Evolving strategies for meningococcal vaccination in Europe: Overview and key determinants for current and future considerations

Abstract

Invasive meningococcal disease (IMD) is a life-threatening, unpredictable condition. Vaccines are available against 5 of the 6 meningococcal serogroups (Men) accounting for nearly all IMD cases worldwide; conjugate monovalent MenC, quadrivalent MenACWY, and protein-based MenB vaccines are commonly used. We provide a comprehensive overview of the evolution of meningococcal vaccination strategies employed in national immunization programmes (NIPs) and their impact on IMD incidence in Europe. A more in-depth description is given for several countries: the United Kingdom (UK), the Netherlands, Greece, Italy, and Ireland. We searched European health authorities' websites and PubMed. Various vaccines and immunization schedules are used in 21 NIPs. Most countries implement MenC vaccination in infants, MenACWY in adolescents, and a growing number, MenB in infants. Only Malta has introduced MenACWY vaccination in infants, and several countries reimburse immunization of toddlers. The UK, Italy, Ireland, Malta, Andorra, and San Marino recommend MenB vaccination in infants and MenACWY vaccination in adolescents, targeting the most prevalent serogroups in the most impacted age groups. Main factors determining new vaccination strategies are fluctuating IMD epidemiology, ease of vaccine implementation, ability to induce herd protection, favorable benefit-risk balance, and acceptable cost-effectiveness. Since 1999, when the UK introduced MenC vaccination, the reduction in IMD incidence has been gradually enhanced as other countries adopted routine meningococcal vaccinations. Meningococcal vaccination strategies in each country are continually adapted to regional epidemiology and national healthcare priorities. Future strategies may include broader coverage vaccines when available (e.g., MenABCWY, MenACWY), depending on prevailing epidemiology.

Overview of meningococcal epidemiology and national immunization programs in children and adolescents in 8 Western European countries

“…Although it is now a vaccine-preventable disease, IMD remains a public health concern given the possibility of outbreaks and its unpredictability, morbidity, and mortality (≈10%). Despite appropriate effective antibiotic treatments and tremendous efforts to improve care, the rates of IMD mortality and of patients with severe neurological and functional sequelae have remained stable in recent years ( 12 ), partly because early clinical signs may be mild and/or nonspecific, making diagnosis difficult, with rapid disease progression.…”

“…There is no universal vaccine preventing all serogroups causing meningococcal disease but, to date, several vaccines have been developed for the prevention of the main IMD-causing serogroups ( 12 ). Over time, 3 types of vaccine have been developed ( 13 , 14 ).…”

“…France is the only country that includes MenC prevention for infants and toddlers in a mandatory immunization program. Finally, as indicated by Martinon-Torres et al ( 12 ), meningococcal vaccination has been introduced in the NIPs of several European countries, but with no consistent strategy across countries. Each country uses different vaccines and schedules in different age groups; vaccination recommendations vary with local and regional disease progression and with national healthcare priorities.…”

Efficacy and Safety of Quadrivalent Conjugate Meningococcal Vaccines: A Systematic Review and Meta-Analysis

“…Similarly, the MenACWY-D is not available in Europe [ 7 ]. In addition, only about 60% of European countries includes MenACWY in their national immunization plans and, among them, vaccination schedules are highly different in terms of inoculation ages and number of doses [ 12 ].…”

Fully Liquid MenACWY-CRM Vaccine: Results from an Integrated Safety Analysis

“…Six of the 12 meningococcal serogroups (MenA, B, C, W, Y, and X) are responsible for almost all IMD cases [ 3 ]. Among the available meningococcal vaccines, monovalent MenC and quadrivalent MenACWY glycoconjugate vaccines and protein-based MenB vaccines are commonly used [ 4 , 5 ].…”