Invasive meningococcal disease and vaccination in Belgium: a critical review of the current vaccination strategy

Abstract

In 2021, the World Health Organization issued a call to action to defeat meningitis by 2030. Neisseria meningitidis is a major cause of meningitis and septicaemia. Invasive meningococcal disease (IMD) is a severe and life-threatening disease but also vaccine-preventable. Monovalent serogroup C vaccines, quadrivalent meningococcal conjugate vaccines (MenACWY), and serogroup B vaccines (4CMenB, MenB-fHbp) have demonstrated safety and effectiveness in preventing IMD in infants through to young adults. Although the highest incidence of IMD is in infants <1 year of age, current recommendations in Belgium are not optimal and could be improved for this age-group. MenACWY is recommended for toddlers, adolescents, and risk-groups and 4CMenB on an individual basis for infants, adolescents and risk-groups. Neither MenACWY nor MenB vaccines are reimbursed. In this setting, low uptake of meningococcal vaccines is not unexpected, and meningococcal vaccines are conceivably less accessible to low-income families. A review and re-purposing of Belgium’s meningococcal vaccination strategy is urgently needed. To this end we propose 6 readily achievable steps: 1) Increase awareness around disease and vaccine options amongst healthcare professionals and the public; 2) Encourage a proactive role for paediatricians and general practitioners; 3) Increase visibility of MenB vaccines in the calendar; 4) Consider reimbursement to increase coverage and avoid inequalities; 5) Learn from other countries that have successfully implemented meningococcal vaccination; 6) Optimise recommendations to protect age-groups/individuals at highest risk. The tools to prevent IMD in Belgium are available but under-utilised. Optimisation of the current meningococcal vaccination strategy could reduce the IMD burden in Belgium.