The everchanging epidemiology of meningococcal disease worldwide and the potential for prevention through vaccination.

Neisseria meningitidis is a major cause of bacterial meningitis and septicaemia worldwide and is associated with high case fatality rates and serious life-long complications among survivors. Twelve serogroups are recognised, of which six (A, B, C, W, X and Y) are responsible for nearly all cases of invasive meningococcal disease (IMD). The incidence of IMD and responsible serogroups vary widely both geographically and over time. For the first time, effective vaccines against all these serogroups are available or nearing licensure. Over the past two decades, IMD incidence has been declining across most parts of the world through a combination of successful meningococcal immunisation programmes and secular trends. The introduction of meningococcal C conjugate vaccines in the early 2000s was associated with rapid declines in meningococcal C disease, whilst implementation of a meningococcal A conjugate vaccine across the African meningitis belt led to near-elimination of meningococcal A disease. Consequently, other serogroups have become more important causes of IMD. In particular, the emergence of a hypervirulent meningococcal group W clone has led many countries to shift from monovalent meningococcal C to quadrivalent ACWY conjugate vaccines in their national immunisation programmes. Additionally, the recent licensure of two protein-based, broad-spectrum meningococcal B vaccines finally provides protection against the most common group responsible for childhood IMD across Europe and Australia. This review describes global IMD epidemiology across each continent and trends over time, the serogroups responsible for IMD, the impact of meningococcal immunisation programmes and future needs to eliminate this devastating disease.
Competing Interests: Declaration of Interests LHH has served as a consultant for GSK, Merck, Pfizer, and Sanofi Pasteur. MAS has received grants to support research projects and consultancy fee from GSK, Pfizer and Sanofi Pasteur. RB performs contract research on behalf of Public Health England for GSK, Pfizer and Sanofi Pasteur. HSM is an investigator on vaccine trials sponsored by industry; her institution receives funding from GSK, Pfizer and Sanofi-Pasteur for investigator-led research: she receives no personal payments from industry. FM-t has received financial and non-financial support outside the submitted work from Pfizer, GSK, MSD and Sanofi Pasteur; he also has received personal fees from Pfizer, Novavax, MSD, GSK and Sanofi Pasteur as consultant/advisor; his institution has also received financial support as trial fees from Ablynx, Jansen, Regeneron, Medimmune, Pfizer, MSD, Sanofi Pasteur, Novavax and Novartis, as well as non-financial support from GSK, Pfizer and MSD and research grants from Pfizer, GSK, MSD and Astra Zeneca. AvG has received reimbursements from Pfizer and Sanofi Pasteur; and students under her supervision have received grants from Sanofi Pasteur. SNL performs contract work for pharmaceutical companies on behalf of St. George's University of London, but does not receive any personal remuneration. All other authors: no conflicts declared
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