The JCVI has today issued its advice to government for a routine targeted vaccination programme for the prevention of gonorrhoea, alongside advising on a routine vaccination programme against mpox for those at highest risk.
The JCVI advice is that both programmes should be offered on an opportunistic basis through specialist sexual health services which have the experience in assessment and identification of those who are at increased risk of infection with bacterial sexually transmitted infections (STIs).
This advice will now be considered in full by Department of Health and Social Care ministers before any policy decisions are made on any new routine immunisation programmes. Should the advice be accepted, operational detail of how the vaccine will be delivered will follow.
The JCVI's advice on gonorrhoea says that a targeted vaccination programme should use the 4CMenB vaccine for the prevention of gonorrhoea. The MenB vaccine is currently used in the routine childhood programme for the prevention of meningococcal disease (meningitis and septicaemia).
Meningococcal disease (Neisseria meningitidis) and gonorrhoea (Neisseria gonorrhoeae) are closely genetically related, with evidence showing that MenB vaccine provides some cross-protection against gonorrhoea.
In reviewing the evidence, the JCVI noted that even with the modest vaccine documented effectiveness against gonorrhoea (between 32.7% to 42%) many cases of gonorrhoea could be prevented. It was also noted that the disease itself doesn't protect from infection and affected individuals are commonly reinfected.
The JCVI considered the evidence presented in terms of programme cost-effectiveness and likely impact on the incidence of gonorrhoea.
While the main benefit of a vaccination programme is expected to be at a community level with a significant reduction in the number of cases overall, vaccinated individuals could expect to have some reduction in their own risk of contracting gonorrhoea.
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 addition, we are advising setting up a routine targeted mpox offer - to prevent a repeat of the large outbreak we saw in early 2022. Both vaccinations should be offered to those at highest risk.
Katy Sinka, Head of Sexually Transmitted Infections at UKHSA, said:
A vaccination programme to impact on gonorrhoea cases would be a hugely welcome intervention to ensure we are better prepared to address this increasing threat. We saw a rapid rise last year with more cases than ever before and with gonorrhoea becoming increasingly resistant to antibiotics, tackling this infection is a serious concern.
And while mpox case numbers across England remain very low, we should not be complacent. 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 advises that a 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.
While a disproportionate number of gonorrhoea cases are within GBMSM, this doesn't cover the entire cohort at higher risk. JCVI advises that efforts should be made to ensure that the vaccine is offered to those at equivalent risk, including other individuals who may be heterosexual or identify otherwise.
The eligibility advice for a routine mpox programme would be for an opportunistic offer to GBMSM at higher risk of mpox infection.
As with all immunisation advice, the JCVI will keep this under review and the programme costs and benefits, and eligibility may be reassessed as further information about vaccine effectiveness and duration of protection becomes available.
