MenB:
A gonnorhoea vaccine?
MenB is a vaccine that has been shown to prevent gonorrhoea. In November 2023, the Joint Scientific Committee on Vaccination and Immunisation (JCVI) recommended the use of MenB to prevent gonorrhoea in people who are more likely to get an STI (especially gay, bisexual, and other men who have sex with men). As of August 2024, none of the JCVI’s recommendations for a MenB gonorrhoea prevention programme have been implemented in the UK.
In light of recent data showing record high levels of gonorrhoea and increases in cases that are resistant to antibiotics, we call for the government to take action and implement the JCVI’s recommendations for a MenB vaccination programme at the earliest opportunity.
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Research shows that the MenB vaccine can prevent gonorrhoea.
The vaccine was originally designed to protect people against meningococcal disease.
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Evidence suggests that MenB is between 31% and 59% effective at preventing gonorrhoea.
Two doses of MenB could provide someone with protection against gonorrhoea for at least three years.
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The vaccine could be particularly useful for gay, bisexual and other men who have sex with men.
These are the people who are at the highest risk of getting gonorrhoea.
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The vaccine could also help save the NHS time and money
by reducing the number of cases of gonorrhoea that need to be treated.
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MenB for gonorrhoea prevention is not yet available on the NHS,
although the Joint Scientific Committee on Vaccination and Immunisation recommended that it be made available in November 2023.
1. What is MenB?
MenB is a vaccine - marketed under the name Bexsero and sometimes referred to as 4CMenB - that can protect against gonorrhoea.
The vaccine was developed to protect people against the B subtype of a bacteria called Neisseria meningitidis - the bacteria that causes meningococcal disease. Research now shows that it can protect people against gonorrhoea too.
2. How does it work?
The bacteria that cause meningococcal disease (Neisseria meningitidis) and the bacteria that cause gonorrhoea (Neisseria gonorrhoeae) are very closely related. Because they are so closely related, the antibodies produced by the vaccine also work against the bacteria that cause gonorrhoea.
The vaccine contains outer membrane vesicles (OMVs) extracted from Neisseria meningitidis. These are, simply put, particles used by bacteria to communicate. When OMVs enter the body (via a vaccine), they cannot cause disease or harm but instead trigger the body’s immune system to produce antibodies to combat the bacteria that the OMVs came from. The production of antibodies by the immune system is how vaccines produce protection against future infection.
3. How well does it work?
Estimates of the level of protection against gonorrhoea offered by MenB vary between studies but range between 31% and 59%. It is thought that two doses of MenB - administered at least one month apart - provide at least three years* of protection against gonorrhoea and that this could be lengthened with booster doses.
The following is a list of estimates of the level of protection offered by two doses of MenB drawn from different studies:
| YEAR | STUDY AUTHORS | ESTIMATE OF PROTECTION |
|---|---|---|
| 2017 | Longtin and colleagues | 59% |
| 2017 | Petousis-Harris and colleagues | 31% |
| 2022 | Petousis-Harris and colleagues | 40% |
| 2022 | Wang and colleagues | 33% |
| 2023 | Bruxvoort and colleagues | 46% |
*Some researchers think that two doses of MenB could provide some level of protection against gonorrhoea infection for up to 10 years.
4. What evidence is there that it works?
Three kinds of scientific study tell us that MenB offers protection against gonorrhoea and what kind of impact it might make:
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The first research to suggest that MenB can offer protection against gonorrhoea came from observational studies. These are studies where researchers look at data that has already been gathered, rather than producing new data (like you would in a clinical trial - see below).
In the case of MenB for gonorrhoea prevention, observational studies involve looking at the number of diagnoses of gonorrhoea infection among individuals who received the MenB vaccine to prevent meningococcal disease compared to the number of diagnoses among individuals who didn’t receive the vaccine.
For instance, Petousis-Harris and colleagues (2017) studied the impact of a mass MenB vaccination campaign that took place between 2004 and 2008 in New Zealand to combat an epidemic of meningococcal infection. Looking at STI diagnoses among people who had been eligible for the vaccine, the researchers found that people who had received the vaccine were less likely to test positive for gonorrhoea and estimated that MenB was 31% effective at preventing gonorrhoea infection.
In another study, Bruxvoort and colleagues (2023) compared the rates of gonorrhoea diagnosis in Southern California in people who had received MenB and people who had received another kind of vaccine to prevent meningococcal infection (the MenACWY vaccine). This study, which also made sure that the groups being compared had similar STI testing histories and sexual behaviours, reported that MenB was 46% effective at preventing gonorrhoea.
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Modelling studies have explored what impact MenB might have on the transmission of gonorrhoea, using estimates of things like the effectiveness of MenB against gonorrhoea and the uptake of vaccines.
Looker and colleagues (2023), for instance, modelled the potential impact of a nationwide MenB vaccination programme in England. They assumed that MenB was 31% effective against gonorrhoea, that 85% of people eligible for the vaccine accepted it, and that the vaccine provided six years of protection. With these figures, the authors concluded that a vaccination programme like this could avert 50,000 cases of gonorrhoea infection over 10 years.
Other modelling studies have looked at what would happen if a MenB vaccination programme was provided for communities that were more likely to acquire gonorrhoea infection - like gay, bisexual and other men who have sex with men (GBMSM). Whittles and colleagues (2022) considered what the impact of a programme like this might be in England, assuming MenB is 31% effective against gonorrhoea infection and provides three years of protection. The authors found that, if vaccination was offered to all GBMSM considered at risk of gonorrhoea (e.g. GBMSM with more than five sexual partners a year), 110,200 cases of gonorrhoea could be prevented over 10 years.
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Clinical trials to assess the effectiveness of MenB are currently underway in the United States and Australia. These trials will compare the rates of gonorrhoea in participants who receive MenB to the rates of gonorrhoea in participants who receive a placebo (i.e. an injection of salt water or something similar).
One clinical trial in France - DOXYVAC - has already examined the impact of MenB vaccination on the rates of gonorrhoea in GBMSM. The study also examined the impact of DoxyPEP on STI diagnoses. Initial results from the study were promising: at the halfway point, DOXYVAC demonstrated that MenB was 51% effective at preventing gonorrhoea. The results were so promising that an independent monitoring board advised the study should be halted early so that all participants could have access to the prevention tools offered in the study.
However, the full analysis of the DOXYVAC data drastically revised the estimated efficacy of MenB to 22%. This figure implies that MenB could still have a small benefit but is below the typical threshold of efficacy for a vaccine to be considered for implementation (30%).
However, the results of DOXYVAC do not mean that MenB is not effective. There are two important reasons for this:
The DOXYVAC study had limitations. For instance, the study authors acknowledge that, because it concluded early, the study may not have recruited enough participants to demonstrate vaccine efficacy. DOXYVAC intended to recruit 720 participants but just 545 were included in the final analysis.
DOXYVAC is just one source of evidence that we have. We need lots of sources of evidence to build a picture of whether new prevention tools work. As well as the results of DOXYVAC, this includes the results of the ongoing MenB clinical trials in the United States and Australia (which may say something different to DOXYVAC) and the results of the observational studies described above (which suggest MenB does offer protection against gonorrhoea infection).
5. Who might benefit from MenB?
MenB could be particularly beneficial for people from communities who are more likely to test positive for gonorrhoea. In the UK, this includes gay, bisexual and other men who have sex with men (GBMSM), Black Caribbean communities, Latin American communities, and young people (aged between 15 and 24).
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In 2023, the Joint Committee on Vaccination and Immunisation (JCVI) - the committee that advises the government about vaccines - recommended that the UK government consider a MenB vaccination programme primarily for GBMSM who are at the highest risk of getting gonorrhoea (for instance, GBMSM who have had sex with multiple partners in the past year or who have recently tested positive for an STI). The JCVI made this recommendation, in part, because GBMSM currently have the highest rates of gonorrhoea diagnosis - so a targeted vaccination programme for GBMSM could make a big impact - and because the benefits of a programme like this one have been clearly modelled (see Section 4: What evidence is there that it works?).
The JCVI also suggested that health professionals should offer vaccines to any individual, regardless of their gender or sexuality, who is regarded as having a similarly elevated risk of STI infection. This could include anyone with a recent history of bacterial STI diagnosis or some sex workers.
6. Are there any other benefits of MenB?
In addition to helping to prevent the spread of STIs, a programme of MenB vaccination for gonorrhoea could have other benefits.
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The modelling study conducted by Whittles and colleagues concluded that as well as helping to prevent 110,200 cases of gonorrhoea infection - a successful vaccination programme amongst gay, bisexual and other men who have sex with men could save the NHS an estimated £7.9 million over 10 years. Reducing the number of cases of gonorrhoea that need to be diagnosed and treated would also free up the capacity of overstretched clinics to deliver other services for those that need them.
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As well as saving time and money for care providers, a vaccination programme could also help address concerns about the development of antimicrobial resistance (AMR) in gonorrhoea. AMR is currently a widespread public health concern. It occurs when bacteria that cause infections acquire genetic material that means they are no longer affected by antibiotics that normally kill them. Generally speaking, the more often that bacteria are exposed to antibiotics, the faster AMR develops.
Since the year 2000, the UK Health Security Agency (UKHSA) has been monitoring AMR in gonorrhoea and observed increases in resistance to a number of antibiotics, including azithromycin and ciprofloxacin, making infections harder to treat. In August 2024, UKHSA reported record high levels of gonorrhoea diagnosis and an increasing number of cases of gonorrhoea that could not be treated by the recommended antibiotics (ceftriaxone). A vaccination programme could help to slow the increase of AMR in gonorrhoea by reducing the number of overall infections. This would mean fewer cases of gonorrhoea to treat and, therefore, reduced exposure of gonorrhoea to antibiotics (which might accelerate the development of AMR).
7. Is MenB currently available in the UK on the NHS?
Alongside other routine childhood vaccinations, the NHS currently offers MenB to all infants in the UK to protect them against meningococcal infection. Outside of this, the vaccine is not currently available on the NHS in the UK.
N.B. Another vaccine that can protect against meningococcal infection - MenACWY - is available on the NHS and offered to teenagers and young adults (up to the age of 25). This is a different vaccine to MenB and has not been shown to provide any protection against gonorrhoea.
In November 2023, the Joint Scientific Committee on Vaccination and Immunisation (JCVI) recommended the use of MenB to prevent gonorrhoea in people at the highest risk of acquiring an STI. However, as of August 2024, none of the JCVI’s recommendations for a MenB gonorrhoea prevention programme have been implemented in the UK.
8. Is there any other way to access MenB?
It is possible to access MenB vaccination outside of the NHS in the UK through private or commercial providers.
Boots and Superdrug, for instance, both offer MenB vaccination to adults for £110 per dose.
Private clinicians can also provide MenB vaccination to adults at a cost. The cost of accessing MenB through private clinicians is likely to be more expensive than the cost of accessing the vaccine through high street pharmacies (like Boots or Superdrug), as they will include appointment fees. For example, in August 2024, one private clinic quoted the cost of MenB vaccination as £155 per dose (including appointment fees).
9. Can any other tools - old or new - help prevent the spread of gonorrhoea?
In addition to MenB, other existing tools can help prevent the spread of gonorrhoea. This includes condoms, STI testing (either using a self-sampling kit or in a clinic), and a course of treatment for people who test positive.
New tools like DoxyPEP have also been shown to help prevent gonorrhoea infections. However, DoxyPEP is less effective at preventing gonorrhoea than other bacterial STIs - like chlamydia and syphilis - because of antimicrobial resistance in gonorrhoea.
Researchers are also working hard to develop a specific vaccine against the bacteria - Neisseria gonorrhoeae - that causes gonorrhoea. A clinical trial is currently underway in eight countries - US, UK, France, Germany, Spain, Brazil, Philippines, and South Africa - to assess the effectiveness of a new vaccine candidate for gonorrhoea prevention. Earlier clinical trial data has shown that this vaccine is safe to use in healthy adults.