Association between 4CMenB vaccination and gonorrhea rates in Washington state by anatomic infection site

Background: N. gonorrhoeae control and prevention is an urgent public health concern. Previous studies have observed that 4CMenB is associated with a decrease in gonorrhea infections, but there have been no observational studies that evaluated whether this association differs by anatomic infection site. Methods: We conducted an observational study in Washington state among all people diagnosed with gonorrhea and chlamydia using surveillance data from 2017-2018. Our exposure was receipt of a dose of 4CMenB vaccine at least 30 days before sexually transmitted infection (STI) diagnosis. Our outcome was reported gonorrhea diagnosis. We used Poisson regression with generalized estimating equations to examine associations by anatomic infection site adjusting for age and gender of sexual partners. Results: A total of 80,236 STI diagnoses across 67,185 individuals were included in our final cohort, and 203 (0.3%) individuals received one dose of 4CMenB before STI diagnosis. Those who were vaccinated were 29% less likely to acquire gonorrhea (aPR: 0.71 [0.50,1.02], p=0.07). We observed a statistically significant interaction between 4CMenB vaccination and gonorrhea diagnosis by anatomic infection site (p=0.002). Those who were vaccinated with the 4CMenB vaccine were 38% less likely to acquire gonorrhea at a urogenital site (aPR: 0.62 [0.39,1.00], p=0.049), but no significant association was observed for pharyngeal, rectal, and multiple sites. Discussion: Our results are somewhat consistent with previous studies suggesting that 4CMenB is probably protective against urogenital gonorrhea. Current randomized control trials are further exploring this relationship, and there is potential for 4CMenB use as another method to prevent gonorrhea.