Meningococcal Disease: Vaccines–Who’s at Risk and the Future

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Meningococcal disease is a serious life-threatening infection that impacts all ages and can cause meningococcemia, meningococcal meningitis, and Waterhouse-Friderichsen hemorrhagic adrenalitis. Meningococcemia has a case fatality of 10% to 15%, with nearly 20% of cases experiencing neurological injury or amputation despite aggressive care. Meningitis is the most common invasive meningococcal disease expression followed by bacteremia. Less common is meningococcal pneumonia and more rarely septic arthritis.1
While many assume that outbreaks are rare, they are not. Global outbreaks particularly in Africa, Norway, Cuba, Chile, and New Zealand have involved thousands of persons and some outbreaks last years. While endemic disease is often sporadic and related to multiple clones, epidemics are more likely related to virulent clones that become dominate in the epidemic area.2Neisseria meningitidis serogroups A, B, C, Y, X, and W are primarily responsible for disease across the world. As locations of outbreaks vary, new virulent clones continue to emerge within serogroups.3,4
In the United States, meningococcal disease is most common among infants and children younger than 5 years, adolescents and young adults 16 to 21 years old, and adults older than 65 years. The most prevalent serogroups are B, C, and Y. Although overall rates of meningococcal disease have declined, meningococcal serogroup B (MenB) remains the most common source of disease, accounting for approximately half of all patients aged 17 to 22 years. Infection can present as otitis media and epiglottitis, and mortality can be as high as 40% in patients with septicemia.4 Survival of infection may include scarring of skin, hearing loss, limb loss, and cognitive disabilities in up to 50% of cases.3
In the United States, 4 meningococcal vaccines are available, differentiated by the type and number of serogroups the vaccine protects against. Meningococcal conjugate vaccines Menactra (Sanofi Pasteur Inc, Swiftwater, Pennsylvania) and Menveo (Novartis, Cambridge, Massachusetts) provide protection against 4 serogroups (A, C, W, Y). Serogroup B meningococcal vaccines (Trumenba [Pfizer, Philadelphia, Pennsylvania] and Bexsero [GlaxoSmithKline, Research Triangle Park, North Carolina]) are monovalent recombinant protein vaccines and provide protection only against MenB.5Table 1 describes available meningococcal vaccines for the United States.
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