New vaccination strategies needed in China to prevent spread of meningococcal disease

An international group of expert scientists, doctors and public health officials has reported that cases of meningococcal group B meningitis and septicaemia (MenB) are increasing in China, and have recommended that an effective MenB vaccination strategy should be in place in preparation for a potential outbreak of the disease.

There are several different types of bacteria that cause meningococcal disease. Meningococcal A, B, C, W, X and Y account for the majority of all cases worldwide. Published in the Journal of Infection, the expert group known as the Global Meningococcal Initiative (GMI), report that the types of meningococcal disease affecting people in China is changing.

Currently MenB is the most prevalent cause of meningococcal disease globally, and cases of MenB have been increasing in China since 2011, with the majority of recorded cases in babies under one year of age.

Rates of MenA have significantly declined in China following the introduction of the MenA polysaccharide vaccine in the 1980s, however there is the emergence of new clones of MenB and MenC and a new threat is the international spread of a particularly deadly strain of MenW.

The vaccination policy in China is currently under review. Polysaccharide vaccines provide direct protection to vaccinated individuals, but conjugate vaccines have the additional benefit of stopping vaccinated individuals from carrying and spreading the meningococcal bacteria to others. In China, no conjugate vaccines to prevent meningococcal disease are available free as part of the vaccination schedule, but the experts recommend that they be considered because they could help stop spread of the bacteria and protect more of the population – a strategy that has been successful in other countries including the UK.

Professor Ray Borrow, GMI Steering Group Member said, “Historically, China has been prone to outbreaks of meningococcal disease. The increase of MenB in China is a concern, and it would be advantageous for there to be a MenB vaccine available free to groups at highest risk of the disease. While that might take time to implement, we recommend a vaccination strategy be put in place in the event that an outbreak of MenB occurs.

“The introduction of conjugate vaccines may need to be considered to reduce the number of people carrying meningococcal bacteria which helps to stop the spread and protect more people from disease.”

Not all hospitals in China have the capacity to diagnose the disease with laboratory tests, therefore it is likely that there are more cases of meningitis and septicaemia than are currently reported. The experts note that improved disease surveillance and standardised laboratory techniques across the country are needed.

Professor Borrow added, “Improved disease surveillance would mean that the different types of meningitis can be effectively monitored and action can be taken by the health authorities to prevent or react to outbreaks.”

Vinny Smith, Chief Executive at Meningitis Research Foundation said, “Meningitis and septicaemia are deadly diseases that can have a devastating impact on individuals and their families. The diseases do not respect country borders and they need to be tackled at a global level to defeat it everywhere. The work of the GMI is important because we need good surveillance to understand how the different types of disease are spreading around the world. We welcome the GMI’s recommendations which look to reduce the impact of the disease in China and ultimately aim to save lives.”

Chris Head, President at the Confederation of Meningitis Organisations said, “We welcome these recommendations from the GMI to improve detection and prevention of meningococcal disease in China. Whilst there has been some anecdotal evidence about a worrying incidence of disease there is no patient group or other meningitis organisation in China to raise awareness and campaign for these improvements, so we are very pleased to see that the issue is being raised by the experts involved in the GMI.”

• Meningococcal Disease and Control in China, published in the Journal of Infection, can be downloaded from www.meningitis.org/GMI
• The GMI is a global expert group of over 50 scientists, clinicians, and public health officials with a wide range of specialties. The purpose of the initiative is to promote the global prevention of meningococcal disease through education, research, and cooperation.
• Meningitis Research Foundation (MRF) and the Confederation of Meningitis Organisations (CoMO) partner with the GMI. Chris Head, President of CoMO, and Vinny Smith, MRF Chief Executive are Steering Group members of GMI.
• The GMI is sponsored by Sanofi Pasteur.