introducing a MenB vaccination programme to prevent gonorrhoea in England would be a world first and should significantly help to reduce levels of gonorrhoea, which are currently at a record high."
In June, the UK Health Security Agency (UKHSA) reported that 82,592 cases of gonorrhoea were recorded in 2022, which was 50.3% higher than the 54,961 cases in 2021. Last year's figure was the highest number of cases of gonorrhoea since records began in 1918, it said.
Gonorrhoea remained a public health concern globally, exacerbated by increased resistance to most antibiotics, the JCVI noted. It pointed out that the disease itself didn't protect from repeat infection and that affected individuals were commonly reinfected.
Even with the "modest" effectiveness against gonorrhoea of the 4CMenB vaccine, estimated from real-world studies at between 32.7% and 42%, the main benefits were expected at a community level "with a significant reduction in the number of cases overall".
The vaccination programme against gonorrhoea should primarily target gay and bisexual men and other men who have sex with men (GBMSM), who have the highest rates of gonorrhoea, the JCVI advised. But efforts should be made to ensure that the vaccine was offered to those at equivalent risk, including other individuals who may be heterosexual or identify otherwise, it added.
As protection against gonorrhoea wasn't currently a licensed indication for the 4CMenB vaccine, its use would be 'off-label'.
Mpox Vaccination Advice
"In addition, we are advising setting up a routine targeted mpox offer – to prevent a repeat of the large outbreak we saw in early 2022," Professor Pollard said.
An epidemiological update this month from the UKHSA reported 3732 confirmed and highly probable mpox cases in the UK for 2022, and 46 cases reported for 2023, up until 21 August. The majority of the cases had occurred in the GBMSM community, without documented history of travel to endemic countries.
"A pre-emptive vaccine strategy could prevent outbreaks occurring and would also allow vaccines to be offered routinely through sexual health services on an ongoing basis, as opposed to an outbreak response which had caused a significant disruption in sexual health services, impacting on their ability to continue with routine work," the JCVI report said.
Katy Sinka, head of sexually transmitted infections at the UKHSA, said: "Any routine vaccination offer to those at highest risk of infection will help ensure we remain on top of the disease and prevent any major future outbreaks."
The JCVI said that it would keep the programmes under review and might reassess costs, benefits, and eligibility as further information about vaccine effectiveness and duration of protection became available.
The JCVI advice will now be considered by the Department of Health and Social Care.