Invasive meningococcal disease (IMD) is a life-threatening disease caused by Neisseria meningitidis and has high mortality rates. Survivors often exhibit long-term sequelae and reduced life expectancy. Disease incidence is highest in infants and toddlers, with a resurgence of cases in adolescents and older adults (>50 years of age). Substantial heterogeneity exists in the recommendations of meningococcal vaccines included in National Immunization Programs (NIPs) across countries. Recommendations are usually based on infant/toddler immunization, with some countries recommending immunization only for toddlers. While existing recommendations have led to a reduced incidence of IMD in children <5 years of age, there has been an increase in cases among adolescents and older adults. Currently, older adults are not included in the recommendations. The higher healthcare burden and the economic costs associated with IMD in these age groups suggest that it is time to consider including adolescents and older adults in NIPs to protect against IMD caused by the five most prevalent serogroups. Currently, the lack of equity of access to vaccines in the immunization programs is a glaring gap in the betterment of public health, and a broader meningococcal strategy is recommended to provide optimal protection for all age groups.
Keywords: Adolescent vaccination; Neisseria meningitidis; age distribution; invasive meningococcal disease; older adults; vaccination strategies; vaccine equity.
Invasive meningococcal diseases, which include meningitis, are rare and unpredictable, but may lead to very important/debilitating long-term sequelae, death, or reduced life expectancy. Vaccination is the best way to prevent them. Vaccination recommendations provided by national health agencies usually target infants (or toddlers), children, and adolescents. Older adults are only considered when they are at risk for invasive meningococcal diseases.Here, we analyzed the vaccination strategies for invasive meningococcal disease in different countries to identify the gaps preventing access to vaccination.We found that recommendations for invasive meningococcal disease vaccination vary markedly among countries. Vaccination programs target mainly infants and toddlers, and they successfully reduced the number of cases among them. However, we also observed that the disease now affects more adults. We also found that the lack of equitable access to vaccination prevents broader meningococcal protection for persons of any age.With this analysis, we suggest improving the current meningococcal vaccination guidelines to also provide adolescents and healthy older adults with access to vaccines. Promoting equal access to vaccination for everyone could reduce the impact on the healthcare system and help reduce social disparity. In order to do so, we advise universal recommendation of meningococcal vaccines, which would provide clear guidance to health-care practitioners.