Potential benefits of using a multicomponent vaccine for prevention of serogroup B meningococcal disease

•4CMenB contains four main antigens, each targeting a different cellular function.•Most meningococcal serogroup B (MenB) strains express at least one 4CMenB antigen and many express two or more.•Antibodies against individual antigens may display cooperative bactericidal activity.•Real-world data have shown that 4CMenB is effective and affords long-lasting protection, with no safety concerns.•4CMenB may afford partial protection against non-MenB disease and Neisseria gonorrhoeae. Meningococcal serogroup B (MenB) has become the main cause of invasive meningococcal disease in industrialized countries in recent years. The diversity of MenB strains and poor immunogenicity of the MenB capsular polysaccharide have made vaccine development challenging. Two MenB vaccines, including factor H binding protein (fHbp) as a major antigenic component, are now licensed for use. In addition to fHbp variant 1, the multicomponent vaccine 4CMenB contains neisserial heparin binding antigen, Neisseria adhesin A, and outer membrane vesicles containing porin A. The vast majority of circulating MenB strains contain genes encoding at least one 4CMenB component and many express genes for more than one vaccine antigen. Recent studies have suggested that serum bactericidal activity is enhanced against strains that express two or more vaccine antigens. Bacterial killing may also occur when antibodies to vaccine components are collectively present at levels that would individually be sub-lethal. The evaluation of immune responses to separate vaccine components does not take cooperative activity into account and may underestimate the overall protection. Available data on 4CMenB effectiveness indicate that this multicomponent vaccine affords broad coverage and protection against MenB disease. 4CMenB also has the potential to protect against disease caused by non-MenB meningococci and Neisseria gonorrhoeae.