title: Control of invasive meningococcal disease: is it achievable?
abstract: Neisseria meningitidis still leads to deaths and severe disability in children, adolescents and adults. Six different capsular groups of N. meningitidis cause invasive meningococcal disease in the form of meningitis and septicaemia in humans. Although conjugate meningococcal vaccines have been developed to provide protection against four of the capsular groups causing most diseases in humans, vaccines against capsular group B, which causes 85% of cases in Australia and the United Kingdom, have only recently been developed. A capsular group B meningococcal vaccine - 4CMenB (Bexsero) - has recently been licensed in the European Union, Canada and Australia. In Australia, a submission for inclusion of 4CMenB in the funded national immunization programme has recently been rejected. The vaccine will now be introduced into the national immunization programme in the United Kingdom following negotiation of a cost-effective price. With the current low incidence of invasive meningococcal disease in many regions, cost-effectiveness of a new capsular group B meningococcal vaccine is borderline in both the United Kingdom and Australia. Cost-effectiveness of an infant programme is determined largely by the direct protection of those vaccinated and is driven by the higher rate of disease in this age group. However, for an adolescent programme to be cost-effective, it must provide both long-term protection against both disease and carriage. The potential of vaccination to reduce the rate of severe invasive disease is a real possibility. A dual approach using both an infant and adolescent immunization programme to provide direct protection to those age groups at highest risk of meningococcal disease and to optimize the potential herd immunity effects is likely to be the most effective means of reducing invasive meningococcal disease. This commentary aims to describe the known disease burden and consequences of meningococcal disease, and the development and potential effectiveness of new capsular group B meningococcal vaccines.
authors.affiliation: 1Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital 2School of Paediatrics and Reproductive Health, University of Adelaide 3Robinson Research Institute, University of Adelaide 4School of Population Health, University of Adelaide 5The South Australian Health and Medical Research Institute, South Australia 6Oxford Vaccine Group, Department of Paediatrics, University of Oxford, United Kingdom 7Oxford NIHR Biomedical Research Centre, Oxford University Hospitals NHS Trust, United Kingdom.
authors.forename: Helen
authors.initials: H
authors.lastname: Marshall
authors.forename: Bing
authors.initials: B
authors.lastname: Wang
authors.forename: Steve
authors.initials: S
authors.lastname: Wesselingh
authors.forename: Matthew
authors.initials: M
authors.lastname: Snape
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Pollard
mesh_terms: D000293:Adolescent; D001315:Australia / Q000453:epidemiology; D003140:Communicable Disease Control / Q000458:organization & administration*; D005260:Female; D006801:Humans; D017589:Immunization Programs; D015994:Incidence; D008297:Male; D008589:Meningococcal Infections / Q000453:epidemiology / Q000517:prevention & control*; D022401:Meningococcal Vaccines / Q000627:therapeutic use*; D009345:Neisseria meningitidis / Q000472:pathogenicity; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
chemical_list: C570015:4CMenB vaccine; D022401:Meningococcal Vaccines