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Meningococcal vaccine: a new vaccine to combat meningococcal disease in India
1Department of Community Medicine, Pt. B.D. Sharma-Postgraduate Institute of Medical Studies, Rohtak, India. dr.rameshverma@yahoo.co.in
Abstract:
Meningococcal meningitis is caused by Neisseria meningitidis, a gram-negative, aerobic, encapsulated diplococcus. Meningococci are divided into numerous serogroups based on the composition of their capsular polysaccharide (Ps) antigens. At least 13 serogroups have been described: A, B, C, D, 29E, H, I, K, L, W-135, X, Y and Z. Out of these 13, six (A, B, C, W135, X and Y) can cause epidemics. The incubation period averages 3-4 d (range 1-10 d), which is the period of communicability. Bacteria can be found for 2-4 d in the nose and pharynx, and for up to 24 h after starting antibiotics. N. meningitidis is a leading cause of meningitis worldwide and a significant public health problem and dreaded disease in most countries. Morbidity and mortality rates from the disease remain high. Apart from epidemics, at least 1.2 million cases of bacterial meningitis are estimated to occur every year, 135,000 of which are fatal--of these, ~500,000 and ~50,000 respectively are caused by meningococci. Many outbreaks of meningococcal meningitis have been documented, with major outbreaks mainly seen in large cities of northern, western and eastern India like New Delhi, Mumbai, Kolkata and northeastern states. In 2011, 245 people died in India, the vast majority (179) in West Bengal, while 467 and 341 people in 2009 and 2010 respectively died of this disease. The meningococcal conjugate vaccines (MCV) are preferred for reasons of immunogenicity and persistence of immunity but are unavailable in India. Only the quadrivalent and bivalent meningococcal Ps vaccines (MPV) are available in India. The quadrivalent MPV is preferred for Haj pilgrims, international travelers and students in that it provides protection against emerging W-135 and Y disease in these areas. A single-dose 0.5mL injection is recommended.
Insights
Meningococcal meningitis, caused by Neisseria meningitidis bacteria, remains a significant global health threat. While conjugate vaccines are preferred, India currently offers only polysaccharide vaccines (MPV), with the quadrivalent MPV recommended for specific high-risk groups.
Area of Science:
- Microbiology and Infectious Diseases
- Vaccinology
- Public Health
Background:
- Meningococcal meningitis is a severe illness caused by Neisseria meningitidis, a bacterium responsible for significant global morbidity and mortality.
- Epidemics are primarily caused by six serogroups (A, B, C, W-135, X, Y), with India experiencing notable outbreaks.
- Current treatment challenges and the high fatality rate underscore the need for effective prevention strategies.
Purpose of the Study:
- To review the epidemiology of meningococcal meningitis, focusing on outbreaks in India.
- To discuss the available meningococcal polysaccharide vaccines (MPV) in India and their recommended usage.
- To highlight the limitations of current vaccine availability compared to preferred meningococcal conjugate vaccines (MCV).
Main Methods:
- Review of existing literature on Neisseria meningitidis, its serogroups, and the epidemiology of meningococcal meningitis.
- Analysis of reported outbreaks and mortality data in India.
- Evaluation of available meningococcal polysaccharide vaccines (MPV) and their application.
Main Results:
- Neisseria meningitidis is a leading cause of bacterial meningitis, with an estimated 500,000 cases and 50,000 deaths annually attributed to it.
- India has faced significant meningococcal meningitis outbreaks, with substantial mortality reported in recent years.
- Meningococcal conjugate vaccines (MCV) are not available in India; only quadrivalent and bivalent meningococcal polysaccharide vaccines (MPV) are accessible.
Conclusions:
- The quadrivalent MPV is recommended for specific populations in India, including Haj pilgrims, international travelers, and students, to protect against serogroups W-135 and Y.
- A single 0.5mL dose of the quadrivalent MPV is the recommended administration.
- The limited availability of MCV in India presents a challenge in combating meningococcal meningitis effectively.
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