Surveillance for meningococcal disease and strategies for use of conjugate meningococcal vaccines in the United States.
BACKGROUND
Neisseria meningitidis is a leading cause of bacterial meningitis in US; new capsular type-specific conjugate vaccines offer an opportunity for improved control of meningococcal disease. We evaluated the relative burdens of invasive meningococcal disease in US and examined the projected impact of various meningococcal conjugate vaccination strategies on rates of meningococcal disease.


METHODS
Meningococcal disease incidence rates were determined from active, population-based surveillance in selected US areas. Models were created to determine impact of vaccination of infants, toddlers, adolescents or college students with meningococcal conjugate vaccines, with assumptions for vaccine coverage, efficacy and duration of protection. Although we examined possible conjugate vaccine formulations including serogroups A, C, Y and W-135, the final vaccine impact analysis excluded serogroups A and W-135. Outcome measures were cumulative meningococcal disease incidence, and incidence 10 years after initiating vaccination among 0-22-year-olds.


RESULTS
In models of serogroup C+Y meningococcal conjugate vaccination of infants, toddlers and adolescents, the cumulative incidence of meningococcal disease was reduced by 54, 48 and 25%, respectively; the toddler strategy had the greatest impact per dose. After 10 years of routine meningococcal conjugate vaccination, meningococcal disease could be reduced by 50% and deaths by 64%.


CONCLUSIONS
Use of meningococcal conjugate vaccine could markedly reduce meningococcal disease incidence. Our data, along with vaccine formulation and vaccination program considerations, will be important in determining the optimal choice of vaccination strategy.
Lingappa
J R
JR
Centers for Disease Control and Prevention, Mailstop C-09, 1600 Clifton Road, NE, Atlanta, GA 30333, USA. JWL8@cdc.gov
Rosenstein
N
N
Zell
E R
ER
Shutt
K A
KA
Schuchat
A
A
Perkins
B A
BA
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D006801:Humans; D017589:Immunization Programs / Q000379:methods*; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008589:Meningococcal Infections / Q000453:epidemiology / Q000517:prevention & control*; D022401:Meningococcal Vaccines / Q000627:therapeutic use*; D009345:Neisseria meningitidis / Q000276:immunology*; D011159:Population Surveillance / Q000379:methods*; D014481:United States / Q000453:epidemiology; D018074:Vaccines, Conjugate / Q000627:therapeutic use
D022401:Meningococcal Vaccines; D018074:Vaccines, Conjugate