Need for Optimisation of Immunisation Strategies Targeting Invasive Meningococcal Disease in the Netherlands

Document Type : Policy Brief


Athena Institute, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands


Invasive meningococcal disease (IMD) is a severe bacterial infectious disease with high mortality and morbidity rates worldwide. In recent years, industrialised countries have implemented vaccines targeting IMD in their National Immunisation Programmes (NIPs). In 2002, the Netherlands successfully implemented a single dose of meningococcal serogroup C conjugate vaccine at the age of 14 months and performed a single catch-up for children ≤18 years of age. Since then the disease disappeared in vaccinated individuals. Furthermore, herd protection was induced, leading to a significant IMD reduction in non-vaccinated individuals. However, previous studies revealed that the current programmatic immunisation strategy was insufficient to protect the population in the foreseeable future. In addition, vaccines that provide protection against additional serogroups are now available. This paper describes to what extent the current strategy to prevent IMD in the Netherlands is still sufficient, taking into account the burden of disease and the latest scientific knowledge related to IMD and its prevention. In particular, primary MenC immunisation seems not to provide long-term protection, indicating a risk for possible recurrence of the disease. This can be combatted by implementing a MenC or MenACWY adolescent booster vaccine. Additional health benefits can be achieved by replacing the primary MenC by a MenACWY vaccine. By implementation of a recently licensed MenB vaccine for infants in the NIP, the greatest burden of disease would be targeted. This paper shows that optimisation of the immunisation strategy targeting IMD in the Netherlands should be considered and contributes to create awareness concerning prevention optimisation in other countries.


Main Subjects

  1. Ali A, Jafri RZ, Messonnier N, et al. Global practices of meningococcal vaccine use and impact on invasive disease. Pathog Glob Health. 2014;108(1):11-20. doi:10.1179/2047773214Y.0000000126
  2. McIntosh ED, Carey V, Toneatto D, Dull P, Wassil J. Prevention of rare diseases: how revolutionary techniques can help vulnerable individuals-the example of serogroup B meningococcal infection. Ther Adv Vaccines. 2015;3(1):13-23. doi:10.1177/2051013614557477
  3. Whelan J, Bambini S, Biolchi A, Brunelli B, Robert-Du Ry van Beest Holle M. Outbreaks of meningococcal B infection and the 4CMenB vaccine: historical and future perspectives. Expert Rev Vaccines. 2015;14(5):713-736. doi:10.1586/14760584.2015.1004317
  4. European Medicines Agency (EMA). European Medicines Agency recommends approval of first vaccine for meningitis B. Vaccine to provide broad coverage against meningococcal group B infections (press release); 2012.
  5. Pace D, Pollard AJ. Meningococcal disease: clinical presentation and sequelae. Vaccine. 2012;30(suppl 2):B3-B9. doi:10.1016/j.vaccine.2011.12.062
  6. Stephens DS, Greenwood B, Brandtzaeg P. Epidemic meningitis, meningococcaemia, and Neisseria meningitidis. Lancet. 2007;369(9580):2196-2210. doi:10.1016/S0140-6736(07)61016-2
  7. Safadi MA, Bettinger JA, Maturana GM, Enwere G, Borrow R. Evolving meningococcal immunization strategies. Expert Rev Vaccines. 2015;14(4):505-517. doi:10.1586/14760584.2015.979799
  8. European Centre for Disease Prevention and Control (ECDC). Surveillance of invasive bacterial disease in Europe, 2012. Invasive pneumococcal disease, invasive Haemophilus influenza disease and invasive meningococcal disease. Stockholm:  ECDC; 2015.
  9. Jorgensen JH, Crawford SA, Fiebelkorn KR. Susceptibility of Neisseria meningitidis to 16 antimicrobial agents and characterization of resistance mechanisms affecting some agents. J Clin Microbiol. 2005;43(7):3162-3171. doi:10.1128/JCM.43.7.3162-3171.2005
  10. Lockyer K, Gao F, Derrick JP, Bolgiano B. Structural correlates of carrier protein recognition in tetanus toxoid-conjugated bacterial polysaccharide vaccines. Vaccine. 2015;33(11):1345-1352. doi:10.1016/j.vaccine.2015.01.046
  11. de Voer RM, Mollema L, Schepp RM, et al. Immunity against Neisseria meningitidis serogroup C in the Dutch population before and after introduction of the meningococcal c conjugate vaccine. PLoS One. 2010;5(8):e12144. doi:10.1371/journal.pone.0012144
  12. Broker M, Jacobsson S, DeTora L, Pace D, Taha MK. Increase of meningococcal serogroup Y cases in Europe: a reason for concern? Hum Vaccin Immunother. 2012;8(5):685-688.  doi:10.4161/hv.20098
  13. Broker M, Jacobsson S, Kuusi M, et al. Meningococcal serogroup Y emergence in Europe: update 2011. Hum Vaccin Immunother. 2012;8(12):1907-1911. doi:10.4161/hv.21794
  14. Bijlsma MW, Bekker V, Brouwer MC, Spanjaard L, van de Beek D, van der Ende A. Epidemiology of invasive meningococcal disease in the Netherlands, 1960-2012: an analysis of national surveillance data. Lancet Infect Dis. 2014;14(9):805-812. doi:10.1016/S1473-3099(14)70806-0
  15. Ruitenberg EJ, Houweling H. [Universal vaccination against group-C meningococci and pneumococci; summary of the advice from the Health Counsil of the Netherlands]. Ned Tijdschr Geneeskd. 2002;146(20):938-940.
  16. Van der Ende A, Spanjaard L. Bacterial Meningitis in the Netherlands; Annual Report 2013. Amsterdam: Netherlands Reference Laboratory for Bacterial Meningitis (AMC/RIVM); 2014.
  17. Hepkema H, Pouwels KB, van der Ende A, Westra TA, Postma MJ. Meningococcal serogroup A, C, W(1)(3)(5) and Y conjugated vaccine: a cost-effectiveness analysis in the Netherlands. PLoS One. 2013;8(5):e65036. doi:10.1371/journal.pone.0065036
  18. van 't Schurink-van 't Klooster TM. The National Immunisation Programme in the Netherlands. Surveillance and developments in 2013-2014. National Institute for Public Health and the Environment (RIVM); 2014.
  19. Stoof SP, van der Klis FR, van Rooijen DM, Knol MJ, Sanders EA, Berbers GA. Timing of an adolescent booster after single primary meningococcal serogroup C conjugate immunization at young age; an intervention study among Dutch teenagers. PLoS One. 2014;9(6):e100651. doi:10.1371/journal.pone.0100651
  20. Mollema L, de Melker HE, Hahne SJM, van Weert JWM, Berbers GAM, van der Klis FRM. PIENTER 2-Project: second research project on the protection against infectious diseases offered by the national immunisation program in the Netherlands. National Institute for Public Health and the Environment (RIVM); 2009.
  21. Kaaijk P, van der Ende A, Berbers G, van den Dobbelsteen GP, Rots NY. Is a single dose of meningococcal serogroup C conjugate vaccine sufficient for protection? experience from the Netherlands. BMC Infect Dis. 2012;12:35. doi:10.1186/1471-2334-12-35
  22. European Centre for Disease Prevention and Control (ECDC). Vaccine Schedule. Accessed August 12, 2015.
  23. National Health Service (NHS) England. The NHS vaccination schedule. Accessed August 12, 2015.
  24. Centers for Disease Control and Prevention (CDC). Vaccines and Immunizations. Meningococcal: Who needs to be vaccinated? Accessed August 12, 2015.
  25. Public Health Agency of Canada. Canadian Immunization Guide. Part 4 Active Vaccines. Meningococcal Vaccine. Recommendations for Use. Available at: Accessed August 12, 2015.
  26. Public Health England. Changes to the meningococcal C conjugate (MenC) vaccine schedule 2013-2015. Information for healthcare professionals. Accessed August 25, 2015. Published July 2014.
  27. Ishola DA, Andrews N, Waight P, et al. Randomized Trial to Compare the Immunogenicity and Safety of a CRM or TT Conjugated Quadrivalent Meningococcal Vaccine in Teenagers who Received a CRM or TT Conjugated Serogroup C Vaccine at Preschool Age. Pediatr Infect Dis J. 2015. doi:10.1097/INF.0000000000000750
  28. Ladhani SN, Beebeejaun K, Lucidarme J, et al. Increase in endemic Neisseria meningitidis capsular group W sequence type 11 complex associated with severe invasive disease in England and Wales. Clin Infect Dis. 2015;60(4):578-585. doi:10.1093/cid/ciu881
  29. Lucidarme J, Hill DM, Bratcher HB, et al. Genomic resolution of an aggressive, widespread, diverse and expanding meningococcal serogroup B, C and W lineage. J Infect. 2015. doi:10.1016/j.jinf.2015.07.007
  30. Medini D, Stella M, Wassil J. MATS: Global coverage estimates for 4CMenB, a novel multicomponent meningococcal B vaccine. Vaccine. 2015;33(23):2629-2636. doi:10.1016/j.vaccine.2015.04.015
  31. Drysdale SB, Pollard AJ. Group B meningococcal vaccine science and policy. J Infect. 2015;71(suppl 1):S15-S20. doi:10.1016/j.jinf.2015.04.021
  32. Vogel U, Taha MK, Vazquez JA, et al. Predicted strain coverage of a meningococcal multicomponent vaccine (4CMenB) in Europe: a qualitative and quantitative assessment. Lancet Infect Dis. 2013;13(5):416-425. doi:10.1016/S1473-3099(13)70006-9
  33. Food and Drug Administration (FDA). FDA News Release: First vaccine approved by FDA to prevent serogroup B Meningococal disease. Accessed May 15, 2015. Published October 29, 2014. 
  34. Novartis (2015). Bexsero® vaccine approved by FDA for the prevention of meningitis B, a leading cause of bacterial meningitis in the US [news release]. Accessed February 5, 2015. Published January 23, 2015.
  35. Christensen H, Hickman M, Edmunds WJ, Trotter CL. Introducing vaccination against serogroup B meningococcal disease: an economic and mathematical modelling study of potential impact. Vaccine. 2013;31(23):2638-2646. doi:10.1016/j.vaccine.2013.03.034
  36. Christensen H, Trotter CL, Hickman M, Edmunds WJ. Re-evaluating cost effectiveness of universal meningitis vaccination (Bexsero) in England: modelling study. BMJ. 2014;349:g5725. doi:10.1136/bmj.g5725
  37. Pouwels KB, Hak E, van der Ende A, Christensen H, van den Dobbelsteen GP, Postma MJ. Cost-effectiveness of vaccination against meningococcal B among Dutch infants: Crucial impact of changes in incidence. Hum Vaccin Immunother. 2013;9(5):1129-1138. doi:10.4161/hv.23888
  38. Vesikari T, Esposito S, Prymula R, et al. Immunogenicity and safety of an investigational multicomponent, recombinant, meningococcal serogroup B vaccine (4CMenB) administered concomitantly with routine infant and child vaccinations: results of two randomised trials. Lancet. 2013;381(9869):825-835. doi:10.1016/S0140-6736(12)61961-8
  39. Public Health England. Vaccine update. Issue 230, June 2015. Accessed July 27,2015.