Potential Use of Neisseria meningitidis Serogroup B Vaccines to Prevent Neisseria gonorrhoeae Infection: Epidemiological Considerations

Abstract

Introduction

Clinical trials are evaluating the efficacy of serogroup B meningococcal (MenB) outer membrane vesicle (OMV) vaccines in preventing gonorrhoea. We assessed the global epidemiology of gonorrhoea and MenB invasive meningococcal disease (IMD) and reviewed national MenB-OMV vaccination policies to inform potential use of these vaccines.

Methods

We included country-specific epidemiologic data from 2015 through October 2025. Gonorrhoea prevalence data for general populations of women were extracted from published systematic reviews and case reports taken from well-established reporting systems. Country-specific MenB IMD incidence rates were drawn from published reviews and surveillance reports. National MenB-OMV immunization policies were obtained from published reviews and databases from the World Health Organization and vaccine manufacturers.

Results

Forty-two countries had ≥1 gonorrhoea prevalence study. Mean prevalence was <1.0% in 19 (45%) countries, 1.0%−2.49% in 10 (24%), 2.5%−4.99% in 10 (24%) and ≥5% in three (7%), with higher prevalences mostly in the WHO African Region. MenB IMD incidence was reported in 62 countries: 17 (27%), mainly in the WHO African Region, had no cases; 28 (45%) had incidence <0.25/100,000; 14 (23%) had incidence 0.25−0.49/100,000; and only three had incidence ≥0.5/100,000 annually. Only 15 countries had data for both conditions. Case-report data showed gonorrhoea incidence peaking at ages 20–24 and being substantially higher among men who have sex with men (MSM). MenB IMD incidence was highest among children <4 years, with a second peak among 15- to 24-year-olds in some countries. Twenty-one countries incorporated MenB-OMV vaccines into infant immunization programmes and seven into adolescent programmes. One country had a targeted MenB-OMV vaccination programme (MSM at high-risk) for gonorrhoea prevention.

Discussion

Epidemiologic data were lacking in many countries; only a handful had a substantial burden of both gonorrhoea and MenB IMD. Low- and middle-income countries with high gonorrhoea prevalence typically reported no MenB IMD or lacked data, whereas high-income countries with higher MenB IMD incidence and MenB-OMV vaccine use had low gonorrhoea prevalence but high rates in subpopulations like MSM.

Conclusions

If trials confirm MenB-OMV vaccine cross-protection against gonorrhoea, global epidemiology can help identify settings and populations for potential vaccine use against gonococcal infection alone, or for both conditions. Improved data collection and cost-effectiveness analyses across both conditions can further inform decision-making.