Universal immunization of infants against Neisseria meningitidis: addressing the remaining unmet medical need in the prevention of meningitis and septicemia.

Effective immunization policies have markedly decreased the incidence of many lethal infectious diseases of childhood, including diphtheria, pertussis, and poliomyelitis, among others. In industrialized countries, relatively recent success in combating meningitis and sepsis has come with the implementation of universal immunization of infants against Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae. These universal immunization programs have reduced disease incidence and related deaths by more than 90%. Thus 2 out of the 3 major bacterial causes of invasive disease in children have now been controlled, leaving Neisseria meningitidis as the obvious next target. Currently, mortality attributable to invasive meningococcal disease remains at a level consistent with that of several other major vaccine-preventable infections prior to the implementation of immunization strategies. Unlike Hib and pneumococcus, US immunization policy against invasive meningococcal disease currently focuses on adolescents, a strategy that has been notably less than successful given that the highest incidence of invasive meningococcal disease occurs early in the first year of life. Development of safe and effective vaccines that broadly protect infants against disease caused by N. meningitidis is the next logical step in the effort to prevent bacterial meningitis and sepsis. Their universal use in infancy would follow a well-established and notably successful path.