Meningococcal Disease in the Era of Multivalent Vaccines: Where Are We Now and Can We Do Better?

Dear Colleagues,

With the development and deployment of vaccines covering most of the Neisseria meningitidis capsular groups causing invasive meningococcal disease (IMD), there is a real opportunity to drastically reduce the disease burden all over the world. IMD is a leading cause of severe bacterial infection in infants and adolescents, causing death and severe sequelae in many countries, including in the Western world. This is partly linked with the speed at which the disease can progress, as it notoriously can kill an otherwise healthy person in a matter of a few days or even hours, and consequently, the death rate has remained the same for decades despite progress in diagnosis and treatment. Vaccination is thus considered the most efficient way to prevent the death and disability caused by IMD, and the ultimate weapon to defeat this devastating disease.

Several vaccines have been developed and are available against most capsular groups causing disease: groups A, B, C, W, and Y, alone or combined into multivalent formulations. Several of these vaccines are included in the immunization schedule of many countries, but not all. For example, the UK has included a vaccine against capsular group B meningococcus (MenB) in their immunization schedule, but only for infants, thus not reaching the other age group most affected by IMD, adolescents. Moreover, limited resources are constraining the use of meningococcal vaccines in developing countries. Therefore, in an era where so many vaccines are available, epidemiological surveillance, at country or regional levels, is key to efficient selection, use, and deployment strategies of meningococcal vaccines, so that strategies can be adapted and fine-tuned to specific situations. A key factor of the meningococcal conjugate vaccines’ success is their ability to induce herd protection, but there is to date no evidence that the most recent, protein-based vaccines against MenB can influence the acquisition and carriage of the bacteria. Clarifying the impact of this finding on the cost effectiveness of an adolescent program is of paramount importance. Finally, with IMD causing strains not covered by any of the currently available vaccines, is there room for further new and improved vaccines, and if so, which modalities are most promising.

The focus of this Special Issue is thus to understand the impact of the available vaccine strategies in different settings, to understand the contribution, or lack of, herd protection to the effectiveness of vaccination programs in particular in the context of the MenB protein-based vaccines, to understand how the cost and uptake of combination vaccines could further change the epidemiology of IMD, and to consider the need for further vaccine development, and finally how the advent of new technologies can contribute to further understanding of the disease, as well as to the development of new treatment or prevention approaches.

Prof. Christine S. Rollier
Guest Editor

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• Neisseria meningitidis
• Meningococcal infection
• Meningococcal carriage
• Invasive meningococcal disease (IMD)
• Meningococcal vaccines
• Conjugate vaccines