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Summary Notwithstanding different meningococcal serogroups have changed their distribution and their impact in different age classes over time, N. meningitidis' invasive diseases are a major public health issue worldwide, due to the related complications and severe sequelae. Nowadays, the highest rates of invasive disease are registered in children younger than 1 year of age, with a second lesser peak in adolescents and young adults (15-25 years of age). On the contrary, the prevalence of carriage is low in newborns and in school-age children, and increases during adolescence and young-adult age; then it decreases again in older age. N. meningitidis' infection prevalence has greatly decreased in Europe and North America thanks to the use of conjugate vaccines (MenC and MenACWY) as well as the incidence of invasive disease due to serogroup A in sub-saharian Africa after the introduction of MenAfriVac conjugate vaccine. The great success of conjugate vaccines is related not only to the direct protection from disease but also to the impact on carriage; this latter allows an indirect protection of unimmunized subjects. For these reasons, the implementation of immunization with the new generation vaccines in the age classes most impacted by disease and carriage (first year of life, adolescence and young adulthood) could permit to achieve an extraordinary decrease of the incidence of meningococcal disease.

Epidemiology of Neisseria meningitidis infections: case distribution by age and relevance of carriage