Invasive meningococcal disease, a type of bacterial infection, is caused by the bacterium Neisseria meningitidis (N. meningitidis).  Worldwide, it is estimated that up to 25 percent of the population carry N. meningitidis at any given time. The bacteria are transmitted from person to person through droplets of respiratory or throat secretions¹.

Invasive meningococcal disease can be acute, contagious and potentially life-threatening. The symptoms – including sudden onset of fever, headache, and stiff neck – progress rapidly. Even with early and appropriate treatment, patients can die within 24-48 hours².

According to the World Health Organization, N. meningitidis causes about 500,000 cases of disease and 50,000 deaths worldwide annually³. Infants and adolescents have the highest rate of disease, with the highest attack rates in infants three to 12 months old³.

Most cases are isolated, but outbreaks do occur. In some regions, like the African Meningitis Belt, widespread and unpredictable epidemics occur regularly.

Despite the best available treatment, the disease is fatal for 5-10 percent of victims in industrialized countries, and is even higher in the developing world. Between 10-20 percent of survivors are left with permanent disability such as epilepsy, mental retardation, hearing loss, or loss of limbs⁴.

Due to the changing epidemiology of meningococcal disease, there is a growing need to vaccinate a broad range of age groups against as many serogroups as possible. There are 13 serogroups of N. meningitidis, based on the bacterial polysaccharide (sugar) capsule. However, a large majority of invasive disease is caused by one of five serogroups: A, B, C, Y and W-135.

• In Europe MenB and MenC are predominate²
  
• Widespread MenC vaccination programs have brought the disease under control
• Asia sees primarily MenA, but recent outbreaks of MenC have been reported²
• Major African epidemics are associated with Men A, Men C and Men W
• In the last decade, multiple large outbreaks of MenW have been reported in Saudi Arabia among pilgrims attending the Hajj/Umra, with subsequent MenW outbreaks caused by pilgrims returning home²
• There has been a recent emergence of serogroup W in Turkey⁵
• The U.S. has recently seen an increase in the incidence of serogroup Y, which now accounts for approximately one third of U.S. meningococcal disease⁶

Globally, two types of vaccines are available. Routine vaccination practices vary by country.

Currently there is no globally available single vaccine to protect all age groups against MenACW-135Y, although the four serogroups currently do have available older generation vaccinations. In particular, there is no effective vaccine protecting infants and young children against serogroups AYW-135.

Meningococcal Polysaccaride Vaccine: This older type of vaccine – available for serogroups AC, C, ACWY, and A – does not generate a sufficient immune response to protect children younger than five years of age. Additionally, this type of vaccine does not induce immune memory, so revaccination is necessary. However, revaccination often is not successful⁶.

Conjugated Meningococcal C Vaccine: Conjugated vaccines link a harmless protein to the polysaccharide to generate a better and longer-lasting immune response. They are effective across age all groups. Their use has been primarily in select countries in Europe, Australia, Canada, and portions of Latin America, and they have proven highly effective in reducing rates of disease when used broadly.
Novartis is developing a conjugated quadrivalent vaccine (ACWY) that has shown a robust and long-lasting immune response across a broad range of age groups, including infants.

^{1, 2} World Health Organization. Meningococcal meningitis Fact sheet. May 2003.

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³ WHO Weekly Epidemiological Record. 2002; 40(77); 329-340.

⁴ Centers for Disease Control and Prevention. Factsheet: Meningococcal Diseases and Meningococcal Vaccines. April 25, 2006.

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⁵ Ceyhan et al. Manuscript in Process.

⁶ Centers for Disease Control and Prevention. Prevention and control of meningococcal disease and meningococcal disease and college students – recommendations of the Advisory Committee on Immunization Practices. MMWR 2000; 49(RR-7):1-22

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