CNS Drugs

, Volume 21, Issue 5, pp 355–366

Bacterial Meningitis

The Impact of Vaccination
Current Opinion
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Abstract

Acute bacterial meningitis remains an important cause of morbidity and mortality in children. Children <2 years of age are particularly susceptible to infection with encapsulated bacteria due to their immature response to polysaccharide antigens. Conjugate vaccines, which induce T cell memory, can provide immunological protection for these children.

The Haemophilus influenzae type b (Hib) conjugate vaccine was the first such vaccine to become available. The efficacy of the vaccine has been quoted as being 98%. Its introduction was followed by a dramatic decrease in the incidence of all invasive Hib disease, including meningitis. This reduction was in part due to the ability of these vaccines to reduce nasopharyngeal carriage of the organism and thereby induce herd immunity.

Different Hib vaccines use a variety of protein carriers and differ in their immunogenicity and efficacy. The most suitable vaccine needs to be determined according to the local epidemiology of Hib disease. Commercial combination vaccines may lead to lower antibody levels. A recent increase in the incidence of Hib disease in the UK highlights the importance of continued surveillance and the need for booster vaccinations to ensure continued protection.

Conjugate vaccines to Streptococcus pneumoniae and Neisseria meningitidis have been developed. The introduction of a pneumococcal conjugate vaccine in the US has led to a decrease in the rate of infection by nearly 60% in children <5 years of age. A reduction in pneumococcal carriage may also modify disease epidemiology.

The UK introduced the conjugate meningococcal C vaccine into its infant schedule with a corresponding reduction in N. meningitidis group C disease. A recent decrease in the effectiveness of the vaccine, however, suggests a booster may be necessary in the future. Our present understanding of the immunology of conjugate vaccines is far from complete.

Developed countries have introduced conjugate vaccines into their immunisation schedules to prevent bacterial meningitis; however, their high cost precludes their use in many developing countries. Progress needs to be made in order to get these highly effective vaccines to those areas that need them.

References

  1. 1.
    Peltola H. Worldwide Haemophilus influenzae type b disease at the beginning of the 21 st century: global analysis of the disease burden 25 years after the use of the polysaccharide vaccine and a decade after the advent of conjugates. Clin Microbiol Rev 2000; 13(2): 302–17PubMedCrossRefGoogle Scholar
  2. 2.
    Hausdorff W. Haemophilus, meningococcus and pneumococcus: comparative epidemiologic patterns of disease. Int J Clin Pract 2001; Suppl. 118: 2–4Google Scholar
  3. 3.
    Oostenbrink R, Maas M, Moons KG, et al. Sequelae after bacterial meningitis in childhood. Scand J Infect Dis 2002; 34(5): 379–82PubMedCrossRefGoogle Scholar
  4. 4.
    Quagliarello VJ, Scheid WM. Treatment of bacterial meningitis. N Engl J Med 1997; 336(10): 708–16PubMedCrossRefGoogle Scholar
  5. 5.
    Ada G. Vaccines and vaccination. N Engl J Med 2001; 345(14): 1042–53PubMedCrossRefGoogle Scholar
  6. 6.
    Goldblatt D. Recent developments in bacterial conjugate vaccines. J Med Microbiol 1998; 47(7): 563–7PubMedCrossRefGoogle Scholar
  7. 7.
    Adams WG, Deaver KA, Cochi SL, et al. Decline of childhood Haemophilus influenzae type b (Hib) disease in the Hib vaccine era. JAMA 1993; 269(2): 221–6PubMedCrossRefGoogle Scholar
  8. 8.
    Levine OS, Schwartz B, Pierce N, et al. Development, evaluation and implementation of Haemophilus influenzae type b vaccines for young children in developing countries: current status and priority actions. Pediatr Infect Dis J 1998; 17(9 Suppl.): S95–113PubMedGoogle Scholar
  9. 9.
    Eskola J, Anttila M. Pneumococcal conjugate vaccines. Pediatr Infect Dis J 1999; 18(6): 543–51PubMedCrossRefGoogle Scholar
  10. 10.
    Salisbury D. Introduction of a conjugate meningococcal type C vaccine programme in the UK. J Paediatr Child Health 2001; 37(5): S34–6PubMedCrossRefGoogle Scholar
  11. 11.
    Shinefield H. Pneumococcal conjugate vaccine and ongoing lessons. Int J Clin Pract 2001; Suppl. 118: 23–5Google Scholar
  12. 12.
    Department of Health. Salisbury DM, Begg NT, editors. Immunisation against infectious disease. London: HMSO, 1996Google Scholar
  13. 13.
    Booy R, Hodgson SA, Slack MP, et al. Invasive Haemophilus influenzae type b disease in the Oxford region (1985–91). Arch Dis Child 1993; 69(2): 225–8PubMedCrossRefGoogle Scholar
  14. 14.
    Bijlmer HA, van Alphen L, Greenwood BM, et al. The epidemiology of Haemophilus influenzae meningitis in children under five years of age in The Gambia, West Africa. J Infect Dis 1990; 161(6): 1210–5PubMedCrossRefGoogle Scholar
  15. 15.
    Global Programme for Vaccines and Immunization (GPV), World Health Organization. The WHO position paper on Haemophilus influenzae type b conjugate vaccines. Wkly Epidemiol Rec 1998; 73(10): 64–71Google Scholar
  16. 16.
    Kelly DF, Moxon ER, Pollard AJ. Haemophilus influenzae type b conjugate vaccines. Immunology 2004; 113(2): 163–74PubMedCrossRefGoogle Scholar
  17. 17.
    The impact of Haemophilus influenzae immunisation on invasive infection in children. Commun Dis Rep CDR Wkly 1993; 3(51): 231Google Scholar
  18. 18.
    Booy R, Heath PT, Slack MP, et al. Vaccine failures after primary immunisation with Haemophilus influenzae type-b conjugate vaccine without booster. Lancet 1997; 349(9060): 1197–202PubMedCrossRefGoogle Scholar
  19. 19.
    Granoff DM, Anderson EL, Osterholm MT, et al. Differences in the immunogenicity of three Haemophilus influenzae type b conjugate vaccines in infants. J Pediatr 1992; 121(2): 187–94PubMedCrossRefGoogle Scholar
  20. 20.
    Decker MD, Edwards KM, Bradley R, et al. Comparative trial in infants of four conjugate Haemophilus influenzae type b vaccines. J Pediatr 1992; 120 (2 Pt 1): 184–9PubMedCrossRefGoogle Scholar
  21. 21.
    Kayhty H, Eskola J, Peltola H, et al. Antibody responses to four Haemophilus influenzae type b conjugate vaccines. Am J Dis Child 1991; 145(2): 223–7PubMedGoogle Scholar
  22. 22.
    Schlesinger Y, Granoff DM. Avidity and bactericidal activity of antibody elicited by different Haemophilus influenzae type b conjugate vaccines. The Vaccine Study Group. JAMA 1992; 267(11): 1489–94PubMedCrossRefGoogle Scholar
  23. 23.
    Englund JA, Glezen WP. Maternal immunization with Haemophilus influenzae type b vaccines in different populations. Vaccine 2003; 21(24): 3455–9PubMedCrossRefGoogle Scholar
  24. 24.
    Granoff DM, Holmes SJ, Osterholm MT, et al. Induction of immunologic memory in infants primed with Haemophilus influenzae type b conjugate vaccines. J Infect Dis 1993; 168(3): 663–71PubMedCrossRefGoogle Scholar
  25. 25.
    Eskola J, Ward J, Dagan R, et al. Combined vaccination of Haemophilus influenzae type b conjugate and diphtheria-tetanus-pertussis containing acellular pertussis. Lancet 1999; 354(9195): 2063–8PubMedCrossRefGoogle Scholar
  26. 26.
    Eskola J, Peltola H, Takala AK, et al. Efficacy of Haemophilus influenzae type b polysaccharide-diphtheria toxoid conjugate vaccine in infancy. N Engl J Med 1987; 317(12): 717–22PubMedCrossRefGoogle Scholar
  27. 27.
    Mulholland K, Hilton S, Adegbola R, et al. Randomised trial of Haemophilus influenzae type-b tetanus protein conjugate vaccine [corrected] for prevention of pneumonia and meningitis in Gambian infants [published erratum appears in Lancet 1997; 350 (9076): 524]. Lancet 1997; 349(9060): 1191–7PubMedCrossRefGoogle Scholar
  28. 28.
    Booy R, Moxon ER, MacFarlane JA, et al. Efficacy of Haemophilus influenzae type B conjugate vaccine in Oxford region. Lancet 1992; 340(8823): 847PubMedCrossRefGoogle Scholar
  29. 29.
    Galil K, Singleton R, Levine OS, et al. Reemergence of invasive Haemophilus influenzae type b disease in a well-vaccinated population in remote Alaska. J Infect Dis 1999; 179(1): 101–6PubMedCrossRefGoogle Scholar
  30. 30.
    Swingler G, Fransman D, Hussey G. Conjugate vaccines for preventing Haemophilus influenzae type b infections. Coch-rane Database Syst Rev 2003; (4): CD001729Google Scholar
  31. 31.
    Peltola H, Kallio MJ, Unkila-Kallio L. Reduced incidence of septic arthritis in children by Haemophilus influenzae type-b vaccination: implications for treatment. J Bone Joint Surg Br 1998; 80(3): 471–3PubMedCrossRefGoogle Scholar
  32. 32.
    Heath PT. Haemophilus influenzae type b conjugate vaccines: a review of efficacy data. Pediatr Infect Dis J 1998; 17(9 Suppl.): S117–22PubMedGoogle Scholar
  33. 33.
    Peltola H. Haemophilus influenzae type b disease and vaccination in Europe: lessons learned. Pediatr Infect Dis J 1998; 17(9 Suppl.): S126–32PubMedGoogle Scholar
  34. 34.
    Laval CA, Pimenta FC, de Andrade JG, et al. Progress towards meningitis prevention in the conjugate vaccines era. Braz J Infect Dis 2003; 7(5): 315–24PubMedCrossRefGoogle Scholar
  35. 35.
    Dickinson FO, Perez AE, Galindo MA, et al. Impact of vaccination against Haemophilus influenzae type b in Cuba [in Spanish]. Rev Panam Salud Publica 2001; 10(3): 169–73PubMedCrossRefGoogle Scholar
  36. 36.
    Ribeiro GS, Reis JN, Cordeiro SM, et al. Prevention of Haemophilus influenzae type b (Hib) meningitis and emergence of serotype replacement with type a strains after introduction of Hib immunization in Brazil. J Infect Dis 2003; 187(1): 109–16PubMedCrossRefGoogle Scholar
  37. 37.
    Agudelo CI, Munoz N, De la Hoz F. Rapid assessment of the impact of Haemophilus influenzae vaccine serotype b in Colombia [in Spanish]: Public Health Laboratories. Rev Panam Salud Publica 2000; 8(3): 181–4PubMedCrossRefGoogle Scholar
  38. 38.
    Diaz JM, Catalan L, Urrutia MT, et al. Trends of etiology of acute bacterial meningitis in Chilean children from 1989 to 1998: impact of the anti-H influenzae type b vaccine [in Spanish]. Rev Med Chil 2001; 129(7): 719–26PubMedGoogle Scholar
  39. 39.
    Barbour ML, Mayon-White RT, Coles C, et al. The impact of conjugate vaccine on carriage of Haemophilus influenzae type b. J Infect Dis 1995; 171(1): 93–8PubMedCrossRefGoogle Scholar
  40. 40.
    Hviid A, Melbye M. Impact of routine vaccination with a conjugate Haemophilus influenzae type b vaccine. Vaccine 2004; 22(3–4): 378–82PubMedCrossRefGoogle Scholar
  41. 41.
    Takala AK, Santosham M, Meido-Hill J, et al. Vaccination with Haemophilus influenzae type b meningococcal protein conjugate vaccine reduces oropharyngeal carriage of Haemophilus influenzae type b among American Indian children. Pediatr Infect Dis J 1993; 12(7): 593–9PubMedCrossRefGoogle Scholar
  42. 42.
    Zhou F, Bisgard KM, Yusuf HR, et al. Impact of universal Haemophilus influenzae type b vaccination starting at 2 months of age in the United States: an economic analysis. Pediatrics 2002; 110(4): 653–61PubMedCrossRefGoogle Scholar
  43. 43.
    Trollfors B. Cost-benefit analysis of general vaccination against Haemophilus influenzae type b in Sweden. Scand J Infect Dis 1994; 26(5): 611–4PubMedCrossRefGoogle Scholar
  44. 44.
    Livartowski A, Boucher J, Detournay B, et al. Cost-effectiveness evaluation of vaccination against Haemophilus influenzae invasive diseases in France. Vaccine 1996; 14(6): 495–500PubMedCrossRefGoogle Scholar
  45. 45.
    Peltola H, Salo E, Saxen H. Incidence of Haemophilus influenzae type b meningitis during 18 years of vaccine use: observational study using routine hospital data. BMJ 2005; 330(7481): 18–9PubMedCrossRefGoogle Scholar
  46. 46.
    Hanna JN. Impact of Haemophilus influenzae type b (Hib) vaccination on Hib meningitis in children in Far North Queensland, 1989 to 2003. Commun Dis Intell 2004; 28(2): 255–7PubMedGoogle Scholar
  47. 47.
    Ruocco G, Curto S, Savio M, et al. Vaccination against Haemophilus influenzae type b in Uruguay: experience and impact [in Spanish]. Rev Panam Salud Publica 1999; 5(3): 197–9PubMedCrossRefGoogle Scholar
  48. 48.
    Dawson KG, Emerson JC, Burns JL. Fifteen years of experience with bacterial meningitis. Pediatr Infect Dis J 1999; 18(9): 816–22PubMedCrossRefGoogle Scholar
  49. 49.
    Garpenholt O, Silfverdal SA, Hugosson S, et al. The impact of Haemophilus influenzae type b vaccination in Sweden. Scand J Infect Dis 1996; 28(2): 165–9PubMedCrossRefGoogle Scholar
  50. 50.
    Teare EL, Fairley CK, White J, et al. Efficacy of Hib vaccine. Lancet 1994; 344(8925): 828–9PubMedCrossRefGoogle Scholar
  51. 51.
    van Alphen L, Spanjaard L, van der Ende A, et al. Predicted disappearance of Haemophilus influenzae type b meningitis in Netherlands. Lancet 1994; 344(8916): 195PubMedCrossRefGoogle Scholar
  52. 52.
    Zielen S, Ahrens P, Hofmann D. Efficacy of Hib vaccine. Lancet 1994; 344(8925): 828PubMedCrossRefGoogle Scholar
  53. 53.
    Peltola H, Kilpi T, Anttila M. Rapid disappearance of Haemophilus influenzae type b meningitis after routine childhood immunisation with conjugate vaccines. Lancet 1992; 340(8819): 592–4PubMedCrossRefGoogle Scholar
  54. 54.
    Heath PT, Bowen-Morris J, Griffiths D, et al. Antibody persistence and Haemophilus influenzae type b carriage after infant immunisation with PRP-T. Arch Dis Child 1997; 77(6): 488–92PubMedCrossRefGoogle Scholar
  55. 55.
    Bell F, Martin A, Blondeau C, et al. Combined diphtheria, tetanus, pertussis, and Haemophilus influenzae type b vaccines for primary immunisation. Arch Dis Child 1996; 75(4): 298–303PubMedCrossRefGoogle Scholar
  56. 56.
    Bell F, Heath P, Shackley F, et al. Effect of combination with an acellular pertussis, diphtheria, tetanus vaccine on antibody response to Hib vaccine (PRP-T). Vaccine 1998; 16(6): 637–42PubMedCrossRefGoogle Scholar
  57. 57.
    Mc Vernon J, Moxon R, Heath P, et al. Haemophilus influenzae type b epiglottitis: article gives timely lesson [letter]. BMJ 2003; 326(7383): 284CrossRefGoogle Scholar
  58. 58.
    Ramsay ME, McVernon J, Andrews NJ, et al. Estimating Haemophilus influenzae type b vaccine effectiveness in England and Wales by use of the screening method. J Infect Dis 2003; 188(4): 481–5PubMedCrossRefGoogle Scholar
  59. 59.
    Heath PT, Booy R, Azzopardi HJ, et al. Antibody concentration and clinical protection after Hib conjugate vaccination in the United Kingdom. JAMA 2000; 284(18): 2334–40PubMedCrossRefGoogle Scholar
  60. 60.
    Madore DV, Johnson CL, Phipps DC, et al. Safety and immunogenicity of Hib oligosaccharide-CRM197 conjugate vaccine in infants aged 15–23 months. Pediatrics 1990; 86: 527–34PubMedGoogle Scholar
  61. 61.
    Goldblatt D, Miller E, McCloskey N, et al. Immunological response to conjugate vaccines in infants: follow up study. BMJ 1998; 316(7144): 1570–1PubMedCrossRefGoogle Scholar
  62. 62.
    McVernon J, Andrews N, Slack MP, et al. Risk of vaccine failure after Haemophilus influenzae type b (Hib) combination vaccines with acellular pertussis. Lancet 2003; 361(9368): 1521–3PubMedCrossRefGoogle Scholar
  63. 63.
    McVernon J, Howard AJ, Slack MP, et al. Long-term impact of vaccination on Haemophilus influenzae type b (Hib) carriage in the United Kingdom. Epidemiol Infect 2004; 132(4): 765–7PubMedCrossRefGoogle Scholar
  64. 64.
    McVernon J, Johnson PD, Pollard AJ, et al. Immunologic memory in Haemophilus influenzae type b conjugate vaccine failure. Arch Dis Child 2003; 88(5): 379–83PubMedCrossRefGoogle Scholar
  65. 65.
    Heath PT, Ramsay ME. Haemophilus influenzae type b vaccine-booster campaign. BMJ 2003; 326(7400): 1158–9PubMedCrossRefGoogle Scholar
  66. 66.
    Peltola H. Need for Haemophilus influenzae type b vaccination in Asia as evidenced by epidemiology of bacterial meningitis. Pediatr Infect Dis J 1998; 17(9 Suppl.): S148–51PubMedGoogle Scholar
  67. 67.
    World Health Organisation. Expert review of a tool for rapidly assessing Haemophilus influenzae type b (Hib) disease burden [online]. Available from URL: http://www.who.int/vaccines-documents/DocsPDF01/www.604.pdf [Accessed 2007 Jan 10]
  68. 68.
    Peltola H. Burden of meningitis and other severe bacterial infections of children in Africa: implications for prevention. Clin Infect Dis 2001; 32(1): 64–75PubMedCrossRefGoogle Scholar
  69. 69.
    Vaccine fund progress report [online]. Available from URL: http://www.gavialliance.org [Accessed 2007 Apr 2]
  70. 70.
    Wenger JD, DiFabio J, Landaverde JM, et al. Introduction of Hib conjugate vaccines in the non-industrialized world: experience in four ‘newly adopting’ countries. Vaccine 1999; 18(7–8): 736–42PubMedCrossRefGoogle Scholar
  71. 71.
    Henrichsen J. Typing of Streptococcus pnemoniae: past, present and future. Am J Med 1999; 107(1A): 50–4SCrossRefGoogle Scholar
  72. 72.
    Mbelle N, Huebner RE, Wasas AD, et al. Immunogenicity and impact on nasopharyngeal carriage of a nonavalent pneumococcal conjugate vaccine. J Infect Dis 1999; 180(4): 1171–6PubMedCrossRefGoogle Scholar
  73. 73.
    Murdoch C, Lakshman R, Burkinshaw R, et al. Effect of heptavalent conjugate pneumococcal vaccine in infancy and booster polysaccharide vaccine at 13 months on nasopharyngeal carriage of S. pneumoniae in children aged 2–4 years [abstract]. Clin Infect Dis 2001; 33: 1148Google Scholar
  74. 74.
    Dagan R, Fraser D. Conjugate pneumococcal vaccine and antibiotic-resistant Streptococcus pneumoniae: herd immunity and reduction of otitis morbidity. Pediatr Infect Dis J 2000; 19(5 Suppl.): S79–87PubMedGoogle Scholar
  75. 75.
    Eskola J, Kilpi T, Palmu A, et al. Efficacy of a pneumococcal conjugate vaccine against acute otitis media. N Engl J Med 2001; 344(6): 403–9PubMedCrossRefGoogle Scholar
  76. 76.
    Gherardi G, Inostrozo JS, O’Ryan M, et al. Genotypic survey of recent beta-lactam-resistant pneumococcal nasopharyngeal isolates from asymptomatic children in Chile. J Clin Microbiol 1999; 37(11): 3725–30PubMedGoogle Scholar
  77. 77.
    Whitney CG, Farley MM, Hadler J, et al. Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. N Engl J Med 2003; 348(18): 1737–46PubMedCrossRefGoogle Scholar
  78. 78.
    Greenwood B. The epidemiology of pneumococcal infection in children in the developing world. Philos Trans R Soc Lond B Biol Sci 1999; 354(1384): 777–85PubMedCrossRefGoogle Scholar
  79. 79.
    Whitney CG, Farley MM, Hadler J, et al. Increasing prevalence of multidrug-resistant Streptococcus pneumoniae in the United States. N Engl J Med 2000; 343(26): 1917–24PubMedCrossRefGoogle Scholar
  80. 80.
    Hausdorff WP, Bryant J, Paradiso PR, et al. Which pneumococcal serogroups cause the most invasive disease: implications for conjugate vaccine formulation and use (Pt I). Clin Infect Dis 2000; 30(1): 100–21PubMedCrossRefGoogle Scholar
  81. 81.
    Hausdorff WP, Bryant J, Kloek C, et al. The contribution of specific pneumococcal serogroups to different disease manifestations: implications for conjugate vaccine formulation and use (Pt II). Clin Infect Dis 2000; 30(1): 122–40PubMedCrossRefGoogle Scholar
  82. 82.
    Black S, Shinefield H, Fireman B, et al. Efficacy, safety and immunogenicity of heptavalent pneumococcal conjugate vaccine in children. Northern California Kaiser Permanente Vaccine Study Center Group. Pediatr Infect Dis J 2000; 19(3): 187–95PubMedCrossRefGoogle Scholar
  83. 83.
    Klugman KP, Madhi SA, Huebner RE, et al. A trial of a 9-valent pneumococcal conjugate vaccine in children with and those without HIV infection. N Engl J Med 2003; 349(14): 1341–8PubMedCrossRefGoogle Scholar
  84. 84.
    Mulholland K. Strategies for the control of pneumococcal diseases. Vaccine 1999; 17Suppl. 1: S79–84PubMedCrossRefGoogle Scholar
  85. 85.
    Klugman KP. Efficacy of pneumococcal conjugate vaccines and their effect on carriage and antimicrobial resistance. Lancet Infect Dis 2001; 1(2): 85–91PubMedCrossRefGoogle Scholar
  86. 86.
    Black SB, Shinefield HR, Hansen J, et al. Postlicensure evaluation of the effectiveness of seven valent pneumococcal conjugate vaccine. Pediatr Infect Dis J 2001; 20(12): 1105–7PubMedCrossRefGoogle Scholar
  87. 87.
    Dagan R, Sikuler-Cohen M, Zamir O, et al. Effect of a conjugate pneumococcal vaccine on the occurrence of respiratory infections and antibiotic use in day-care center attendees. Pediatr Infect Dis J 2001; 20(10): 951–8PubMedCrossRefGoogle Scholar
  88. 88.
    Dagan R, Melamed R, Muallem M, et al. Reduction of nasopharyngeal carriage of pneumococci during the second year of life by a heptavalent conjugate pneumococcal vaccine. J Infect Dis 1996; 174(6): 1271–8PubMedCrossRefGoogle Scholar
  89. 89.
    Schwartz B, Moore PS, Broome CV. Global epidemiology of meningococcal disease. Clin Microbiol Rev 1989; 2 Suppl.: S118–24PubMedGoogle Scholar
  90. 90.
    Ramsay ME, Kaczmarski E, Rush M, et al. Changing patterns of case ascertainment and trends in meningococcal disease in England and Wales. Commun Dis Rep CDR Rev 1997; 7(4): R49–54PubMedGoogle Scholar
  91. 91.
    Gotschlich EC, Goldschneider I, Artenstein MS. Human immunity to the meningococcus. IV: immunogenicity of group A and group C meningococcal polysaccharides in human volunteers. J Exp Med 1969; 129(6): 1367–84PubMedCrossRefGoogle Scholar
  92. 92.
    Ramsay ME, Andrews N, Kaczmarski EB, et al. Efficacy of meningococcal serogroup C conjugate vaccine in teenagers and toddlers in England. Lancet 2001; 357(9251): 195–6PubMedCrossRefGoogle Scholar
  93. 93.
    Trotter CL, Ramsay ME, Kaczmarski EB. Meningococcal serogroup C conjugate vaccination in England and Wales: coverage and initial impact of the campaign. Commun Dis Public Health 2002; 5(3): 220–5PubMedGoogle Scholar
  94. 94.
    Trotter CL, Edmunds WJ. Modelling cost effectiveness of meningococcal serogroup C conjugate vaccination campaign in England and Wales. BMJ 2002; 324(7341): 809–14PubMedCrossRefGoogle Scholar
  95. 95.
    Maiden MC, Stuart JM. Carriage of serogroup C meningococci 1 year after meningococcal C conjugate polysaccharide vaccination. Lancet 2002; 359(9320): 1829–31PubMedCrossRefGoogle Scholar
  96. 96.
    Trotter CL, Andrews NJ, Kaczmarski EB, et al. Effectiveness of meningococcal serogroup C conjugate vaccine 4 years after introduction. Lancet 2004; 364(9431): 365–7PubMedCrossRefGoogle Scholar
  97. 97.
    Ramsay ME, Andrews NJ, Trotter CL, et al. Herd immunity from meningococcal serogroup C conjugate vaccination in England: database analysis. BMJ 2003; 326(7385): 365–6PubMedCrossRefGoogle Scholar
  98. 98.
    Cartwright K, Noah N, Peltola H. Meningococcal disease in Europe: epidemiology, mortality, and prevention with conjugate vaccines. Report of a European Advisory Board meeting, Vienna, Austria, 6–8 October, 2000. Vaccine 2001; 19(31): 4347–56PubMedCrossRefGoogle Scholar
  99. 99.
    Connolly M, Noah N. Is group C meningococcal disease increasing in Europe: a report of surveillance of meningococcal infection in Europe 1993–6. European Meningitis Surveillance Group. Epidemiol Infect 1999; 122(1): 41–9PubMedCrossRefGoogle Scholar
  100. 100.
    Segal S, Pollard AJ. The future of meningitis vaccines. Hosp Med 2003; 64(3): 161–7PubMedGoogle Scholar
  101. 101.
    Baker MG, Martin DR, Kieft CE, et al. A 10-year serogroup B meningococcal disease epidemic in New Zealand: descriptive epidemiology, 1991–2000. J Paediatr Child Health 2001; 37(5): S13–9PubMedCrossRefGoogle Scholar
  102. 102.
    Pollard AJ, Maiden MC. Epidemic meningococcal disease in sub-Saharan Africa: towards a sustainable solution? Lancet Infect Dis 2003; 3(2): 68–70PubMedCrossRefGoogle Scholar
  103. 103.
    Lingappa JR, Al-Rabeah AM, Hajjeh R, et al. Serogroup W-135 meningococcal disease during the Hajj, 2000 [published erratum appears in Emerg Infect Dis 2003; 9 (8): 1028]. Emerg Infect Dis 2003; 9(6): 665–71PubMedCrossRefGoogle Scholar
  104. 104.
    Pollard AJ, Scheifele D. Meningococcal disease and vaccination in North America. J Paediatr Child Health 2001; 37(5): S20–7PubMedCrossRefGoogle Scholar
  105. 105.
    Rennels M, King Jr J, Ryall R, et al. Dosage escalation, safety and immunogenicity study of four dosages of a tetravalent meningococcal polysaccharide diphtheria toxoid conjugate vaccine in infants. Pediatr Infect Dis J 2004; 23(5): 429–35PubMedCrossRefGoogle Scholar
  106. 106.
    Campbell JD, Edelman R, King Jr JC, et al. Safety, reactogenicity, and immunogenicity of a tetravalent meningococcal polysaccharide-diphtheria toxoid conjugate vaccine given to healthy adults. J Infect Dis 2002; 186(12): 1848–51PubMedCrossRefGoogle Scholar
  107. 107.
    Rennels M, King Jr J, Ryall R, et al. Dose escalation, safety and immunogenicity study of a tetravalent meningococcal polysaccharide diphtheria conjugate vaccine in toddlers. Pediatr Infect Dis J 2002; 21(10): 978–9PubMedCrossRefGoogle Scholar
  108. 108.
    Granoff DM, Harris SL. Protective activity of group C anticapsular antibodies elicited in two-year-olds by an investigational quadrivalent Neisseria meningitidis-diphtheria toxoid conjugate vaccine. Pediatr Infect Dis J 2004; 23(6): 490–7PubMedCrossRefGoogle Scholar
  109. 109.
    Granoff DM, Morgan A, Welsch JA. Persistence of group C anticapsular antibodies two to three years after immunization with an investigational quadrivalent Neisseria meningitidis-diphtheria toxoid conjugate vaccine. Pediatr Infect Dis J 2005; 24(2): 132–6PubMedCrossRefGoogle Scholar
  110. 110.
    Bilukha OO, Rosenstein N. Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunisation Practices (ACIP). MMWR Recomm Rep 2005; 54RR-7): 1–21PubMedGoogle Scholar
  111. 111.
    Harrison LH. Prospects for vaccine prevention of meningococcal infection. Clin Microbiol Rev 2006; 19(1): 142–64PubMedCrossRefGoogle Scholar
  112. 112.
    Pan American Health Organisation. Meningococcal conjugate vaccines for Africa. Washington, DC: Pan American Health Organisation, 2002Google Scholar
  113. 113.
    Buttery JP, Riddell A, McVernon J, et al. Immunogenicity and safety of a combination pneumococcal-meningococcal vaccine in infants: a randomized controlled trial. JAMA 2005; 293(14): 1751–8PubMedCrossRefGoogle Scholar

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© Adis Data Information BV 2007

Authors and Affiliations

  1. 1.Department of Child HealthRoyal Liverpool Children’s HospitalLiverpoolEngland
  2. 2.Haematology Treatment CentreRoyal Liverpool Children’s HospitalLiverpoolEngland

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