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These correlates of protection were subsequently validated against postlicensure estimates of observed vaccine effectiveness up to 7 to 9 months after the administration of the MCC vaccine. Vaccine effectiveness was, however, shown to fall significantly more than 1 year after the administration of a 3-dose course in infancy. Despite this finding, the marked impact on serogroup C disease has been sustained, with the lowest recorded incidence (0.02 case per 100,000 population) in the 2008-2009 epidemiological year, mainly due to the indirect herd immunity effect of the vaccine in reducing carriage. Updated estimates of vaccine effectiveness through 30 June 2009 confirmed high short-term protection after vaccination in infancy, at 97% (95% confidence interval [CI], 91% to 99%), falling to 68% (95% CI, \u221263% to 90%) more than a year after vaccination. The observed vaccine effectiveness more than 12 months postvaccination was consistent with measured declining SBA levels, but confidence intervals were imprecise; vaccine effectiveness estimates were consistent with SBA titers of 1:4 or 1:8 as correlates of long-term protection after a primary course in infants. Modeling suggested that protection against carriage persists for at least 3 years and predicted the stabilization of serogroup C disease at low levels (fewer than 50 cases per year) up to 2015-2016.<\/jats:p>","DOI":"10.1128\/cvi.00529-09","type":"journal-article","created":{"date-parts":[[2010,3,11]],"date-time":"2010-03-11T03:33:57Z","timestamp":1268278437000},"page":"840-847","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":185,"title":["Updated Postlicensure Surveillance of the Meningococcal C Conjugate Vaccine in England and Wales: Effectiveness, Validation of Serological Correlates of Protection, and Modeling Predictions of the Duration of Herd Immunity"],"prefix":"10.1128","volume":"17","author":[{"given":"Helen","family":"Campbell","sequence":"first","affiliation":[{"name":"Immunisation, Hepatitis and Blood Safety Department, Health Protection Agency Centre for Infections, 61 Colindale Avenue, London NW9 5EQ, United Kingdom"},{"name":"Statistics, Modelling &amp; Bioinformatics, Health Protection Agency, Centre for Infections, 61 Colindale Avenue, London NW9 5EQ, United Kingdom"},{"name":"Meningococcal Reference Unit, Health Protection Agency North West, Manchester Royal Infirmary, Manchester, United Kingdom"},{"name":"Department of Social Medicine, University of Bristol, Canynge Hall, Whatley Road, Bristol BS8 2PS, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick","family":"Andrews","sequence":"additional","affiliation":[{"name":"Immunisation, Hepatitis and Blood Safety Department, Health Protection Agency Centre for Infections, 61 Colindale Avenue, London NW9 5EQ, United Kingdom"},{"name":"Statistics, Modelling &amp; Bioinformatics, Health Protection Agency, Centre for Infections, 61 Colindale Avenue, London NW9 5EQ, United Kingdom"},{"name":"Meningococcal Reference Unit, Health Protection Agency North West, Manchester Royal Infirmary, Manchester, United Kingdom"},{"name":"Department of Social Medicine, University of Bristol, Canynge Hall, Whatley Road, Bristol BS8 2PS, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ray","family":"Borrow","sequence":"additional","affiliation":[{"name":"Immunisation, Hepatitis and Blood Safety Department, Health Protection Agency Centre for Infections, 61 Colindale Avenue, London NW9 5EQ, United Kingdom"},{"name":"Statistics, Modelling &amp; Bioinformatics, Health Protection Agency, Centre for Infections, 61 Colindale Avenue, London NW9 5EQ, United Kingdom"},{"name":"Meningococcal Reference Unit, Health Protection Agency North West, Manchester Royal Infirmary, Manchester, United Kingdom"},{"name":"Department of Social Medicine, University of Bristol, Canynge Hall, Whatley Road, Bristol BS8 2PS, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Trotter","sequence":"additional","affiliation":[{"name":"Immunisation, Hepatitis and Blood Safety Department, Health Protection Agency Centre for Infections, 61 Colindale Avenue, London NW9 5EQ, United Kingdom"},{"name":"Statistics, Modelling &amp; Bioinformatics, Health Protection Agency, Centre for Infections, 61 Colindale Avenue, London NW9 5EQ, United Kingdom"},{"name":"Meningococcal Reference Unit, Health Protection Agency North West, Manchester Royal Infirmary, Manchester, United Kingdom"},{"name":"Department of Social Medicine, University of Bristol, Canynge Hall, Whatley Road, Bristol BS8 2PS, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Miller","sequence":"additional","affiliation":[{"name":"Immunisation, Hepatitis and Blood Safety Department, Health Protection Agency Centre for Infections, 61 Colindale Avenue, London NW9 5EQ, United Kingdom"},{"name":"Statistics, Modelling &amp; Bioinformatics, Health Protection Agency, Centre for Infections, 61 Colindale Avenue, London NW9 5EQ, United Kingdom"},{"name":"Meningococcal Reference Unit, Health Protection Agency North West, Manchester Royal Infirmary, Manchester, United Kingdom"},{"name":"Department of Social Medicine, University of Bristol, Canynge Hall, Whatley Road, Bristol BS8 2PS, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","first-page":"780","volume":"10","year":"2003","unstructured":"Andrews, N., R. 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