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Review
. 2024 Jun;15(3):729-741.
doi: 10.1007/s41999-024-00969-0. Epub 2024 May 6.

Invasive meningococcal disease in older adults: current perspectives and call for action

Catherine Weil-Olivier  1 , Muhamed-Kheir Taha  2 , Sean Leng  3 , Ener Cagri Dinleyici  4 , Paolo Bonanni  5 , Elena Moya  6 , Andreas Leischker  7 , Saber Yezli  8
Affiliations
Review

Invasive meningococcal disease in older adults: current perspectives and call for action

Catherine Weil-Olivier et al. Eur Geriatr Med. 2024 Jun.

Abstract

Purpose: Invasive meningococcal disease (IMD) is a devastating condition. While most attention is directed towards disease in children and adolescents, IMD poses an important cause of morbidity and mortality in adults ≥60 years. While immunization is a critical component of healthy ageing strategies, meningococcal immunization is not routinely offered to older adults. The aim of this review was to summarize clinical and epidemiological aspects of IMD and available immunization strategies, with a particular focus on disease in older individuals, to emphasize the importance of this rather neglected area.

Methods: An expert working group was established to evaluate clinical and epidemiological data to raise awareness of IMD in older individuals, and develop suggestions to improve the existing burden.

Results: Routine child and adolescent meningococcal immunization has substantially reduced IMD in these targeted populations. Consequently, prevalence and proportion of IMD among those ≥60 years, mostly unvaccinated, is increasing in developed countries (accounting for up to 25% of cases). IMD-related mortality is highest in this age-group, with substantial sequelae in survivors. IMD due to serogroups W and Y is more prevalent among older adults, often with atypical clinical features (pneumonia, gastrointestinal presentations) which may delay timely treatment.

Conclusions: IMD in older adults remains overlooked and greater awareness is required at clinical and societal levels. We encourage clinicians and immunization policy makers to reconsider IMD, with a call for action to remedy existing inequity in older adult access to protective meningococcal immunization.

Keywords: Immunization; Increased risk; Invasive meningococcal disease; Older adults; Vaccine equity.

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Conflict of interest statement

MKT conducts work contracts funded by GSK, Pfizer and Sanofi for the Institut Pasteur, Paris. He also reports the patent NZ630133A “Vaccines for serogroup X meningococcus” issued with GSK. SL declares participation in Sanofi’s International Advisory Board on SARS-CoV-2 vaccine development and engaged in speaking for GSK on Shingrix vaccine. ECD declares performing contract work for Eskisehir Osmangazi University, funded by GSK, Sanofi Pasteur, and Pfizer. PB declares speaking engagements and participation in Advisory Boards for GSK, MSD, Pfizer, Seqirus, Astra Zeneca, Janssen, Sanofi Pasteur, and Moderna. AL declares consulting fees and participation in Advisory Boards for Sanofi Pasteur, and being a member of the “Working Group on Vaccination” of the German Geriatric Society. SY declares receiving consultation fees, travel grants, and honoraria from Sanofi for attending scientific meetings and presentations. CWO declares participation to speaking engagements and in Advisory boards for Sanofi, Pfizer, Sequirus, Astra-Zeneca, Janssen and Novavax; and EM declare no competing interests.

Figures

Fig. 1
Fig. 1
Atypical presentations of meningococcal infections in older adults
Fig. 2
Fig. 2
Distribution of invasive meningococcal disease case burden in Europe, the United States and Australia in select age-strata. European data sourced from the ECDC Surveillance Atlas of Infectious Diseases tool [18]. Data for the United States as reported by the CDC [19]. Australian data sourced from national surveillance reports [20]
Fig. 3
Fig. 3
IMD serogroup distribution in older adults (≥50 years) in Europe and those ≥65 years in the United States and Australia. European data sourced from the ECDC Surveillance Atlas of Infectious Diseases tool [18]. Data for the United States as reported by the CDC [19]. Australian data sourced from national surveillance reports [20]
Fig. 4
Fig. 4
The proportion of all IMD cases which involved those aged ≥65 years in select countries in 2019. European data sourced from the ECDC Surveillance Atlas of Infectious Diseases tool [18]. Data for the United States as reported by the CDC [19]. Australian data sourced from national surveillance reports [20]
Fig. 5
Fig. 5
Invasive meningococcal disease case fatality rates in Europe (2011–2021). Data sourced from the ECDC Surveillance Atlas of Infectious Diseases tool [18]
See this image and copyright information in PMC

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