Regional Inequity in 4CMenB Vaccination Coverage in Belgium: A Retrospective Ecological Study

Abstract

Invasive meningococcal disease is associated with a high mortality rate and severe long-term health issues. In Belgium, most serogroup-documented invasive meningococcal disease cases are caused by serogroup B. The four-component meningococcal serogroup B vaccine (4CMenB) is recommended in Belgium for certain age groups but is not a publicly funded vaccine. This analysis aimed to estimate 4CMenB coverage and the association between 4CMenB coverage, age and household income at a municipality level in Belgium. 4CMenB vaccinations between November 2022 and October 2023, as well as individuals’ age, location and household income level were obtained. Individuals with two to three doses of 4CMenB and municipalities with ≥100 vaccinees were included in this analysis. Of the 16,816 individuals vaccinated, 71% were concentrated within 11% (65/593) of municipalities. 4CMenB coverage was highest amongst the <1 (16%) and 1–2 years (14%) age groups. There was a correlation observed between 4CMenB coverage and age, as well as 4CMenB coverage and household income at a municipality level. This interaction was observed in individuals up to 11 years, with the most statistically significant correlation occurring in age groups <1 and 1–2 years (both p<0.001). 4CMenB not being a publicly funded vaccine may contribute to inequity in vaccine access, potentially placing low-income populations in Belgium at increased risk of invasive meningococcal disease. Universal vaccine recommendations and inclusion of 4CMenB into Belgium’s National Immunisation Program could reduce potential inequity in vaccine access.  

A graphical abstract is provided at the end of the article.