Epidemiology of invasive meningococcal disease in Germany, 2002-2010, and impact of vaccination with meningococcal C conjugate vaccine.

OBJECTIVES To analyse serogroup (Sg)- and finetype-specific invasive meningococcal disease burden (IMD) in Germany, 2002-2010, with emphasis on effects of vaccination with conjugate SgC vaccines targeting one-year old children since 2006, including individual-based catch-up to 17 years of age. METHODS Serogroup- and age-specific IMD incidence and trends were calculated using statutory surveillance data. The national reference laboratory performed genetic finetyping. Vaccination uptake data were obtained from school entry surveys and prescription monitoring. RESULTS In persons <25 years, SgB and SgC IMD incidence decreased significantly from 0.63 to 0.32/100,000 and 0.26 to 0.10/100,000, respectively. The decline was significantly steeper for SgC than SgB in 1-5 year-olds, the primary vaccination target group, but not other ages. The slope of the SgC incidence curves was similar before and after vaccination implementation in all age groups; however, the decrease in incidence was steeper in states with higher vaccination uptake. Declining SgC incidence was associated with decreased SgC finetype diversity. An increase in SgY incidence was limited to adults. CONCLUSIONS Results suggest effects of the German SgC vaccination strategy are limited, although interpretation is complicated by already low and decreasing incidence before vaccination. More effective use of vaccination resources might be achieved by rigorously targeting adolescents in addition to 1-year-olds.