Meningitis B

Abstract

Invasive meningococcal disease is a serious global health threat that kills about one in 20 infected individuals. Meningitis B accounts for about 80% of cases of invasive meningococcal disease in high-income countries, 50% of whom are children younger than 2 years; it is the foremost cause of infant bacterial meningitis and severe sepsis in Europe.The UK has the fourth highest incidence of meningitis in Europe. In 2011–12, 613 meningitis B cases were confirmed in England and Wales, and 93% of children younger than 5 years with meningitis had meningitis B. Of these 613, 33 individuals died, 15 of whom were aged 0–4 years. The infection’s indistinct, influenza-like symptoms can lead to misdiagnoses or delayed treatment, although even after administration of antibiotics severe sepsis can develop rapidly and result in death. Roughly one in ten survivors will have major physical or neurological disabilities, or both, including loss of limbs, deafness, epilepsy, neurodevelopmental delay, and learning disabilities. About one in three have less severe disabilities, including psychological disorders.During the past decade, incidence of invasive meningococcal disease in England and Wales roughly halved. Total incidence of meningitis B has been decreasing since 1998–99; however, incidence has historically fluctuated and it could increase again, with the potential to cause severe and persistent epidemics.The key to reduction of incidence, disability, and death from meningitis B is vaccination. Last week, the UK Joint Committee on Vaccination and Immunisation rejected the routine vaccination of children with Bexsero, the first broadly effective vaccine against meningitis B, citing unsatisfactory cost-effectiveness.Difficult public health decisions are heightened by challenging economic conditions. However, with child mortality rates among the highest in Europe, many parents will reasonably ask whether the UK can afford not to lead the world, as it did with meningitis C vaccinations in 1999, and take this opportunity to subdue a devastating but beatable disease. Invasive meningococcal disease is a serious global health threat that kills about one in 20 infected individuals. Meningitis B accounts for about 80% of cases of invasive meningococcal disease in high-income countries, 50% of whom are children younger than 2 years; it is the foremost cause of infant bacterial meningitis and severe sepsis in Europe. The UK has the fourth highest incidence of meningitis in Europe. In 2011–12, 613 meningitis B cases were confirmed in England and Wales, and 93% of children younger than 5 years with meningitis had meningitis B. Of these 613, 33 individuals died, 15 of whom were aged 0–4 years. The infection’s indistinct, influenza-like symptoms can lead to misdiagnoses or delayed treatment, although even after administration of antibiotics severe sepsis can develop rapidly and result in death. Roughly one in ten survivors will have major physical or neurological disabilities, or both, including loss of limbs, deafness, epilepsy, neurodevelopmental delay, and learning disabilities. About one in three have less severe disabilities, including psychological disorders. During the past decade, incidence of invasive meningococcal disease in England and Wales roughly halved. Total incidence of meningitis B has been decreasing since 1998–99; however, incidence has historically fluctuated and it could increase again, with the potential to cause severe and persistent epidemics. The key to reduction of incidence, disability, and death from meningitis B is vaccination. Last week, the UK Joint Committee on Vaccination and Immunisation rejected the routine vaccination of children with Bexsero, the first broadly effective vaccine against meningitis B, citing unsatisfactory cost-effectiveness. Difficult public health decisions are heightened by challenging economic conditions. However, with child mortality rates among the highest in Europe, many parents will reasonably ask whether the UK can afford not to lead the world, as it did with meningitis C vaccinations in 1999, and take this opportunity to subdue a devastating but beatable disease. The price of prevention: what now for immunisation against meningococcus B?Meningococcal sepsis is one of the most dreaded bacterial infections: the death rate remains at about 5% and the effects for survivors include neurological damage, limb amputation, and widespread skin necrosis.1 There is a compelling case for prevention of meningococcal disease by immunisation. On July 24, 2013, in an interim position statement,2 the UK Joint Committee on Vaccination and Immunisation (JCVI) concluded that it cannot currently recommend a vaccine (4CMenB, licensed as Bexsero, Novartis Vaccines and Diagnostics, Siena, Italy) for use in the UK routine immunisation programme. Full-Text PDF