U.K. recommendation could lead to world’s first use of meningitis vaccine to curb gonorrhea

An expert panel that advises the United Kingdom on vaccine policy has recommended using a meningitis B vaccine to try to bring down spiking rates of gonorrhea. If adopted, the U.K. would be the first country to use the meningitis B vaccine for this purpose.

The Joint Committee on Vaccination and Immunization released a report Friday saying that targeted use of a meningitis B vaccine — GSK’s Bexsero — in people at high risk of contracting gonorrhea should reduce the incidence of an infection that is becoming increasingly difficult to treat.

“Introducing a MenB vaccination program to prevent gonorrhea in England would be a world first and should significantly help to reduce levels of gonorrhea, which are currently at a record high,” JCVI Chair Andrew Pollard said in a statement.

The committee recommended 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, either because they currently have it or have been previously diagnosed with it, or who report high-risk sexual behavior with multiple partners. Gonorrhea infection does not induce immunity; people who have been cured can be reinfected.

The decision to offer the vaccine to an individual should be based on a risk assessment by a sexual health clinical professional, the JCVI report said. The report notes there is no evidence on whether being vaccinated while infected would work, so it recommends holding off on vaccination until the infection has been cured.

It also suggested other individuals 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 a bacterial STI, and sex workers.

Gonorrhea is the second most commonly diagnosed sexually transmitted infection in England, with around 80,000 diagnoses a year.

Neisseria gonorrhoeae, the bacteria responsible for the infection, has over the years developed resistance to virtually every antibiotic that has been used to treat it. The current recommended therapy, ceftriaxone, is the last licensed antibiotic that can reliably cure gonorrhea. But there have been increasing reports of ceftriaxone-resistant cases of the infection.

“A vaccination program to impact … gonorrhea cases would be a hugely welcome intervention to ensure we are better prepared to address this increasing threat,” said Katy Sinka, head of the sexually transmitted infections program at the U.K. Health Security Agency. “We saw a rapid rise last year with more cases than ever before and with gonorrhea becoming increasingly resistant to antibiotics, tackling this infection is a serious concern.”

JCVI also recommended routine use of mpox vaccine among at-risk people, a step that its U.S. equivalent, the Advisory Committee on Immunization Practices, recommended last month. The U.K.’s department of health and social care will now study both recommendations. It must approve them before the JCVI advice can be put into effect.

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% alike.

In theory, the similarity of the two bacteria suggests that the meningitis B vaccine could offer some protection against gonorrhea. And over the past decade or so, real-world evidence to support the idea has been piling up.

A range of studies that have been conducted in a number of countries have estimated that the vaccine is between about 33% and 42% effective at protecting against gonorrhea.

But to date all of the data supporting the use of the vaccine to protect against gonorrhea have been observational, meaning researchers have looked at gonorrhea rates in cohorts of people who received the vaccine for meningitis-control purposes. To get a clearer picture of whether and how well using it to protect against gonorrhea works, data from a randomized controlled trial that compares gonorrhea rates among vaccinated people to similar people who are unvaccinated will be needed.

Scientists funded by the National Institutes of Health are conducting just such a study, enrolling 2,200 adults in the U.S., Thailand, and sites in Africa. Jodie Dionne, an STI expert at the University of Alabama at Birmingham, is one of the trial site investigators and protocol co-chair. She told STAT that so far about 1,600 people have been enrolled. It’s expected that the trial will 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 very soon.”

Asked about the JCVI’s recommendation, Dionne noted that Bexsero has a good safety profile, which is reassuring in terms of what would be off-label use of the vaccine. But she thinks that making a decision like this without clinical trial data is “early.”

“I think that waiting for the clinical trial data is preferable whenever you can,” Dionne said. “I think for the average person, they are reassured when 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 maybe this will have an impact.’ That’s not quite as powerful.”

If the vaccine is protective against gonorrhea, it’s not yet known for how long the protection will last, the JCVI report noted. It also said it will be important to impress upon people getting the vaccine that they are still at risk of becoming infected.

“Although vaccination would be expected to reduce the chance of becoming infected with gonorrhea, it would not completely eliminate the possibility,” it stated.