BACKGROUND: Meningococcal disease continues to be a global public health concern due to its epidemic potential, severity, and sequelae. The global epidemiological data on circulating meningococcal serogroups have never been reviewed concurrently with the laboratory capacity for meningococcal surveillance at the national level. We, therefore, aimed to conduct a country-level review of meningococcal surveillance, serogroup distribution, and vaccine use. METHODS: We conducted a systematic literature review across six databases to identify studies (published January 1, 2010 to October 16, 2017) and grey literature reporting meningococcal serogroup data for the years 2010-2016. We performed independent random effects meta-analyses for serogroups A, B, C, W, X, Y, and other. We developed and circulated a questionnaire-based survey to surveillance focal points in countries (N = 95) with known regional bacterial meningitis surveillance programs to assess their surveillance capacity and summarized using descriptive methods. RESULTS: We included 173 studies from 59 countries in the final analysis. The distribution of meningococcal serogroups differed markedly between countries and regions. Meningococcal serogroups C and W accounted for substantial proportions of meningococcal disease in most of Africa and Latin America. Serogroup B was the predominant cause of meningococcal disease in many locations in Europe, the Americas, and the Western Pacific. Serogroup Y also caused many cases of meningococcal disease in these regions, particularly in Nordic countries. Survey responses were received from 51 countries. All countries reported the ability to confirm the pathogen in-country, while approximately 30% either relied on reference laboratories for serogrouping (N = 10) or did not serogroup specimens (N = 5). Approximately half of countries did not utilize active laboratory-based surveillance system (N = 22). Nationwide use of a meningococcal vaccine varied, but most countries (N = 36) utilized a meningococcal vaccine at least for certain high-risk population groups, in private care, or during outbreaks. CONCLUSIONS: Due to the large geographical variations in circulating meningococcal serogroups, each country should continue to be monitored for changes in major disease-causing serogroups in order to inform vaccine and control policies. Similarly, laboratory capacity should be appropriately scaled up to more accurately understand local epidemiology and disease burden, as well as the impact of vaccination programs.

Centre for Global Health Research Usher Institute of Population Health Sciences and Informatics University of Edinburgh Edinburgh Scotland UK

Infectious Disease Prevention and Control Unit Msida Malta

Joint authors in this position

Kannerklinik Centre Hospitalier du Luxembourg Luxembourg

Medical School University of Edinburgh Edinburgh Scotland UK

National Center of Infectious and Parasitic Diseases Sofia Bulgaria

National Centre for Microbiology Instituto de Salud Carlos 3 Madrid Spain

National Reference Centre for Bacterial Meningitis National Medicines Institute Warsaw Poland

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

Public Health Foundation of India New Delhi India

Sanofi Pasteur Marcy l'Etoile France

Sanofi Pasteur Swiftwater Pennsylvania USA

World Health Organization Inter Country Support Team for West Africa Ouagadougou Burkina Faso

See more in PubMed

Rouphael NG, Stephens DS. Neisseria meningitidis: biology, microbiology, and epidemiology. Methods Mol Biol. 2012;799:1–20. doi: 10.1007/978-1-61779-346-2_1. PubMed DOI PMC

Flexner S. The results of the serum treatment in thirteen hundred cases of epidemic meningitis. J Exp Med. 1913;17:553–76. doi: 10.1084/jem.17.5.553. PubMed DOI PMC

Greenwood B. Manson lecture: meningococcal meningitis in Africa. Trans R Soc Trop Med Hyg. 1999;93:341–53. doi: 10.1016/S0035-9203(99)90106-2. PubMed DOI

World Health Organization Meningococcal vaccines: WHO position paper, November 2011. Wkly Epidemiol Rec. 2011;86:521–39. PubMed

Centers for Disease Control and Prevention (CDC). Epidemiology and prevention of vaccine-preventable diseases. Washington DC: Public Health Foundation; 2015.

Sáfadi MAP, Berezin EN, Arlant LHF. Meningococcal disease: epidemiology and early effects of immunization programs. J Pediatric Infect Dis Soc. 2014;3:91–3. doi: 10.1093/jpids/piu027. PubMed DOI

Ramakrishnan M, Ulland AJ, Steinhardt LC, Moďsi JC, Were F, Levine OS. Sequelae due to bacterial meningitis among African children: a systematic literature review. BMC Med. 2009;7:47. doi: 10.1186/1741-7015-7-47. PubMed DOI PMC

Edmond K, Clark A, Korczak VS, Sanderson C, Griffiths UK, Rudan I. Global and regional risk of disabling sequelae from bacterial meningitis: a systematic review and meta-analysis. Lancet Infect Dis. 2010;10:317–28. doi: 10.1016/S1473-3099(10)70048-7. PubMed DOI

World Health Organization. Laboratory methods for the diagnosis of meningitis caused by Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae: WHO manual, 2nd Edition. Geneva: WHO; 2011.

Bruce MG, Rosenstein NE, Capparella JM, Shutt KA, Perkins BA, Collins M. Risk factors for meningococcal disease in college students. JAMA. 2001;286:688–93. doi: 10.1001/jama.286.6.688. PubMed DOI

Brundage JF, Ryan MAK, Feighner BH, Erdtmann FJ. Meningococcal disease among United States military service members in relation to routine uses of vaccines with different serogroup-specific components, 1964–1998. Clin Infect Dis. 2002;35:1376–81. doi: 10.1086/344273. PubMed DOI

Aguilera JF, Anne P, Christine M, Susan H. Outbreak of serogroup W135 meningococcal disease after the Hajj pilgrimage, Europe, 2000. Emerg Infect Dis. 2002;8:761–7. doi: 10.3201/eid0808.010422. PubMed DOI PMC

National Foundation for Infectious Diseases (NFID). Meningococcal Serogroup B Cases and Outbreaks on US College Campuses. 2017. Available: http://www.nfid.org/idinfo/meningococcal/meningococcal-b-college-outbreaks.html. Accessed: 16 November 2017.

Harrison OB, Claus H, Jiang Y, Bennett J, Bratcher H, Jolley K, et al. Description and nomenclature of Neisseria meningitidis capsule locus. Emerg Infect Dis. 2013;19:566–73. doi: 10.3201/eid1904.111799. PubMed DOI PMC

Borrow R, Alarcón P, Carlos J, Caugant DA, Christensen H, Debbag R, et al. The Global Meningococcal Initiative: global epidemiology, the impact of vaccines on meningococcal disease and the importance of herd protection. Expert Rev Vaccines. 2017;16:313–28. doi: 10.1080/14760584.2017.1258308. PubMed DOI

Harrison LH, Pelton SI, Wilder-Smith A, Holst J, Safadi MAP, Vazquez JA, et al. The Global Meningococcal Initiative: recommendations for reducing the global burden of meningococcal disease. Vaccine. 2011;29:3363–71. doi: 10.1016/j.vaccine.2011.02.058. PubMed DOI

Berti F. Development of a carbohydrate-based vaccine against meningococcal serogroup X infection. J Vaccines Vaccin. 2014;5:129.

Serum Institue of India Pvt. Ltd. Product Pipeline. 2017. Available: http://www.seruminstitute.com/product_horizon.php. Accessed: 26 July 2017.

Donnelly J, Medini D, Boccadifuoco G, Biolchi A, Ward J, Frasch C, et al. Qualitative and quantitative assessment of meningococcal antigens to evaluate the potential strain coverage of protein-based vaccines. Proc Natl Acad Sci U S A. 2010;107:19490–5. doi: 10.1073/pnas.1013758107. PubMed DOI PMC

Sáfadi MAP, O’Ryan M, Valenzuela Bravo MT, Brandileone MCC, Gorla MCO, de Lemos APS, et al. The current situation of meningococcal disease in Latin America and updated Global Meningococcal Initiative (GMI) recommendations. Vaccine. 2015;33:6529–36. doi: 10.1016/j.vaccine.2015.10.055. PubMed DOI

Borrow R, Lee J-S, Vázquez JA, Enwere G, Taha M-K, Kamiya H, et al. Meningococcal disease in the Asia-Pacific region: findings and recommendations from the Global Meningococcal Initiative. Vaccine. 2016;34:5855–62. doi: 10.1016/j.vaccine.2016.10.022. PubMed DOI

Borrow R, Caugant DA, Ceyhan M, Christensen H, Dinleyici EC, Findlow J, et al. Meningococcal disease in the Middle East and Africa: Findings and updates from the Global Meningococcal Initiative. J Infect. 2017;75:1–11. doi: 10.1016/j.jinf.2017.04.007. PubMed DOI

Harrison LH, Trotter CL, Ramsay ME. Global epidemiology of meningococcal disease. Vaccine. 2009;27:B51–63. doi: 10.1016/j.vaccine.2009.04.063. PubMed DOI

Centers for Disease Control and Prevention (CDC) Evaluation of meningitis surveillance before introduction of serogroup A meningococcal conjugate vaccine – Burkina Faso and Mali. MMWR Morb Mortal Wkly Rep. 2012;61:1025–28. PubMed

Halperin SA, Bettinger JA, Greenwood B, Harrison LH, Jelfs J, Ladhani SN, et al. The changing and dynamic epidemiology of meningococcal disease. Vaccine. 2012;30:B26–36. doi: 10.1016/j.vaccine.2011.12.032. PubMed DOI

Jafri RZ, Ali A, Messonnier NE, Tevi-Benissan C, Durrheim D, Eskola J, et al. Global epidemiology of invasive meningococcal disease. Popul Health Metr. 2013;11:17–9. doi: 10.1186/1478-7954-11-17. PubMed DOI PMC

Lingani C, Bergeron-Caron C, Stuart JM, Fernandez K, Djingarey MH, Ronveaux O, et al. Meningococcal meningitis surveillance in the African meningitis belt, 2004–2013. Clin Infect Dis. 2015;61:S410–5. doi: 10.1093/cid/civ597. PubMed DOI PMC

Crum-Cianflone N, Sullivan E. Meningococcal vaccinations. Infect Dis Ther. 2016;5:89–112. doi: 10.1007/s40121-016-0107-0. PubMed DOI PMC

Nyaga VN, Arbyn M, Aerts M. Metaprop: a Stata command to perform meta-analysis of binomial data. Arch Public Health. 2014;72:39. doi: 10.1186/2049-3258-72-39. PubMed DOI PMC

European Centre for Disease Prevention and Control (ECDC). Laboratory capacity and capability. 2016. Available: http://ecdc.europa.eu/en/healthtopics/microbiology/microbiology-activities/laboratory-capability/Pages/default.aspx. Accessed: 22 February 2017.

World Health Organization. Executive summary meeting report, WHO-coordinated IBVPD surveillance network, laboratory technical working group meeting (Draft). Geneva: WHO; 2014.

Vázquez JA, Taha MK, Findlow J, Gupta S, Borrow R. Global Meningococcal Initiative: guidelines for diagnosis and confirmation of invasive meningococcal disease. Epidemiol Infect. 2016;144:3052–7. doi: 10.1017/S0950268816001308. PubMed DOI PMC

European Centre for Disease Prevention and Control (ECDC). Vaccine schedule: recommended immunisations for meningococcal disease. 2017. Available: http://vaccine-schedule.ecdc.europa.eu/Pages/Scheduler.aspx. Accessed: 7 March 2017.

World Health Organization (WHO). WHO vaccine-preventable diseases: monitoring system. 2016 global summary. 2016. Available: http://apps.who.int/immunization_monitoring/globalsummary/schedules. Accessed: 23 February 2017.

Borrow R, Abad R, Trotter C, van der Klis FR, Vázquez JA. Effectiveness of meningococcal serogroup C vaccine programmes. Vaccine. 2013;31:4477–86. doi: 10.1016/j.vaccine.2013.07.083. PubMed DOI

Ladhani SN, Flood JS, Ramsay ME, Campbell H, Gray SJ, Kaczmarski EB, et al. Invasive meningococcal disease in England and Wales: implications for the introduction of new vaccines. Vaccine. 2012;30:3710–6. doi: 10.1016/j.vaccine.2012.03.011. PubMed DOI

Department of Health. England. Meningococcal B vaccination programme to be introduced. [press release]. 2014. Available: https://www.gov.uk/government/news/meningococcal-b-vaccination-programme-to-be-introduced. Accessed: 20 March 2017.

Diomandé FVK, Djingarey MH, Daugla DM, Novak RT, Kristiansen PA, Collard J-M, et al. Public health impact after the introduction of PsA-TT: the first 4 years. Clin Infect Dis. 2015;61:S467–72. doi: 10.1093/cid/civ499. PubMed DOI PMC

Djingarey MH, Diomandé FVK, Barry R, Kandolo D, Shirehwa F, Lingani C, et al. Introduction and rollout of a new group A meningococcal conjugate vaccine (PsA-TT) in African meningitis belt countries, 2010–2014. Clin Infect Dis. 2015;61:S434–41. doi: 10.1093/cid/civ551. PubMed DOI PMC

Public Health England (PHE). Meningococcal ACWY conjugate vaccination (MenACWY). PHE, 2015 June 22, 2015. Report No.

Kwambana-Adams BA, Asiedu-Bekoe F, Sarkodie B, Afreh OK, Kuma GK, Owusu-Okyere G, et al. An outbreak of pneumococcal meningitis among older children (>=5 years) and adults after the implementation of an infant vaccination programme with the 13-valent pneumococcal conjugate vaccine in Ghana. BMC Infect Dis. 2016;16:575. doi: 10.1186/s12879-016-1914-3. PubMed DOI PMC

World Health Organization. Training for mid-level managers (MLM): making disease surveillance work. Geneva: WHO; 2008.

World Health Organization. Serogroup C in the meningitis belt: facing the challenge. Geneva: WHO; 2015.

Australian Government. Invasive meningococcal disease national surveillance report: With a focus on MenW. Canberra ACT: Department of Health; 2017.

Knol MJ, Hahné SJM, Lucidarme J, Campbell H, de Melker HE, Gray SJ, et al. Temporal associations between national outbreaks of meningococcal serogroup W and C disease in the Netherlands and England: an observational cohort study. Lancet Public Health. 2017;2:e473–82. doi: 10.1016/S2468-2667(17)30157-3. PubMed DOI

Invasive meningococcal disease in South-Eastern European countries: Do we need to revise vaccination strategies?