Meningococcal meningitis in India: An expert consensus on use of MCVs.

Invasive meningococcal disease (IMD) is a significant but under-recognized public health challenge in India, marked by rapid progression, high mortality, and severe sequelae. This consensus document, developed from literature review, outbreak analyses, and deliberations by 14 Indian experts, highlights outbreaks from 1966 (Delhi: 616 cases, case fatality ration: CFR 20.9%) to 2022-2023 (Kolkata). Serogroup A remains predominant, with emerging serogroups C, W, and Y. Systematic review evidence shows 12.1% prevalence in epidemics (CFR 12.8%) and 0.76% in endemic settings (CFR 3.0%), though true burden is underestimated due to weak surveillance. IMD shows bimodal age distribution, highest in children < 5 y (61.8%) and adolescents. MenACWY conjugate vaccines show 95.7-99.5% seroprotection across serogroups. Experts recommend vaccination at 9-12 months with booster at 10-11 y, mandatory reporting, sentinel surveillance, and clinician awareness. The roadmap stresses awareness, short-term surveillance, and long-term data generation toward National Immunization Program inclusion.