Abstract
The epidemiology of meningococcal disease in Canada has been punctuated by outbreaks caused by serogroup A strains in the 1940s, virulent serogroup C clones from 1985 to 2001, a serogroup B clone in Quebec from 2003 to 2014, and more recently a W clone in British Columbia. Region- and province-wide immunization campaigns have been implemented to control these outbreaks using meningococcal C polysaccharide and conjugate vaccines, a quadrivalent ACWY conjugate vaccine, and a serogroup B protein-based vaccine. Meningococcal C conjugate vaccines have been included in routine immunization programs for children, and ACWY conjugate vaccines have been included in school-based programs for adolescents in most jurisdictions. In contrast, serogroup B protein-based vaccines were only recommended and used for high-risk individuals and to control outbreaks. Currently, the immunization schedules adopted in provinces and territories are not uniform. This is not explained by notable epidemiologic differences. Publicly funded immunization programs are the result of a complex decision-making process. Political factors including public opinion, media attention, interest groups' advocacy campaigns, decision-makers' priorities and budgetary constraints have played important roles in shaping meningococcal programs in Canada, and this should be recognized. As the recent occurrence of outbreaks caused by virulent W clones shows, continued investments in epidemiological surveillance at both the provincial and national levels are necessary, so there can be early warning and informed decisions can be made.
Highlights
Invasive meningococcal disease (IMD) in Canada is characterized by its unpredictability and severity
Monovalent serogroup C conjugate (MenC-Con) and quadrivalent serogroup ACWY conjugate (MenACWYCon) vaccines are included in publicly funded immunization programs for children and adolescents in Canada, whereas serogroup B protein vaccines (MenB-Prot) are only offered to high-risk individuals and to control outbreaks [4, 5]. e objective of this article is to tell the story of the epidemiology of invasive meningococcal disease (IMD) and immunization programs in Canada, starting in 1940
Canada is a very large country with six time zones and a distance of 7,200 km between St-Johns in Newfoundland and Victoria in British Columbia, with diverse climatic conditions ranging from mild maritime influences to the harsh arctic environment and a diversity of lifestyles influenced by socioeconomic and cultural factors
Summary
Invasive meningococcal disease (IMD) in Canada is characterized by its unpredictability and severity. Ese outbreaks led to immunization campaigns using polysaccharide vaccines in Prince Edward Island, Ontario, and Quebec. Another highly publicized cluster of serogroup C cases occurred in the Ottawa-Carleton region of Ontario and in the adjacent Gatineau region of Quebec during the winter of 1991–1992 [17,18,19]. In January 1992, a mass immunization campaign using an ACWY polysaccharide vaccine was launched in the Ottawa-Carleton region, and approximately 145,000 residents 6 months to 20 years of age were vaccinated for an estimated total cost of $2.6 million. In the first year following the campaign, the incidence of serogroup C IMD showed a marked drop among vaccinees as well as the unvaccinated fraction of the target population, while remaining unchanged among people over 20 years of age. Net societal costs of the campaign were between $18 million and $21 million (using a 3% discount rate) and between $49,000 and $87,000 per quality-adjusted life-year (QALY) gained
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