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Review
. 2009 Jul;8(7):851-61.
doi: 10.1586/erv.09.48.

Meningococcal vaccines and herd immunity: lessons learned from serogroup C conjugate vaccination programs

Caroline L Trotter  1 , Martin C J Maiden
Affiliations
Review

Meningococcal vaccines and herd immunity: lessons learned from serogroup C conjugate vaccination programs

Caroline L Trotter et al. Expert Rev Vaccines. 2009 Jul.

Abstract

Effective vaccines provide direct protection to immunized individuals, but may also provide benefits to unvaccinated individuals by reducing transmission and thereby lowering the risk of infection. Such herd immunity effects have been demonstrated following the introduction of meningococcal serogroup C conjugate (MCC) vaccines, with reductions in disease attack rates in unimmunized individuals and significantly lower serogroup C carriage attributable to the vaccine introduction. In the UK, targeting teenagers for immunization was crucial in maximizing indirect effects, as most meningococcal transmission occurs in this age group. Questions remain regarding the duration of herd protection and the most appropriate long-term immunization strategies. The magnitude of the herd effects following MCC vaccination was largely unanticipated, and has important consequences for the design and evaluation of new meningococcal vaccines.

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Figures

Figure 1
Figure 1. Transmission of meningococci in the population
Figure 2
Figure 2. Cases of laboratory-confirmed serogroup C disease in England & Wales by age-group and year (July to June), July 1993 to June 2007.
Source: Health Protection Agency Centre for Infections and Meningococcal Reference Unit.
Figure 3
Figure 3. Diagrammatic representation of the cps region in meningococci that express sialic acid containing capsules.
Genes are represented by arrows, which point in the direction of transcription. The genetic organisation of capule null (cnl) meningococci, which cannot express a capsule, is shown for comparison. Exchanges of the siaD gene result in capsule switching among the different serogroups. After Claus H, et al 2002 and Dolan-Livengood JM et al, 2003.
Figure 4
Figure 4. Observed reduction in serogroup C disease in England & Wales, compared to model predictions with and without herd immunity.
See this image and copyright information in PMC

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