Invasive Meningococcal Disease in the Vaccine Era

Abstract

Infection with the meningococcus is one of the main causes of meningitis and septicaemia worldwide. Humans are the only natural reservoir for the meningococcus which is found primarily as a commensal inhabitant in the nasopharynx in ~10% of adults, and may be found in over 25% of individuals during adolescence. Prompt recognition of meningococcal infection and early aggressive treatment are essential in order to reduce mortality, which occurs in up to 10% of those with invasive meningococcal disease (IMD). This figure may be significantly higher in those with inadequate or delayed treatment. Early administration of effective parenteral antimicrobial therapy and prompt recognition and appropriate management of the complications of IMD, including circulatory shock and raised intracranial pressure (ICP), are critical to help improve patient outcome. This review summarizes clinical features of IMD and current treatment recommendations. We will discuss the evidence for immunization and effects of vaccine strategies, particularly following implementation of effective vaccines against Group B meningococcus.

The Inflammatory and Hemostatic Response in Sepsis and Meningococcemia

“…Reviews on meningococcal sepsis epidemiology, clinical features, management, and prevention are found elsewhere. 8,9…”

Antibody persistence following meningococcal ACWY conjugate vaccine licensed in the European Union by age group and vaccine

“…Plain polysaccharide vaccines, protein polysaccharide conjugate vaccines, and serogroup B protein-based vaccines are the three meningococcal vaccines currently licensed and in use. The first two contain the capsular polysaccharides of meningococci [9]. Quadrivalent ACWY vaccine (MenACWY-PS) is a typical example of pure polysaccharide vaccine.…”

Pediatric Vaccines and Cost-Effectiveness Thresholds: How Much is Too Much to Pay for Prevention?

“…The disease is caused by the bacterium Neisseria meningitidis (or meningococcus), which is a leading cause of bacterial meningitis and sepsis in the US today [ 13 – 15 ]. The rate of fatality in IMD is approximately 10%, even with appropriate treatment, and approximately 30% of survivors experience permanent sequelae, including neurologic damage, hearing loss, renal failure, paralysis, and amputation [ 16 ]. While N. meningitidis remains susceptible to many commonly used antibiotics, treatment is often initiated too late to significantly alter the course of the disease and to prevent complications and death; prevention is therefore a much better clinical strategy than treatment [ 13 , 14 ].…”