Prevention of Meningococcal Infections in the First 2 Years of Life

The spectrum of disease caused by Neisseria meningitidis includes bacteremia, fulminant sepsis (meningococcemia), meningitis, and pneumonia. The incidence of meningococcal infection has long been higher in infancy than adolescents or adults older than 65 years (a third group with an increased risk based on age). Five meningococcal serogroups (A, B, C, Y, and W135) cause the great majority of human disease. Serogroup B strains cause about two-thirds of disease in children younger than 6 years. For this reason, new meningococcal vaccine formulations have been developed and evaluated in children younger than 2 years. Of four meningococcal vaccines currently licensed in the United States, two conjugate products, (MenACWY-D [Menactra], Sanofi Pasteur; HibMenCY-TT [MenHibrix], GlaxoSmithKline), are recommended for infants and toddlers younger than 2 years who have an increased risk for invasive meningococcal disease. High-risk conditions are complement deficiencies, community outbreaks, functional or anatomic asplenia, and travel to high-risk areas in which serogroup A infection is prevalent. Recommendations vary by age, dosing, and indication between these two products. Both licensed products are immunogenic and have side-effect profiles that are considered safe for use. In most cases, concomitant use with other recommended childhood vaccines does not interfere with responses to these vaccines. As of yet, there has not been universal adoption of this immunization in the infant population by parents or providers. Factors that weigh against the implementation of a national routine infant program include the prevention of only 40 to 50 meningococcal cases, two to four deaths per year, and a relatively low case fatality among infants. Some argue that costs should not be considered a barrier because infant deaths and morbidity would be prevented. The availability of a serogroup B vaccine would improve impact and cost-effectiveness of a routine infant meningococcal vaccine program. Debate over the implementation of routine infant meningococcal vaccination in the United States is ongoing. This review focuses on vaccines for the prevention of N. meningitidis infection in infants and young toddlers in the first 2 years of life.