The need for meningococcal vaccination: lessons from family cases

Abstract

Meningococcal infection remains one of the most dangerous infections with a high mortality potential. In recent years, the Russian Federation has seen instability in the epidemic process, changes in the dominant serogroups (activation of serogroups A and W), and an increase in the incidence of invasive meningococcal diseases. Two clinical cases of invasive meningococcal diseases observed at the Saratov regional infectious clinical hospital named after N.R. Ivanov in 2022– 2023 are presented: Case 1 –a 12-year-old adolescent (fatal outcome), Case 2 – а 9-month -28 days-old infant (favorable outcome). In the first case, fulminant meningococcemia complicated by septic shock and Waterhouse-Friderichsen syndrome led to a fatal outcome despite resuscitation efforts. In the second case, despite a complicated epidemiological history (death of a sister from invasive meningococcal diseases) and late pre-hospital diagnosis, timely intensive therapy with extracorporeal hemocorrection saved the child. Both cases share the absence of specific vaccination. Data on the activation of serogroups A and W in the Russian Federation, the emergence of rare serogroups (X, Y), and vaccination with polyvalent conjugate vaccines for the prevention of meningococcal diseases. The presented observations confirm that the lack of vaccination is a fatal risk factor. Expanding the serogroup coverage of vaccines to 5 (ACWYX) and 6 (ACWYX + B) components is a strategic direction in combating the «fluctuating epidemiology» of meningococcus.