Invasive meningococcal disease epidemiology and vaccination strategies in four Southern European countries: a review of the available data

Figures & data

Figure 1. Annual IMD incidence by age group in Italy (2005–2019), Portugal (2003–2019), Greece (2010–2019), and Spain (2012–2019) IMD, invasive meningococcal disease.

Figure 2. Annual IMD incidence and number of laboratory confirmed IMD cases by serogroup and evolution of National Immunization Programmes in Italy (2000–2019), Portugal (2003–2019), Greece (2000–2020), and Spain (1999–2000–2019–2020). IMD, invasive meningococcal disease; MenACWY, serogroup a, c, W and Y meningococcal (vaccine); Menb, serogroup B meningococcal (vaccine); Menc, serogroup c meningococcal (vaccine); NIP, National Immunization Program.

Table 1. Evolution of meningococcal vaccination strategies in Italy, Portugal, Greece and Spain for the general pediatric and adolescent population.

Country	Vaccine type	Year(s) or period	Dose schedule and target age group	Ref.
Italy	Monovalent conjugate MenC vaccine	2005	1 year old in certain regions^†	[39–45], [61, 70–76]
		2008–2010	Single dose for 13–15 months of age^‡
		2012	Single dose for 13–15 months of age and for 11–18 years old, if not previously vaccinated, and risk groups
	Quadrivalent MenACWY vaccine	2017	Single dose for adolescents
			Single dose for 13–15 months of age in 12 out of 21 regions^† (Basilicata, Calabria, Campania, Emilia Romagna, Friuli Venezia Giulia, Lazio, Marche, Molise, Puglia, Sicilia, Trento, Veneto)
	4CMenB vaccine	2017	3 + 1 dose series for infants
	MenB-fHbp vaccine	2017	Apulia: adolescents at the age of 11–12 years in conjunction with the offer of tetravalent anti-meningococcal vaccination ACYW
			Sicily: during the twelfth year of age (eleven years plus one day)
		2019	Campania: adolescents during the thirteenth year of age (twelve years plus one day) in conjunction with the offer of tetravalent anti-meningococcal vaccination ACYW
			Lazio: from the cohort of 2007 at the age of 11 years of life up to 18 years and 364 days.
		2021	Basilicata: adolescents at the age of 14 with the possibility of recovery up to 18 years
		2022	Calabria: adolescents in the age group 12–18 years
Portugal	Monovalent conjugate MenC vaccine	2006	2 + 1 dose series for 3, 5 and 12 months of age, born after 2005	[46–48]
		2006	Three-dose for 4 to 15 months old of age, born between October 2004 and September 2005^⌠
		2006–2007	Single-dose catch-up for 2–18 years old, born between January 1989 and September 2004, not yet vaccinated or who had received one dose before 12 months-old^⌠
		2012	Single dose for 12 months of age with no booster dose afterward
	4CMenB vaccine	2020	2 + 1 dose series at 2, 4 and 12 months of age, for infants born from 2019
Greece	Monovalent conjugate MenC vaccine	2005	2 + 1 dose series for infants	[49–51]
		2015	Single dose for toddlers
	Quadrivalent MenACWY vaccine	2011	Booster dose for 11–18 years old
Spain	Monovalent conjugate MenC vaccine	2000	Three-dose for infants, single-dose catch-up for young adults until 20 years of age	[54–60, 65, 77–84]
		2005–2006	2 + 1 dose series for infants, single-dose catch-up for young adults until 20 years of age
		2012–2013	Three-dose for infants and adolescents
		2018–2019	Two-dose for infants and adolescents
	Quadrivalent MenACWY vaccine	2019	Single dose for 12-years old, single-dose catch-up for 13–18 years old^#
		2019	Single dose in 12 months of age in Castilla y Leon
		2020	Single dose in 12 months of age in Andalusia
		2021	Single dose in 12 months of age in Melilla
		2022	Single dose in 12 months of age in Murcia and Balearic Island
	4CMenB vaccine	2019	2 + 1 dose series at 2, 4 and 12 months in Castilla y Leon and Canary Islands
		2021	2 + 1 dose series at 2, 4 and 12 months in Andalusia
		2022	2 + 1 dose series at 2, 4 and 12 months in Catalonia

^†Regional recommendations before introduction into NIP; ^‡ Offered free of charge nationwide before introduction into NIP; ^⌠ Retrospective campaigns in the NIP; ^# Currently, there are regions where the MenACWY vaccine is included in the calendar at 12 months and at 12 years of age.

Abbreviations: MenACWY, serogroup A, C, W and Y meningococcal (vaccine); MenC, serogroup C meningococcal (vaccine); NIP, National Immunization Program.

Figure 3. Clonal complex distribution across MenB invasive isolates in Italy (2014–2019), Portugal (2012–2019), Greece (2010–2019) and Spain (2001–2018).

MenB, serogroup B meningococcal (isolate).

Figure 4. Distribution of fHbp subfamily a and b antigens across MenB isolates in (a) Italy (2014–2019), (b) Portugal (2012–2019), (c) Greece (2010–2019), and (d) Spain (2001–2018). fHbp, factor H binding protein; MenB, serogroup B meningococcal (isolate).

Figure 5. Reactivity of MenB-fHbp and 4CMenB vaccines with invasive MenB isolates in (a) Italy (2014–2019), (b) Portugal (2012–2019), (c) Greece (2010–2019), and (d) Spain (2011–2020). MenB, serogroup B meningococcal (isolate).

Ministero della Salute, DIREZIONE GENERALE DELLA PREVENZIONE SANITARIA. UFFICIO 5 – PREVENZIONE DELLE MALATTIE TRASMISSIBILI E PROFILASSI INTERNAZIONALE. [cited 2021 Dec 15]. Available from: https://www.iss.it/documents/20126/0/Circolare_su_prevenzione_e_controllo_delle_malattie_batteriche_invasive_prevenibili_con_vaccinazione_2017.pdf/617b3ec6-fddc-fc76-1eda-e9db0700624a?t=1616751347702,2017.

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Ministerio de Sanidad, Real Decreto 2210/1995, de 28 de diciembre, por el que se crea la red nacional de vigilancia epidemiológica. [cited 2021 Dec 15]. Available from: https://www.boe.es/buscar/act.php?id=BOE-A-1996-1502.

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