Meningococcus

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pathogen

• Neisseria meningitidis
• gram negative diplococci
• carriage in nasopharynx
• 12 identified capsular serogroups
• common pathogenic serogroup A, B, C, W, X, Y
• seasonal epidemics by group A, C
  • meningitis belt
• sporadic cases by e.g. group B
  • Latin America
  • Norway
  • New Zealand
• immunity generated by polysaccharide capsule except B
  • may be the reason that herd immunity development relatively slow and sporadic outbreaks continue in above countries

epidemiology

• highest < 2 y/o and adolescent
• annual outbreak during dry season in meningitis belt
  • dry winds make people's nose drier resulting in easy
• wide range difference of nasopharynx carriage between countries
  • reason totally unknown
  • NZ & 3%
  • Nigeria boarding house 30-40%

transmission

• aerosol
• fomite
• adolescent activity

clinical picture

• fever
• distinctive petechiae anywhere in whole body
• no fading by pressure with glass tumbler - "tumbler test"
• resulting in purple bruising of skin
• photophobia
• headache, neck stiffness, vomiting
• irritability and/or confusion

vaccine

development history

• 1960s - purified PS vaccines for A and C
  • immunity short term due to lack of T-cell involvement
• 1990s - conjugated vaccines for A and C after success of Hib conjugate vaccine
• 2000s - monovalent A vaccine for Africa
  • "MenAfriVac"

current vaccines

• A polysaccharide
  • MenAfriVac
• C conjugate
• A,C,Y,W135 conjugate
  • Menactra (Sanofi Pasteur)
  • Menveo (GSK)
  • Nimenrix (Pfizer)
• B polysaccharide
  • Bexsero (GSK)
  • Trumenba (Pfizer)
  • VA-MENGOC-BC (Finlay Institute of Cuba)

issues of men B vaccine

• polysaccharide of B is relatively low immunogenic
  • the reason is considered because of interaction between B polysaccharide and fetal brain tissue, resulting in possible immunotolerance
    • interaction is observed as antibodies against B-PS have also affinity to fetal brain tissue
  • it means B-PS vaccine has potential of neurological damage for young infants
• currently available men B vaccines are protein-based vaccine, not PS vaccine
  • proteins expressed on the surface of N. meningitidis group B are purified through bacterial culture