The price of prevention: What now for immunisation against meningococcus B?

摘要

Meningococcal sepsis is one of the most dreaded bacterial infections: the death rate remains at about 5% and the effects for survivors include neurological damage, limb amputation, and widespread skin necrosis. There is a compelling case for prevention of meningococcal disease by immunisation. On July 24, 2013, in an interim position statement, the UK Joint Committee on Vaccination and Immunisation (JCVI) concluded that it cannot currently recommend a vaccine (4CMenB, licensed as Bexsero, Novartis Vaccines and Diagnostics, Siena, Italy) for use in the UK routine immunisation programme. Many will be disappointed that for the time being meningo-coccus B will continue to exact its toll of deaths and disabilities. There have been more than 10 000 cases of meningococcal B disease in England and Wales during the past 10 years. In the past two decades, vaccines against strains of meningococcal sepsis other than meningococcus B have been developed and included in routine or selective immunisation programmes. However, it had not been possible to develop a vaccine suitable for routine use to prevent disease caused by meningococcus B, the most common cause of sepsis and meningitis in the UK and in many other countries. Currently used meningococcal vaccines are based on inducing antibodies to the major virulence factor of the meningococcus, its capsular polysaccharide. This approach was not feasible in the case of strains of meningococcus B because its capsule, a homopolymer of sialic acid, is a poor immunogen.