Meningococcal Disease Thomas Clark MD MPH Meningitis and

Meningococcal Disease Thomas Clark, MD, MPH Meningitis and Vaccine Preventable Diseases Branch National Center for Immunization and Respiratory Diseases

Incidence and Case-Fatality - US, 1920 -2005* *NETSS data

Incidence and case-fatality, U. S. , 1970 -2005* *NETSS data

Rates of meningococcal disease by age group and year - ABCs, 1991 -2005* *ABCs data

Cross-sectional View of the Meningococcal Cell Capsular polysaccharide (serogroup) Outer-membrane proteins (serotype/subserotype)

Serogroup Distribution of Meningococcal Isolates - ABCs, 1991 -2005* C=31 % B=25 % Y=36 % *ABCs data

Rates of Meningococcal Disease by Serogroup and Year - ABCs, 1991 -2005* *ABCs data, excluding OR

Cases of Meningococcal Disease by Vaccine-containing Serogroups and Age, 1996 -2005 ABCs data excluding OR *184 cases with unknown serogroup

Meningococcal Disease Outbreaks in the United States, 1994 - July 2001

Current Recommendations • Vaccination of all adolescents – Routine vaccination of 11 -12 year-olds at recommended preventive care visit – Vaccination of all 13 -18 year-olds at earliest opportunity • Vaccination of persons (aged 2 -55 years) at increased risk

Estimated potential vaccine-preventable cases per year, United States, 0 -21 years* 0 -2 year-old total: 160 cases/year 2 -10 year-old total: 160 cases/year 11 -19 year-old total: 250 cases/year *Estimated cases of serogroup A, C, Y, and W-135 cases using ABCs cases from 1996 -2005 and projected to the U. S. population

Rate of meningococcal disease by single age year, all serogroups* 2 year-old 11 -12 year-old *NETTS data, average annual incidence, 2003 -2006

Vaccine-preventable proportion of meningococcal disease, 1996 -2005* *ABCs excluding Oregon, 1996 -2005. N=1820 (unknown serogroup excluded)

Further Opportunities for Prevention • • • Improved adolescent coverage Toddler ACWY - single dose Infant/toddler ACWY - two-dose Infant ACWY vaccine - multiple doses Serogroup B vaccine

Goal Routine vaccination at preadolescent (11 -12 year-old) healthcare visit

Estimated coverage levels with MCV 4 by age, 2006 NIS-Teen MMWR. 2007; 56: 885 -888.

Why is meningococcal disease serogroup data important? • First procedure in conventional strain designation of N. meningitidis (descriptive epidemiology) • Serogroup data inform vaccination recommendations during outbreaks • Serogroup data support assessments of the need for and impact of new vaccines

National, published data on the completeness of meningococcal disease serogrouping by Census division, 2004 -2005

Two Dimensions to the Problem 1. Serogrouping is not performed for various reasons. 2. Serogrouping is performed, but data not reported to NETSS.

H. Flu Serotype Distribution, 2006 Children < 5 years Cases reported to NNDSS Cleaned 2006 includes serotype data from ABCs and other sources