Despite there being a increased risk of meningococcal disease among persons living with HIV (PLWH), uptake of the meningococcal A, C, W, Y (MenACWY) vaccine remains at suboptimal levels among those with a new diagnosis, according to 2016-2018 insurance claims data for patients 2 years and older who have a new HIV diagnosis.

In addition, education on the importance of the vaccine needs to be stepped up, wrote the authors, whose retrospective findings appear in JAMA Network Open.

“In the United States, individuals with HIV infection have been recommended to receive a 2-dose series of the MenACWY vaccine since 2016 owing to their increased risk of meningococcal disease,” the authors wrote. “Our goal was to examine uptake and time to receipt of the MenACWY vaccine among people with a new diagnosis of HIV.”

Among their 1208-patient cohort, everyone had 1 or more inpatients claims or 2 or more outpatient claims in the Optum Research Database in connection with their new HIV diagnosis and 12 or more months before and 6 or more months after that diagnosis of continuous insurance coverage. This patient population was mostly male (84.8%), adult (mean [SD] age, 38.8 [12.5] years), and Black (22.6%) or White (36.6%).

Just over 16% of patients received their initial MenACWY dose in the first 2 years after their HIV diagnosis, and this jumped to 66.2% for those receiving their second dose within a year of the first dose—overage an average 33 months of follow-up. The following factors were significantly associated with a greater chance of having receiving the MenACWY vaccine:

• Receiving the pneumococcal vaccine (HR, 23.03; 95% CI, 13.93-38.09)
• Having a well-care visit (HR, 3.67; 95% CI, 1.11-12.12)
• Living in the West region of the United States (HR, 2.24; 95% CI, 1.44-3.47)
• Living in the Midwest region of the United States (HR, 1.78; 95% CI, 1.16-2.71)
• Being male (HR, 2.72; 95% CI, 1.18-6.26)

Compared with patients aged 2 to 18 years and 19 to 55 years, respectively, patients 56 years and older had a significantly reduced vaccination rate, as seen across the entire study follow-up: 30.8% vs 13.8% 4.6%. Further, a baseline emergency department visit was also associated with a reduced likelihood of vaccine uptake (HR, 0.54; 95% CI, 0.37-0.79).

The US Advisory Committee on Immunization Practices’ recommendation for vaccination among PLWH against meningococcal serogroups A, C, W, and Y was formally adopted in 2016, the study authors noted, and regular boosters follow the 2-dose primary series. The youngest ages at which this vaccine can be given are 2 months (MenACWY-CRM, Menveo), 9 months (MenACWY-D, Menactra), or 2 years (MenACWY-TT, MenQuadfi).

Additional study results show the following:

• By 12 and 18 months, respectively after receiving their HIV diagnosis, 10.6% and 12.9% of PLWH had received at least 1 dose if they were eligible
• Infectious disease specialists most often gave the MenACWY (25.5%), followed by internal medicine physicians (20.4%), primary care doctors (17.4%), pediatricians (2.6%) and other specialists (31.2%)
• Everyone aged 11 to 18 years had a pediatrician administer their vaccine
• For patients identified as having HIV after December 2016, rates of first vaccine dose rose to 11.6% at 12 months and 13.9% at 18 months

“To our knowledge, no US studies have reported coverage of the MenACWY vaccine among people with HIV, although 2 US studies have reported coverage among men who have sex with men,” the authors wrote, “with results according to HIV status.”

Strengths of these findings include their focus those with a new HIV diagnosis—“so we could study time to vaccination”—and the geographic distribution of the study population.

Limitations include including patients starting from January 2016 even though the MenACWY recommendations were not adopted until November 2016. There is also the possibility of survivor bias, due to the insurance coverage restriction of 6 or more continuous months of insurance coverage following diagnosis.

They also note that their findings show both higher and lower rates of meningococcal vaccine vs previous studies.

“These data highlight the need for better education of patients and clinicians,” they concluded, “about the risk of meningococcal disease and the need for vaccination.”

Reference

Ghaswalla PK, Marshall GA, Bengston LGS, et al. Meningococcal vaccination rates among people with a new diagnosis of HIV infection in the US. JAMA Netw Open. Published online April 29, 2022. doi:10.1001/jamanetworkopen.2022.8573