Case fatality

Like other vaccine-preventable diseases, meningococcal disease caused by Neisseria meningitidis is associated with high fatality.²

References:

1. Stein-Zamir C, Shoob H, Sokolov I, Kunbar A, Abramson N, Zimmerman D. The clinical features and long-term sequelae of invasive meningococcal disease in children. Pediatr Infect Dis J. 2014;33(7):777-779.
2. WHO. Fact sheet – meningitis. World Health Organization. Published September 28, 2021. Accessed August 5, 2022. https://www.who.int/news-room/fact-sheets/detail/meningitis
3. Center for Disease Control and Prevention. Meningococcal disease. Updated August 18, 2021. Accessed August 5, 2022. https://www.cdc.gov/vaccines/pubs/pinkbook/mening.html
4. Center for Disease Control and Prevention. Haemophilus influenzae type b. Updated August 18, 2021. Accessed August 5, 2022. https://www.cdc.gov/vaccines/pubs/pinkbook/hib.html
5. Center for Disease Control and Prevention. Pneumococcal disease. Updated August 18, 2021. Accessed August 5, 2022. https://www.cdc.gov/vaccines/pubs/pinkbook/pneumo.html
6. Center for Disease Control and Prevention. Epidemiology of vaccine-preventable diseases. Diphtheria. Updated August 18, 2021. Accessed August 5, 2022. https://www.cdc.gov/vaccines/pubs/pinkbook/dip.html

Sequelae & mortality

In 20% of survivors The impact of meningococcal disease can last a lifetime due to devastating long-term sequelae².
Meningococcal disease is a severe infection that progresses rapidly.³

*Data are from a literature review for high-income countries, 2001–2016.³

References:

1. Stein-Zamir C, Shoob H, Sokolov I, Kunbar A, Abramson N, Zimmerman D. The clinical features and long-term sequelae of invasive meningococcal disease in children. Pediatr Infect Dis J. 2014;33(7):777-779.
2. Center for Disease Control and Prevention. Meningococcal disease. Updated August 18, 2021. Accessed August 5, 2022. https://www.cdc.gov/vaccines/pubs/pinkbook/mening.html
3. Olbrich KJ, Müller D, Schumacher S, Beck E, Meszaros K, Koerber F. Systematic Review of Invasive Meningococcal Disease: Sequelae and Quality of Life Impact on Patients and Their Caregivers. Infect Dis Ther. 2018;7(4):421-438.

Diagnosis challenges

Meningococcal disease can be difficult to diagnose and cases are potentially underreported.²
  

  



















References:

1. Stein-Zamir C, Shoob H, Sokolov I, Kunbar A, Abramson N, Zimmerman D. The clinical features and long-term sequelae of invasive meningococcal disease in children. Pediatr Infect Dis J. 2014;33(7):777-779.
2. Azzari C, Nieddu F, Moriondo M, et al. Underestimation of Invasive Meningococcal Disease in Italy. Emerg Infect Dis. 2016;22(3):469-475.
3. Sáfadi MA, González-Ayala S, Jäkel A, Wieffer H, Moreno C, Vyse A. The epidemiology of meningococcal disease in Latin America 1945-2010: an unpredictable and changing landscape. Epidemiol Infect. 2013;141(3):447-458.

Disease burden

Infants are at an increased risk of meningococcal disease.²

Infants aged less than 1 year are highly vulnerable to meningococcal disease with the highest rate of disease incidence, followed by those aged 1–4 years.²
 

Incidence is highest in young children.
  

 
Adapted from ECDC Annual Epidemiological Report: Invasive meningococcal disease. 2017.
Sources: Country reports from Austria, Belgium, Bulgaria, Cyprus, the Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, the Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Sweden, and the United Kingdom.

IMD incidence was highest in infants and young children, with a notification rate of 8.2 confirmed cases per 100 000 population in children under one year of age.²
 

 
Adapted from Presa JV, et al. Int J Infect Dis. 2019; Villena R, et al. Vaccine. 2019; European Centre for Disease Control and Prevention (ECDC). Invasive meningococcal disease. 2019; Public Health Agency of Canada. The use of bivalent factor H binding protein meningococcal serogroup B (Men B-fHBP) vaccine for the prevention of meningococcal B disease. 2019; Lahra MM, et al. Commun Dis Intell. (2018). 2020.

In Asia Pacific, the burden of meningococcal disease is high among children and adolescents⁷
  

 
A second peak of meningococcal disease incidence occurs in adolescents and young adults.⁸

Adolescent behaviours lead to an increased carriage of N meningitidis.⁹

 
Adolescents and young adults are much more likely to be carriers of N meningitidis, having the highest carriage rate of all age groups.¹¹

Adapted from Christensen H et al, 2010.
 

The incidence of meningococcal disease is approximately 1.5- to 3-fold higher in older adolescents/ young adults than in the general population based on the most recent surveillance data.¹³

• Vaccination programmes targeting adolescents and young adults help reduce meningococcal disease in infants and the elderly¹⁴
• Vaccinating people in age groups with high levels of carriage is a key driver of herd protection across a population, due to a reduction in transmission¹⁴

EU, European Union; EEA, European Economic Area; IMD, Invasive meningococcal disease.

References:

1. Stein-Zamir C, Shoob H, Sokolov I, Kunbar A, Abramson N, Zimmerman D. The clinical features and long-term sequelae of invasive meningococcal disease in children. Pediatr Infect Dis J. 2014;33(7):777-779.
2. European Centre for Disease Control and Prevention (ECDC). Invasive meningococcal disease. Published April, 2019. Accessed August 5, 2022. https://www.ecdc.europa.eu/sites/default/files/documents/AER_for_2017-invasive-meningococcal-disease.pdf
3. Presa JV, de Almeida RS, Spinardi JR, Cane A. Epidemiological burden of meningococcal disease in Brazil: A systematic literature review and database analysis. Int J Infect Dis. 2019;80:137-146.
4. Villena R, Valenzuela MT, Bastías M, Santolaya ME. Meningococcal invasive disease by serogroup W and use of ACWY conjugate vaccines as control strategy in Chile. Vaccine. 2019;37(46):6915-6921.
5. Public Health Agency of Canada. An Advisory Committee Statement (ACS) National Advisory Committee on Immunization (NACI). The use of bivalent factor H binding protein meningococcal serogroup B (Men B-fHBP) vaccine for the prevention of meningococcal B disease. December 2019. Accessed August 5, 2022. https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/vaccines-immunization/naci-imd-b-statement-eng.pdf
6. Lahra MM, Hogan TR; National Neisseria Network, Australia. Australian Meningococcal Surveillance Programme annual report, 2019. Commun Dis Intell. (2018). 2020;44. doi: 10.33321/cdi.2020.44.62.
7. Aye AMM, Bai X, Borrow R, et al. Meningococcal disease surveillance in the Asia-Pacific region (2020): The global meningococcal initiative. J Infect. 2020;81(5):698-711.
8. Pelton SI. The Global Evolution of Meningococcal Epidemiology Following the Introduction of Meningococcal Vaccines. J Adolesc Health. 2016;59(2 Suppl):S3-S11.
9. Kimmel SR. Prevention of meningococcal disease. Am Fam Physician. 2005;72(10):2049-2056.
10. WHO. Fact sheet – meningococcal meningitis. World Health Organization. Published September 28, 2021. Accessed August 5,2022. https://www.who.int/mediacentre/factsheets/fs141/en/
11. Atkinson B, Gandhi A, Balmer P. History of Meningococcal Outbreaks in the United States: Implications for Vaccination and Disease Prevention. Pharmacotherapy. 2016;36(8):880-892.
12. Christensen H, May M, Bowen L, Hickman M, Trotter CL. Meningococcal carriage by age: a systematic review and meta-analysis [published correction appears in Lancet Infect Dis. 2011 Aug;11(8):584]. Lancet Infect Dis. 2010;10(12):853-861.
13. Cynthia B, Lidia S, Charles N, Jessica P, Paul B, and Laura Y. Meningococcal disease in adolescents and young adults: a review of the rationale for prevention through vaccination. Hum. Vaccines Immunother. 2019;15(2):459-469.
14. Vetter V, Baxter R, Denizer G, et al. Routinely vaccinating adolescents against meningococcus: targeting transmission & disease. Expert Rev Vaccines. 2016;15(5):641-658.

At risk

Immunocompromised individuals are more susceptible to meningococcal disease.²

Although several factors may contribute to the susceptibility of an individual to meningococcal disease, the ability to mount a serum bactericidal response is probably the most important.²

Individuals are at increased risk (from 2- to 20-fold) when they have conditions such as³:
 

• People with an anatomic or functional asplenia are at an increased risk for meningococcal disease⁴
• Individuals deficient in components of the alternative and terminal complement pathways are highly predisposed to invasive, often recurrent meningococcal infections²
• Interaction of molecules of the complement system with the meningococcus has proven important in disease pathogenesis² 

1. Stein-Zamir C, Shoob H, Sokolov I, Kunbar A, Abramson N, Zimmerman D. The clinical features and long-term sequelae of invasive meningococcal disease in children. Pediatr Infect Dis J. 2014;33(7):777-779.
2. Lewis LA, Ram S. Meningococcal disease and the complement system. Virulence. 2014;5(1):98-126.
3. Muhamed-Kheir T, Catherine W, Stéphane B, et al. Risk factors for invasive meningococcal disease: a retrospective analysis of the French national public health insurance database. Hum. Vaccines Immunother. 2021;17(6):1858­­-1866.
4. Bilukha OO, Rosenstein N; National Center for Infectious Diseases, Centers for Disease Control and Prevention (CDC). Prevention and control of meningococcal disease. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2005;54(RR-7):1-21.
5. Muttalif AR, Presa JV, Haridy H, Gamil A, Serra LC, Cané A. Incidence and Prevention of Invasive Meningococcal Disease in Global Mass Gathering Events. Infect Dis Ther. 2019;8(4):569-579.
6. Khan ID, Khan SA, Asima B, Hussaini SB, Zakiuddin M, Faisal FA. Morbidity and mortality amongst Indian Hajj pilgrims: A 3-year experience of Indian Hajj medical mission in mass-gathering medicine. J Infect Public Health. 2018;11(2):165-170.
7. Yezli S. The threat of meningococcal disease during the Hajj and Umrah mass gatherings: A comprehensive review. Travel Med Infect Dis. 2018;24:51-58.