Vaccines to Prevent Meningitis: Historical Perspectives and Future Directions

Abstract

Despite advances in the development and introduction of vaccines against the major bacterial causes of meningitis, the disease and its long-term after-effects remain a problem globally. The Global Roadmap to Defeat Meningitis by 2030 aims to accelerate progress through visionary and strategic goals that place a major emphasis on preventing meningitis via vaccination. Global vaccination against Haemophilus influenzae type B (Hib) is the most advanced, such that successful and low-cost combination vaccines incorporating Hib are broadly available. More affordable pneumococcal conjugate vaccines are becoming increasingly available, although countries ineligible for donor support still face access challenges and global serotype coverage is incomplete with existing licensed vaccines. Meningococcal disease control in Africa has progressed with the successful deployment of a low-cost serogroup A conjugate vaccine, but other serogroups still cause outbreaks in regions of the world where broadly protective and affordable vaccines have not been introduced into routine immunization programs. Progress has lagged for prevention of neonatal meningitis and although maternal vaccination against the leading cause, group B streptococcus (GBS), has progressed into clinical trials, no GBS vaccine has thus far reached Phase 3 evaluation. This article examines current and future efforts to control meningitis through vaccination.

Synthetic Glycans to Improve Current Glycoconjugate Vaccines and Fight Antimicrobial Resistance

“…89 Development of Hia vaccines should be technically feasible, but a limited market would likely require donor support to incentivize a manufacturer. 90 An approach similar to the Hib oligomers can be envisaged. Considering the structural and infectious similarities between Hia and Hib serotypes, the success of Hib vaccination could suggest a rational background for the development of a Hia glycoconjugate vaccine protective both in adults and infants.…”

Evaluation of Critical Quality Attributes of a Pentavalent (A, C, Y, W, X) Meningococcal Conjugate Vaccine for Global Use

“…For the past two decades, high quality meningococcal glycoconjugate vaccines have been responsible for protection against significant mortality and morbidity from meningitis and septicemia [ 5 ]. Immunity generated through the development of T-cell dependent bactericidal antibody in those most at risk has resulted in reducing nasopharyngeal carriage and inducing herd immunity in highly vaccinated populations [ 6 ].…”

Editorial for the Special Issue: Bacterial Meningitis—Epidemiology and Vaccination

“…The principal means of achieving targets to reduce cases and deaths from meningitis will inevitably be through vaccination. Alderson et al [ 6 ] gave a comprehensive overview of past and present developments in meningitis vaccines. They drew attention to the importance of low-cost vaccines for global introduction, the expanding range of conjugate vaccines and the more recently developed meningococcal protein vaccines, and the challenges in reaching prevention goals.…”

“…Karachaliou Prasinou et al [ 8 ] showed how mathematical models can be used to optimise the effectiveness of vaccination programmes, with two key parameters being the duration of protection and age at vaccination. Such models are relevant both for the serogroup A vaccine currently being deployed in the meningitis belt and for the anticipated roll out of pentavalent (ACWXY) conjugate vaccines [ 6 ]. The need for broader-valency vaccines in the global control of invasive meningococcal disease was well demonstrated in the paper by Tzeng and Stephens [ 9 ], describing the changing epidemiology and emerging disease due to serogroups other than A, B, and C.…”

“…Vaccines are in development but not yet available to protect against disease due to GBS [ 6 ]. Prevention of GBS in newborns currently relies on risk-based or microbiological screening for infection in pregnancy.…”