Epidemiology and prevention of meningococcal disease: a critical appraisal of vaccine policies

Abstract

Meningococcal disease is characterized by a marked variation in incidence and serogroup distribution by region and over time. In several European countries, Canada and Australia, immunization programs, including universal vaccination of infants or toddlers with catch-up campaigns in children and adolescents, aimed at controlling disease caused by meningococcal serogroup C have been successful in reducing disease incidence through direct and indirect protection. More recently, meningococcal conjugate vaccines targeting disease caused by serogroups A, C, W-135 and Y have been licensed and are being used in adolescent programs in the USA and Canada while a mass immunization campaign against serogroup A disease has been implemented in Africa. Positive results from clinical trials using vaccines against serogroup B disease in various age groups suggest the possibility of providing broader protection against serogroup B disease than is provided by the currently used outer membrane vesicle vaccines. The purpose of our review of meningococcal epidemiology and assessment of existing policies is to set the stage for future policy decisions. Vaccination policies to prevent meningococcal disease in different regions of the world should be based on quality information from enhanced surveillance systems.

Keywords::

• herd protection
• immunization
• meningococcal disease
• meningococcal vaccine
• Neisseria meningitidis
• public health

Acknowledgements

The authors would like to thank Lisa DeTora, Michael Broeker and Jeff Stoddard for their critical reading of the manuscript and comments.

Financial & competing interests disclosure

MAP Sáfadi has received consultation and lecture fees from Baxter, GlaxoSmithKline, MSD, Novartis, sanofi-pasteur and Wyeth. EDG McIntosh is an employee of Novartis Vaccines and Diagnostics. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Writing assistance was utilized in the production of this manuscript. The authors would like to acknowledge KR Collins from JK Associates (Conshohocken, PA, USA) for editorial assistance and manuscript preparation funded by Novartis Vaccines and Diagnostics.