Trends in meningococcal disease: challenges for vaccine control when disease is rare

The clinical, social and economic value of vaccination varies both with time and by population group In most wealthy and in many middle income countries, capsular group B Neisseria meningitidis (MenB) remains an important cause of invasive disease, particularly in the era of control of other major bacterial pathogens, such as MenC, Haemophilus influenzae type b, and vaccine-type pneumococcus. Two new MenB vaccines (now licensed in many countries) provide the potential for a comprehensive approach to controlling these invasive bacterial pathogens. However, decisions about vaccination at the population level are complex when there are low rates of disease: cost-effectiveness is a particularly important factor