Present situation and new perspectives for vaccination against Neisseria meningitidis in Tuscany, Central Italy

BACKGROUND: In Italy one third of bacterial meningitis are caused by Neisseria meningitidis. In March 2005, the Regional Health Authority of Tuscany included the meningococcal serogroup C conjugate (MCC) vaccine in the recommended vaccination program with a schedule of three doses to all newborns at 3, 5 and 13 months of age (from 2008 amended to a single dose at 13 months) and a single catch-up dose until age 6. OBJECTIVE: To evaluate the impact of the current national and regional immunization strategies against N. meningitidis and to highlight new perspectives for meningococcal disease prevention with the existing tetravalent meningococcal vaccine (ACWY) and with the future incoming meningococcal B vaccines. METHODS: Meningitis incidence rates in Italy and in Tuscany were calculated for the period 1994-2011 and 2005-2011,respectively. Immunization coverage with MCC vaccine in Tuscany and vaccination status of meningitis cases were reported. Literature review on meningococcal conjugate vaccine use and recommendation was performed. RESULTS: A decrease in incidence rates of meningococcal meningitis was observed in all age groups involved in the immunization campaign. Immunization coverage with MCC increased progressively year by year in Tuscany. A herd immunity effect was measured in unvaccinated age groups. Since 2006 no cases of invasive meningococcal C infection in vaccinated subjects were observed in Tuscany. CONCLUSIONS: Implementation of MCC vaccination in Tuscany was effective in preventing meningococcal C disease, confirming the effectiveness of the vaccine. A new tetravalent (ACWY) conjugate vaccine is now available and its use in all Italian Regions should be considered.