Epidemiology of invasive meningococcal B disease in Australia, 1999–2015: priority populations for vaccination

Objectives: To describe trends in the age-specific incidence of serogroup B invasive meningococcal disease (IMD) in Australia, 1999–2015. Design, setting, participants: Analysis in February 2017 of de-identified notification data from the Australian National Notifiable Diseases Surveillance System of all notifications of IMD in Australia with a recorded diagnosis date during 1999–2015. Major outcomes: IMD notification rates in Australia, 1999–2015, by age, serogroup, Indigenous status, and region. Results: The incidence of meningococcal serogroup B (MenB) disease declined progressively from 1.52 cases per 100 000 population in 2001 to 0.47 per 100 000 in 2015. During 2006–2015, MenB accounted for 81% of IMD cases with a known serogroup; its highest incidence was among infants under 12 months of age (11.1 [95% CI, 9.81–12.2] per 100 000), children aged 1–4 years (2.82 [95% CI, 2.52–3.15] per 100 000), and adolescents aged 15–19 years (2.40 [95% CI, 2.16–2.67] per 100 000). Among the 473 infants under 2 years of age with MenB, 43% were under 7 months and 69% under 12 months of age. The incidence of meningococcal serogroup C (MenC) disease prior to the introduction of the MenC vaccine in 2003 was much lower in infants than for MenB (2.60 cases per 100 000), the rate peaking in people aged 15–19 years (3.32 per 100 000); the overall case fatality rate was also higher (MenC, 8%; MenB, 4%). The incidence of MenB disease was significantly higher among Indigenous than non-Indigenous Australians during 2006–2015 (incidence rate ratio [IRR], 3.8; 95% CI, 3.3–4.5). Conclusions: Based on disease incidence at its current low endemic levels, priority at risk age/population groups for MenB vaccination include all children between 2 months and 5 years of age, Indigenous children under 10 years of age, and all adolescents aged 15–19 years. Given marked variation in meningococcal disease trends over time, close scrutiny of current epidemiologic data is essential.