title: A critical appraisal of the recommendations for the use of meningococcal conjugate vaccines.
abstract: OBJECTIVE
  To assess the epidemiology of meningococcal disease (MD) in Brazil and the impact that recent evidence and lessons learned from the introduction of meningococcal C conjugate (MCC) vaccines into immunization programs may have on different strategies of vaccine use.
  
  
  METHODS
  Non-systematic review of the MEDLINE, SciELO and LILACS databases covering the period from 2000 to 2011.
  
  
  RESULTS
  Meningococcal disease is endemic in Brazil, with periodic occurrence of outbreaks. Most cases are associated with serogroup C and the highest incidence rates are observed in infants, encouraging the introduction of MCC vaccine in the National Immunization Program in 2010 for children under 2 years old. The introduction of MCC vaccines into immunization programs in Europe, Canada and Australia proved to be effective, with dramatic reduction in the incidence of serogroup C meningococcal disease, not only in the vaccinated, but also in the unvaccinated individuals. Long-term effectiveness of MCC vaccines was dependent on a combination of antibody persistence, immunologic memory and herd protection. Recent evidence indicating that antibody persistence is not long-lasting in young immunized children, and that immunologic memory is not fast enough to protect them against the disease, emphasize the importance of herd protection to maintain the population protected.
  
  
  CONCLUSIONS
  The rapid decline of antibody titers in children vaccinated in the first years of life suggests the need to incorporate booster doses before adolescence, especially in locations like Brazil, where the immunization program did not incorporate catch-up campaigns including adolescents, lacking the herd immunity effect.
authors.affiliation: Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil. masafadi@uol.com.br
authors.forename: Marco Aurélio Palazzi
authors.initials: MA
authors.lastname: Sáfadi
authors.forename: Eitan Naaman
authors.initials: EN
authors.lastname: Berezin
authors.forename: Gabriel Wolf
authors.initials: GW
authors.lastname: Oselka
mesh_terms: D001315:Australia; D001938:Brazil / Q000453:epidemiology; D005060:Europe; D006801:Humans; D032521:Immunity, Herd; D017589:Immunization Programs / Q000706:statistics & numerical data*; D015994:Incidence; D008585:Meningitis, Meningococcal / Q000453:epidemiology* / Q000517:prevention & control*; D022401:Meningococcal Vaccines / Q000627:therapeutic use*; D038542:Neisseria meningitidis, Serogroup C / Q000276:immunology*; D009656:North America; D018074:Vaccines, Conjugate / Q000627:therapeutic use
chemical_list: D022401:Meningococcal Vaccines; D018074:Vaccines, Conjugate