Burden of Invasive Meningococcal Disease: Evolving Epidemiology and Implications for Prevention Policy

Invasive meningococcal disease (IMD), caused by Neisseria meningitidis, remains a rare but devastating condition characterized by rapid clinical progression, high case fatality, and long-term morbidity. Despite effective conjugate (or alternative) vaccine availability, sporadic cases and outbreaks persist across the age spectrum in the USA and globally. Contemporary surveillance data reveal a dynamic epidemiologic landscape, shifting serogroup dominance, evolving outbreak patterns involving community-based and socially connected groups, and growing recognition of disease burden among adults. Adolescents serve as key reservoirs of nasopharyngeal carriage; however, despite IMD incidence and case-fatality rates being highest among infants and older adults, respectively, both populations lack routine age-based vaccination recommendations. Prevention strategies in the USA remain anchored to historical incidence peaks and narrowly defined risk groups, leaving substantial gaps in protection, as highlighted by the sharp contrast between high adolescent quadrivalent meningococcal conjugate vaccine coverage and low serogroup B vaccine uptake under shared clinical decision-making. This narrative review synthesizes contemporary evidence on age-specific IMD burden, serogroup dynamics, and long-term sequelae, and critically examines how existing vaccination policies align with infection risk across the lifespan, with emphasis on US vaccination policy. Additional country-specific studies were included to contextualize age-specific epidemiology and provide policy comparators. A life-course-based prevention framework integrating age-related vulnerability, severity, and evolving transmission dynamics is needed to mitigate the burden of IMD.