Elsevier

Vaccine

Volume 27, Supplement 2, 24 June 2009, Pages B51-B63
Vaccine

Review
Global epidemiology of meningococcal disease

https://doi.org/10.1016/j.vaccine.2009.04.063Get rights and content

Abstract

As reviewed in this paper, meningococcal disease epidemiology varies substantially by geographic area and time. The disease can occur as sporadic cases, outbreaks, and large epidemics. Surveillance is crucial for understanding meningococcal disease epidemiology, as well as the need for and impact of vaccination.

Despite limited data from some regions of the world and constant change, current meningococcal disease epidemiology can be summarized by region. By far the highest incidence of meningococcal disease occurs in the meningitis belt of sub-Saharan Africa. During epidemics, the incidence can approach 1000 per 100,000, or 1% of the population. Serogroup A has been the most important serogroup in this region. However, serogroup C disease has also occurred, as has serogroup X disease and, most recently, serogroup W-135 disease. In the Americas, the reported incidence of disease, in the range of 0.3–4 cases per 100,000 population, is much lower than in the meningitis belt. In addition, in some countries such as the United States, the incidence is at an historical low. The bulk of the disease in the Americas is caused by serogroups C and B, although serogroup Y causes a substantial proportion of infections in some countries and W-135 is becoming increasingly problematic as well. The majority of meningococcal disease in European countries, which ranges in incidence from 0.2 to 14 cases per 100,000, is caused by serogroup B strains, particularly in countries that have introduced serogroup C meningococcal conjugate vaccines. Serogroup B also predominates in Australia and New Zealand, in Australia because of the control of serogroup C disease through vaccination and in New Zealand because of a serogroup B epidemic. Based on limited data, most disease in Asia is caused by serogroup A and C strains.

Although this review summarizes the current status of meningococcal disease epidemiology, the dynamic nature of this disease requires ongoing surveillance both to provide data for vaccine formulation and vaccine policy and to monitor the impact of vaccines following introduction.

Introduction

Neisseria meningitidis is a major cause of invasive bacterial infections globally [1], [2], [3]. A notable feature of the meningococcus is its fluid epidemiology. There are substantial cyclical fluctuations in meningococcal disease incidence and the occurrence of outbreaks and epidemics. Furthermore, meningococcal incidence and serogroup distribution are highly regional. The purpose of this review is to discuss the current global epidemiology of meningococcal disease in major areas of the world, including recent changes. As most information derives from disease surveillance, apparent differences in epidemiology can only be understood in the context of the underlying surveillance systems. A major focus of this review is information on regional meningococcal disease incidence and the serogroup distribution of meningococcal strains causing invasive disease, key issues for vaccine formulation and immunization policy.

Section snippets

Types of surveillance for meningococcal infection

Meningococcal disease surveillance is required for the assessment of local epidemiology and assessments of disease burden. There are a variety of methods for conducting meningococcal surveillance, which vary in their ability to accurately portray the epidemiology [4]. The gold standard is laboratory-based surveillance, which specifically identifies N. meningitidis in cases with clinical invasive meningococcal disease. Most laboratory-based surveillance systems for meningococcal meningitis rely

Further characterization of N. meningitidis

An understanding of meningococcal epidemiology and the potential prevention of disease by vaccination requires knowledge beyond the capsular serogroup. N. meningitidis can be characterized using traditional serological methods [18] and newer molecular approaches[214].

A commonly used tool for molecular characterization of N. meningitidis is multilocus sequence typing (MLST), which is performed through DNA sequencing of portions of 7 housekeeping genes [19]. The rationale for focusing on

Mechanisms that contribute to dynamic nature of meningococcal epidemiology

N. meningitidis uses a variety of mechanisms to undergo antigenic variability, particularly in the face of natural or vaccine-induced immunity [214]. This antigenic variability occurs mainly through horizontal gene transfer, which allows the organism to acquire large DNA sequences. The meningococcus also uses gene conversion, which is autologous recombination and does not require the acquisition of DNA from another strain [61], [62]. N. meningitidis is also capable of varying its antigenic

United States

Much of our knowledge about the recent epidemiology of meningococcal disease in the United States comes from the Active Bacterial Core surveillance (ABCs) network, an active, population- and laboratory-based surveillance system for invasive disease caused by N. meningitidis and other pathogens [11]. ABCs is considered to be highly sensitive for culture-positive meningococcal disease. The total population under surveillance in 2007 was approximately 39.5 million, representing 13% of the U.S.

Acknowledgments

We thank Eliseu Waldman for his review of the manuscript.

This work was supported in part by a career development award to Dr. Harrison, National Institute of Allergy and Infectious Diseases (K24 AI52788). Dr. Trotter is funded by a Personal Award Scheme Post-Doctoral Award from the National Institute of Health Research (UK Department of Health). Conflict of interest statement: None declared. Financial disclosures: Dr. Harrison reports receiving consulting fees and honoraria from Wyeth, Sanofi

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