Effectiveness of the four-component protein-based meningococcal vaccine against Neisseria gonorrhoeae infections: Mounting evidence and public health implications for Canada.

Background: In Canada, the burden of gonorrhea has been increasing steadily over the last decade with emerging multi-drug-resistant strains. There is a high genomic similarity between Neisseria meningitidis and Neisseria gonorrhoea.

Methods: Review of published studies and on-going trials with the four-component meningococcal serogroup B vaccine (4CMenB-Bexsero®).

Results: Observational studies have shown protection against gonorrhea infection ranging from 35% to 59% for up to three years after the administration of 4CMenB. Several randomized clinical trials are also under way. Results from the DOXYVAC trial have been published but the sample size was too small to exclude a protective effect in the 30%-50% range. Recommendations on the use of 4CMenB for individuals at high risk of gonorrhea infection have been issued in the United Kingdom and New York state based on results of observational studies.

Conclusion: If results of observational studies are confirmed by randomized trials with an acceptable cost-effectiveness profile in the Canadian context, a targeted immunization program using 4CMenB could be implemented.