Meningococcal meningitis in Spain in the Horizon 2030: A position paper

Abstract

Meningococcal meningitis (MM) and invasive meningococcal disease remain a major public health problem that generates enormous public alarm. It is caused by Neisseria meningitidis, a Gram-negative diplococcus with an enormous capacity for acute and rapidly progressive disease, both episodic and epidemic in nature, with early diagnosis and treatment playing a major role. It occurs at any age, but is most common in children under 5 years of age followed by adolescents. Although most cases occur in healthy people, the incidence is higher in certain risk groups. Despite advances in reducing the incidence, it is estimated that in 2017 there were around 5 million new cases of MM worldwide, causing approximately 290,000 deaths and a cumulative loss of about 20,000,000 years of healthy life. In Spain, in the 2021/22 season, 108 microbiologically confirmed cases of MM were reported, corresponding to an incidence rate of 0.23 cases per 100,000 inhabitants. This is a curable and, above all, vaccine-preventable disease, for which the World Health Organisation has drawn up a roadmap with the aim of reducing mortality and sequelae by 2030. For all these reasons, the Illustrious Official College of Physicians of Madrid (ICOMEM) and the Medical Associations of 8 other provinces of Spain, have prepared this opinion document on the situation of MM in Spain and the resources and preparation for the fight against it in our country. The COVID-19 and Emerging Pathogens Committee of ICOMEM has invited experts in the field to participate in the elaboration of this document.

Keywords: Neisseria meningitidis; antimicrobial treatment; chemoprophylaxis; epidemicst; meningitis; meningococcus; prevention; vaccines.

Figure 1

Incidence rate of meningitis per 100,000 population and year in children under 5 years of age (2019). Adapted from Global Burden of Disease Study 2019 [11]

Figure 2

Meningitis mortality rate per 100,000 population and year in children under 5 years of age (2019). Adapted from Global Burden of Disease Study 2019 [11]

Figure 3

Rate of deaths per 100,000 inhabitants caused by Invasive Meningococcal Disease in Spain and the Community of Madrid. Prepared by the General Directorate of Public Health of the Community of Madrid TM, Total Mortality and TMC , Total Mortality Community of Madrid

Figure 4

Most complete meningococcal vaccination schedule according to the vaccines currently available. The application of this schedule is subject to the technical data sheets of the vaccines according to the age at which they are administered, as well as to the epidemiological context. Adapted from MartinónTorres et al. [41,42] ^*According to current data sheets, vaccination of infants under 6 months of age requires at least two doses of primary vaccination. Replacing the current 4-month monovalent C dose with ACWY would be sufficient for protection against serogroup C. The results of a clinical trial evaluating the 1+1 schedule with ACWY-TT (Nimenrix) at 3 and 12 months of age have recently been reported, showing its safety and immunogenicity. It could be considered to progressively dispense with the infant doses against ACWY, once indirect protection in the community has been achieved through high and maintained coverage in the cohort of adolescents with ACWY, as was done in the past with the monovalent vaccine doses against C in infants. & The second dose of meningococcal B could be administered as early as 3 months of age in the 3-dose primary vaccination schedule. In the 2-dose regimens, the minimum interval between doses is 8 weeks according to the technical data sheet. $ This dose could be administered at 12 or 14 years of age, taking advantage of other vaccination visits. We do not yet have data to justify the need for a booster dose of meningococcal B in children who have been correctly primed, nor that a dose at this age is sufficient to maintain adequate levels of protection or to obtain the potential benefits of cross-protection described in the literature for this age group. # Information on meningococcal vaccination in adults is limited and restricted to its use in specific risk groups. We do not know the persistence of the protection of childhood primovaccination in adults. More data are needed to justify routine adult vaccination as part of a vaccination schedule.