Epidemiology and Control of Meningococcal Disease in Canada: A Long, Complex, and Unfinished Story

Abstract

The epidemiology of meningococcal disease in Canada has been punctuated by outbreaks caused by serogroup A strains in the 1940s, virulent serogroup C clones from 1985 to 2001, a serogroup B clone in Quebec from 2003 to 2014, and more recently a W clone in British Columbia. Region- and province-wide immunization campaigns have been implemented to control these outbreaks using meningococcal C polysaccharide and conjugate vaccines, a quadrivalent ACWY conjugate vaccine, and a serogroup B protein-based vaccine. Meningococcal C conjugate vaccines have been included in routine immunization programs for children, and ACWY conjugate vaccines have been included in school-based programs for adolescents in most jurisdictions. In contrast, serogroup B protein-based vaccines were only recommended and used for high-risk individuals and to control outbreaks. Currently, the immunization schedules adopted in provinces and territories are not uniform. This is not explained by notable epidemiologic differences. Publicly funded immunization programs are the result of a complex decision-making process. Political factors including public opinion, media attention, interest groups' advocacy campaigns, decision-makers' priorities and budgetary constraints have played important roles in shaping meningococcal programs in Canada, and this should be recognized. As the recent occurrence of outbreaks caused by virulent W clones shows, continued investments in epidemiological surveillance at both the provincial and national levels are necessary, so there can be early warning and informed decisions can be made.

Meningococcal Disease Outbreaks: A Moving Target and a Case for Routine Preventative Vaccination

“…Mobilisation of vaccine supplies, coordination of vaccination clinics and data management related to vaccine uptake were identified as the main challenges while executing the programme [ 73 ]. No cases were subsequently observed throughout 2018 [ 74 ].…”

The Power of Policy Entrepreneur in Disability- inclusive Policy-Making

“…The policy stream frames the process of making and changing policies so that policies are in line with what is desired (Béland& Howlett, 2016;Blum, 2018;Petridou & Mintrom, 2020;Shephard et al, 2020). Moreover, the political stream is a power that greatly influences policy, since the political arena does influence policy greatly (Graaf & Snowden, 2020;Hsueh, 2020;Mauti et al, 2019;Wals, 2019). In addition, coalitions and a strong network between actors in policy-making or policy change are also needed (Rahardian & Zarkasi, 2021;Suherman, et al, 2021;Weible et al, 2011;Wong, 2016).…”

Characterization of invasive meningococcal disease case isolates in Atlantic Canada, 2014 to 2020: spatial–temporal variations of clones and predicted meningococcal B vaccine coverage

“…In Canada, most IMD is caused by strains belonging to four serogroup: B, C, Y and W (MenB, MenC, MenY and MenW, respectively) [1]. Because effective vaccines against these four serogroups have been licensed in Canada, IMD is considered to be a vaccine-preventable disease [2]. MenC polysaccharide conjugate vaccine has been licensed in Canada since 2001 and now most provinces and territories have adopted a publicly funded MenC conjugate vaccine programme into their infant immunization programmes [2].…”

“…Because effective vaccines against these four serogroups have been licensed in Canada, IMD is considered to be a vaccine-preventable disease [2]. MenC polysaccharide conjugate vaccine has been licensed in Canada since 2001 and now most provinces and territories have adopted a publicly funded MenC conjugate vaccine programme into their infant immunization programmes [2]. Quadrivalent polysaccharide conjugate vaccines against serogroup A, MenC, MenY and MenW have also been licensed in Canada since 2006, and all provinces and territories have either adopted these quadrivalent vaccines into their childhood immunization programmes or used them in high school children before college entrance [2].…”

“…MenC polysaccharide conjugate vaccine has been licensed in Canada since 2001 and now most provinces and territories have adopted a publicly funded MenC conjugate vaccine programme into their infant immunization programmes [2]. Quadrivalent polysaccharide conjugate vaccines against serogroup A, MenC, MenY and MenW have also been licensed in Canada since 2006, and all provinces and territories have either adopted these quadrivalent vaccines into their childhood immunization programmes or used them in high school children before college entrance [2]. One of the two protein based MenB vaccines licensed in Canada is the four-component MenB vaccine Bexsero, which consists of a family B factor H-binding protein (Fhbp) variant 1, peptide 1 (1.1), Neisseria heparin-binding antigen (NHBA) peptide 2 and Neisseria adhesin antigen (NadA) peptide 8 (2/3.8), together with an outer membrane vesicle prepared from a N.…”