A Review of Meningococcal Disease and Vaccination Recommendations for Travelers

Abstract

International travel has been steadily increasing since the middle of the twentieth century, including travel to regions with high levels of endemic meningococcal disease and areas with sporadic or sustained meningococcal outbreaks. Although invasive meningococcal disease (IMD) is relatively rare in travelers since the advent of quadrivalent meningococcal vaccines, it remains a serious concern because of its rapid progression, poor prognosis and outcomes, associated treatment delays, and the potential to precipitate outbreaks. Moreover, fatality occurs in up to 22% of those infected. This review will focus on IMD in travelers, with an emphasis on IMD epidemiology and the geographic regions of potential concern for international travelers. As vaccination is the best approach for preventing IMD among travelers, currently available meningococcal vaccines and corresponding country-specific national meningococcal vaccination recommendations, where available, will be summarized by age and type of vaccine recommended. The use of the quadrivalent meningococcal vaccines, specifically the tetanus toxoid conjugate vaccine (including MenACWY-TT; Nimenrix®), as a protective measure against IMD in travelers will be emphasized.FundingPfizer Inc.

Child with serogroup W135 primary meningococcal septic arthritis

“…In 2002, routine conjugate Meningococcal-C immunisation was implemented in The Netherlands for the 14-month-old age group resulting in a significant decline of invasive meningococcal infection. However, following similar trends in the UK, a dramatic increase of invasive meningococcal disease from a clonal complex variant of serogroup W (cc11) was seen in our country, The Netherlands 6. From 2014 to 2016, incidence rates increased from 0.03 cases to 0.15 cases per 100.000 with a reported mortality rate of approximately 10% 7.…”

Immunogenicity and safety of a quadrivalent meningococcal tetanus toxoid-conjugate vaccine (MenACYW-TT) in healthy toddlers: a Phase II randomized study

“…There are currently three licensed quadrivalent conjugate vaccines against serogroups A, C, W, and Y. Menactra® (MCV4-DT; Sanofi Pasteur, USA), which contains a diphtheria toxoid protein carrier, was licensed in the USA in 2005 for babies aged 9–23 months (administered as two doses three months apart), and for individuals aged 2 to 55 years as a single dose; it is not licensed in Europe. 11 , 12 Menveo® (MCV4-CRM; GlaxoSmithKline, Italy), which has Corynebacterium diphtheriae CRM 197 protein as a protein carrier, was licensed in 2010, and is administered as a single dose from age ≥2 years in Europe, with no upper age limit. 13 Lastly, Nimenrix® (MCV4-TT; Pfizer Europe, Belgium), a polysaccharide-tetanus toxoid conjugate vaccine, was licensed in Europe in 2012, but not in the USA, and is administered as a single dose for infants aged ≥6 weeks with no upper age limit.…”

Neurologic Infections in Travelers

“…19 The greatest burden of meningitis is in sub-Saharan Africa, with estimates of 1,000 per 100,000 cases during the dry season (December-June). 20 The highest rates of transmission occur in Ethiopia, Nigeria, and Burkina Faso, with the meningitis belt that stretches across sub-Saharan Africa from Senegal to Eritrea. 2 The largest travel-related outbreaks of meningococcal meningitis have occurred during the annual Hajj pilgrimage in Saudi Arabia, with an incidence of 640 per 100,000 pilgrims during the 2,000 pilgrimage.…”

“…2 The largest travel-related outbreaks of meningococcal meningitis have occurred during the annual Hajj pilgrimage in Saudi Arabia, with an incidence of 640 per 100,000 pilgrims during the 2,000 pilgrimage. 20 Even with adequate medical care, case-fatality rates can reach 22%, and more than 10% of survivors develop neurological sequelae. Therefore, prevention through vaccination has been the primary target for decreasing meningococcal meningitis.…”