1. Your paper in Infectious Diseases and Therapy describes shifting serogroup patterns in invasive meningococcal disease. What are the most significant changes clinicians should be aware of today?
Although most invasive meningococcal disease (IMD) cases in the United States are sporadic, outbreaks continue to occur among socially connected populations and groups experiencing crowding or limited vaccine access. The epidemiology of IMD is evolving, with infants younger than one year experiencing the highest incidence, older adults having the highest case-fatality rates, and adults aged 24–64 accounting for an increasing proportion of cases. Serogroup B remains a leading cause of sporadic disease, particularly among adolescents and young adults, while serogroups W and Y have become increasingly important among adults. The emergence of hyperinvasive serogroup Y strains, including ST-1466, and the 2022–2024 outbreak in Virginia highlight changing transmission patterns and the importance of maintaining clinical vigilance across all age groups. These trends underscore that meningococcal disease is not limited to college-aged populations and that ongoing surveillance and vaccination remain essential.
2. Outbreaks are increasingly occurring beyond traditional college settings. What is driving this shift, and which populations are now most at risk?
The epidemiology of invasive meningococcal disease in the United States is shifting beyond college campuses into communities, with a resurgence driven largely by the emergence of a hypervirulent serogroup Y strain (CC174/ST 1466). Following a pandemic-era decline, cases more than doubled by 2024, with an increasing proportion linked to community outbreaks rather than college campuses. Serogroup B remains an important threat to adolescents and young adults but the burden of disease also increasingly affects adults aged 24–64 and disproportionately impacts Black Americans, people with HIV, men who have sex with men, and individuals experiencing homelessness. Low MenB vaccination coverage, waning immunity, and emerging antibiotic resistance further complicate prevention. These changing patterns challenge the traditional perception of meningococcal disease as primarily a college-campus threat and underscore the urgent need for equitable men B and men ACWY vaccinations.
3. The study highlights a growing burden among adults. Why has adult meningococcal disease been relatively overlooked, and what are the clinical consequences?
Invasive meningococcal disease (IMD) in adults has historically been underrecognized, as vaccination policies, surveillance, and clinical awareness have largely focused on infants, adolescents, and college students. However, recent epidemiologic shifts, particularly the emergence of hypervirulent serogroup Y strains, have increased the burden among adults aged 24–64 years. Adult IMD frequently presents as bloodstream infection rather than classic meningitis, potentially delaying diagnosis and treatment. Adults also experience higher rates of severe complications, intensive care utilization, mortality, and long-term sequelae. These evolving trends highlight a critical gap in meningococcal disease prevention and underscore the need for greater clinical awareness, enhanced adult surveillance, and reassessment of vaccination strategies to address the changing burden of disease.
4. Current prevention policies focus mainly on adolescents and narrowly defined risk groups. Where do you see the biggest gaps, and how should policy evolve to address them?
Current U.S. meningococcal vaccination recommendations focus primarily on adolescents and individuals with defined medical or exposure-related risks, leaving most adults aged 24 years and older without routine vaccine recommendations. This age- and risk-based approach may not adequately reflect the evolving epidemiology of invasive meningococcal disease, particularly the increasing burden of serogroup Y disease among adults aged 24–64 and disproportionately affected populations, including Black Americans, people with HIV, and individuals experiencing homelessness. Additional gaps include limited MenB vaccination coverage, waning protection, reactive rather than proactive outbreak prevention. These emerging disparities highlight the need to reassess adult vaccination strategies, strengthen surveillance, and evaluate broader, more equitable approaches to meningococcal disease prevention.
5. How can shared clinical decision-making work in practice for meningococcal vaccination, particularly for adults who fall outside standard recommendations?
Shared clinical decision-making (SCDM) for MenB vaccination remains inconsistently implemented, with persistent knowledge gaps among clinicians, patients, and families contributing to missed vaccination opportunities and disparities in uptake. Proactive discussions, individualized risk assessment, and appropriate timing of vaccination are essential to improving protection among adolescents and young adults aged 16–23. Adults outside established risk based recommendations lack a formal SCDM framework, further limiting opportunities for prevention. These challenges underscore the need for clearer vaccination guidance, stronger provider education, and simplified recommendations to improve access and reduce missed opportunities for meningococcal disease prevention.
6. What is the single most important change – in policy or clinical practice – that would reduce preventable meningococcal disease over the next five years?
The changing epidemiology of invasive meningococcal disease highlights the need for pro-active vaccination strategies and to consider to expand the list of risk conditions in adults. Expanding MenACWY vaccination to populations disproportionately affected by recent outbreaks, including people experiencing homelessness and men who have sex with men, could help close important prevention gaps. Adults with HIV, asplenia, complement deficiency etc already have a risk-based MenACWY recommendation, but improving coverage remains essential. Integrating vaccination into existing healthcare and community services, simplifying MenB recommendations, expanding access to pentavalent MenABCWY vaccines, and strengthening surveillance could further improve protection. Ultimately, shifting from reactive outbreak response to proactive prevention may offer a more equitable and effective approach to reducing meningococcal disease in vulnerable adult populations. However, further evidence is needed to establish the clinical and economic benefits of expanding current recommendations.
