The changing and dynamic epidemiology of meningococcal disease☆
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.