Assessing the impact of revising MenACWY vaccination schedule for adolescents in the United States: a modelling study
Bibliographic record
Abstract
Background: The current recommendation for MenACWY vaccination against invasive meningococcal disease (IMD) in the United States (US) includes two doses: the first dose at ages 11-12 and a booster dose at age 16. The Advisory Committee on Immunization Practices has proposed options for revising this schedule by either eliminating the first dose or adjusting the timing of the first dose to age 15 and the booster to ages 17-18. The impact of these alternative schedules on IMD incidence remains undetermined. Methods: We developed an age-stratified, agent-based Monte-Carlo simulation model of meningococcal transmission dynamics, parameterised with US age demographics, to assess the impact of the proposed changes to the MenACWY vaccination schedules. Excluding serogroup A, absent in the US for decades, the model included serogroups C, W, and Y for asymptomatic infection (carriage) and vaccine effectiveness against IMD. We calibrated serogroup-specific transmission and IMD development probabilities by fitting the model to reported IMD cases from 1997 to 2004, before vaccine introduction. The calibrated model then simulated the current vaccination schedule (CVS) starting in 2005 and alternative schedules from January 1, 2025 to December 31, 2035, comparing outcomes over the same period. Findings: Switching from the CVS to a single-dose program at age 16 with 61% vaccine uptake (as reported for the booster in 2022) would result in 1062 (95% Uncertainty Range [UR]: 724-1419) additional IMD cases during the 11-year study period. With a case fatality rate of 14.5%, this change could cause an estimated 154 (95% UR: 105-206) additional deaths. Even if vaccine uptake increased to 90% at age 16, the program would still result in 934 (95% UR: 640-1242) additional cases and 135 (95% UR: 93-180) more deaths compared to the CVS. The second alternative schedule (i.e. first dose at age 15, booster at ages 17-18) also increased IMD cases, notably shifting a substantial burden to adolescents aged 11-15 years. Interpretation: Our findings indicate that the current MenACWY vaccination program remains more effective than the proposed alternatives, even with increased vaccine uptake during late adolescence. Improving the uptake rate of the booster at age 16 while maintaining the 11-12-year dose within the existing program would reduce the IMD burden among high-risk adolescents and young adults. Funding: This study was in part supported by Sanofi. Seyed M. Moghadas acknowledges support from the Natural Sciences and Engineering Research Council of Canada Discovery Grant and Alliance Grant (ALLRP 576914-22). Alison P. Galvani acknowledges support from The Notsew Orm Sands Foundation.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".