New vaccines targeting meningococci expressing serogroup B polysaccharide have been developed, with some being licensed in Europe. Coverage depends on the distribution of disease-associated genotypes, which may vary by age. It is well established that a small number of hyperinvasive lineages account for most disease, and these lineages are associated with particular antigens, including vaccine candidates. A collection of 4,048 representative meningococcal disease isolates from 18 European countries, collected over a 3-year period, were characterized by multilocus sequence typing (MLST). Age data were available for 3,147 isolates. The proportions of hyperinvasive lineages, identified as particular clonal complexes (ccs) by MLST, differed among age groups. Subjects <1 year of age experienced lower risk of sequence type 11 (ST-11) cc, ST-32 cc, and ST-269 cc disease and higher risk of disease due to unassigned STs, 1- to 4-year-olds experienced lower risk of ST-11 cc and ST-32 cc disease, 5- to 14-year-olds were less likely to experience ST-11 cc and ST-269 cc disease, and ≥25-year-olds were more likely to experience disease due to less common ccs and unassigned STs. Younger and older subjects were vulnerable to a more diverse set of genotypes, indicating the more clonal nature of genotypes affecting adolescents and young adults. Knowledge of temporal and spatial diversity and the dynamics of meningococcal populations is essential for disease control by vaccines, as coverage is lineage specific. The nonrandom age distribution of hyperinvasive lineages has consequences for the design and implementation of vaccines, as different variants, or perhaps targets, may be required for different age groups.

Department of Bacteriology and Immunology Norwegian Institute of Public Health Oslo Norway

Department of Infectious Parasitic and Immune Mediated Diseases Istituto Superiore di Sanità Rome Italy

Department of Microbiology Landspitali University Hospital Reykjavik Iceland

Department of Veterinary Medicine University of Cambridge Cambridge United Kingdom

Department of Zoology University of Oxford Oxford United Kingdom

Institut für Hygiene und Mikrobiologie Würzburg Germany

Irish Meningococcal and Meningitis Reference Laboratory Dublin Ireland

Laboratory of Antimicrobial Resistance Department of Infectious Diseases National Institute of Health Dr Ricardo Jorge Lisbon Portugal

Meningococcal Reference Laboratory Madrid Spain

Meningococcal Reference Laboratory Scientific Institute of Public Health Brussels Belgium

Meningococcal Reference Unit Manchester Royal Infirmary Manchester United Kingdom

National Institute for Health and Welfare Helsinki Finland

National Meningococcal Reference Laboratory National School of Public Health Athens Greece

National Reference Centre for Meningococci Institute for Medical Microbiology and Hygiene Graz Austria

National Reference Centre for Meningococci Pasteur Institute Paris France

National Reference Laboratory for Meningococcal Infections National Institute of Public Health Prague Czech Republic

National Reference Laboratory for Pathogenic Neisseria Department of Laboratory Medicine Clinical Microbiology Örebro University Hospital Örebro Sweden

Neisseria and Streptococcus Reference Laboratory Statens Serum Institut Copenhagen Denmark

Public Health England London United Kingdom

The Netherlands Reference Laboratory for Bacterial Meningitis Academic Medical Centre Department of Medical Microbiology Amsterdam Netherlands

The Scottish Haemophilus Legionella Meningococcus and Pneumococcus Reference Laboratory Glasgow United Kingdom

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$a New vaccines targeting meningococci expressing serogroup B polysaccharide have been developed, with some being licensed in Europe. Coverage depends on the distribution of disease-associated genotypes, which may vary by age. It is well established that a small number of hyperinvasive lineages account for most disease, and these lineages are associated with particular antigens, including vaccine candidates. A collection of 4,048 representative meningococcal disease isolates from 18 European countries, collected over a 3-year period, were characterized by multilocus sequence typing (MLST). Age data were available for 3,147 isolates. The proportions of hyperinvasive lineages, identified as particular clonal complexes (ccs) by MLST, differed among age groups. Subjects <1 year of age experienced lower risk of sequence type 11 (ST-11) cc, ST-32 cc, and ST-269 cc disease and higher risk of disease due to unassigned STs, 1- to 4-year-olds experienced lower risk of ST-11 cc and ST-32 cc disease, 5- to 14-year-olds were less likely to experience ST-11 cc and ST-269 cc disease, and ≥25-year-olds were more likely to experience disease due to less common ccs and unassigned STs. Younger and older subjects were vulnerable to a more diverse set of genotypes, indicating the more clonal nature of genotypes affecting adolescents and young adults. Knowledge of temporal and spatial diversity and the dynamics of meningococcal populations is essential for disease control by vaccines, as coverage is lineage specific. The nonrandom age distribution of hyperinvasive lineages has consequences for the design and implementation of vaccines, as different variants, or perhaps targets, may be required for different age groups.

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