Surveillance for meningococcal disease and strategies for use of conjugatemeningococcal vaccines in the United States

Background: Neisseria meningitidis is a leading cause of bacterial meningit is in US; new capsular type-specific conjugate vaccines offer an opportunit y for improved control of meningococcal disease. We evaluated the relative burdens of invasive meningococcal disease in US and examined the projected impact of various meningococcal conjugate vaccination strategies on rates o f meningococcal disease. Methods: meningococcal disease incidence rates wer e determined from active, population-based surveillance in selected US area s. Models were created to determine impact of vaccination of infants. toddl ers, adolescents or college students with meningococcal conjugate vaccines, with assumptions for vaccine coverage, efficacy and duration of protection . Although we examined possible conjugate vaccine formulations including se rogroups A, C, Y and W-135, the final vaccine impact analysis excluded sero groups A and W-135. Outcome measures were cumulative meningococcal disease incidence, and incidence 10 years after initiating vaccination among 0-22-y ear-olds. Results: in models of serogroup C + Y meningococcal conjugate vac cination or infants, toddlers and adolescents, the cumulative incidence of meningococcal disease was reduced by 54, 48 and 25%. respectively, the todd ler strategy had the greatest impact per dose. After 10 years of routine me ningococcal conjugate vaccination. meningococcal disease could be reduced b y 50%,, and deaths by 64%. Conclusions: use of meningococcal conjugate vacc ine could markedly reduce meningococcal disease incidence. Our data, along with vaccine formulation and vaccination program considerations, will be im portant in determining the optimal choice of vaccination strategy. Publishe d by Elsevier Science Ltd.