Elsevier

Vaccine

Volume 30, Supplement 2, 30 May 2012, Pages B26-B36
Vaccine

The changing and dynamic epidemiology of meningococcal disease

https://doi.org/10.1016/j.vaccine.2011.12.032Get rights and content

Abstract

The epidemiology of invasive meningococcal disease continues to change rapidly, even in the three years since the first Meningococcal Exchange Meeting in 2008. Control of disease caused by serogroup C has been achieved in countries that have implemented meningococcal C or quadrivalent meningococcal ACWY conjugate vaccines. Initiation of mass immunization programs with meningococcal A conjugate vaccines across the meningitis belt of Africa may lead to the interruption of cyclical meningococcal epidemics. A meningococcal B vaccination program in New Zealand has led to a decreased incidence of high rates of endemic serogroup B disease. Increases in serogroup Y disease have been observed in certain Nordic countries which, if they persist, may require consideration of use of a multiple serogroup vaccine. The imminent availability of recombinant broadly protective serogroup B vaccines may provide the tools for further control of invasive meningococcal disease in areas where serogroup B disease predominates. Continued surveillance of meningococcal disease is essential; ongoing global efforts to improve the completeness of reporting are required.

Highlights

► The epidemiology of invasive meningococcal disease varies by geographic region. ► Universal vaccination programs have dramatically reduced the incidence of meningococcal disease. ► Continued global surveillance is essential to evaluate the effect of the use of new vaccines.

Introduction

In 2008, at the first Meningococcus Scientific Exchange Meeting in Siena, Italy, Harrison et al. reviewed the global epidemiology of meningococcal disease [1]. In that review, it was stressed that the nature and quality of the surveillance undertaken in a region has a direct bearing on the reported incidence of invasive meningococcal disease (IMD). The ideal of population-based, active surveillance with clinical cases confirmed by laboratory testing and strain characterization is still not attainable in most places in the world. Instead, combinations of syndromic surveillance, active and passive surveillance, sentinel surveillance, and laboratory-based surveillance are used, making comparison between jurisdictions difficult and calculation of true incidence impossible. Changes in the epidemiology of IMD over time can be described with some accuracy in regions where surveillance methodology has remained consistent. The purpose of this review is to provide an update on the global epidemiology of IMD in the 3 years since the first Meningocococcus Scientific Exchange Meeting. The effects of implementation of universal meningococcal C (MenC) or quadrivalent meningococcal ACWY (MenACWY) conjugate vaccines in various regions will be described, as will the long-awaited implementation of the meningococcal A conjugate vaccine (MenA) program in the African meningitis belt. Additional details related to the epidemiology of meningococcal B strains will also be provided in anticipation of the licensure of meningococcal B vaccines (MenB) in the near future.

Section snippets

Description of the pathogen

Neisseria meningitidis is a gram-negative diplococcus which colonizes the pharynx and upper respiratory tract. Thirteen serogroups have been identified based on unique capsular polysaccharides; 6 serogroups cause virtually all human disease (A, B, C, W, X, Y) [2]. The reported incidence of IMD varies by region, ranging from less than 0.5 cases per 100,000 in North America and just under 1 case per 100,000 in Europe up to 10–1000 cases per 100,000 during epidemic years in Africa (Table 1). The

Africa

The geography of Africa varies from desert to tropical rain forest and so it is not surprising that the epidemiology of IMD, strongly influenced by climate, varies markedly across the continent. Different patterns of IMD are seen in North Africa, the Sahel and sub-Sahel, and in Africa south of the sub-Sahel.

The next five years

In view of the dynamic nature of IMD epidemiology, global surveillance will continue to be a priority over the next 5 years. In Africa, as the MenA vaccination programs are fully implemented across the meningitis belt, there will be an ongoing need for surveillance and other observational approaches such as case control studies to measure the vaccine's effectiveness. MenC vaccination programs will continue to be implemented in jurisdictions where rates of serogroup C disease remain high. The

Conflict of interest statement

The authors have received grant and contract funding from Novartis Vaccines, sponsor of the Meningococcus Scientific Exchange Meeting, but have no financial interest in the company.

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    Presented in part at the Meningococcus Scientific Exchange Meeting “Towards a meningitis free world”, July 2–3, 2011, Siena Italy, sponsored by Novartis Vaccines.

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