The implications of vaccines for prevention of bacterial meningitis.

PURPOSE OF REVIEW: Conjugate vaccines now exist that can protect against some types of bacterial meningitis (Haemophilus influenzae type b, Neisseria meningitidis group C and seven serotypes of Streptococcus pneumoniae). To broaden the protection against meningitis, new vaccines are needed. This article reviews new uses of the established vaccines and the new meningitis vaccines in development.

RECENT FINDINGS: A conjugate group A meningococcal vaccine to prevent epidemics of meningitis in Africa is about to be used widely in the 'meningitis belt'. A 'quadrivalent' conjugate vaccine against meningococcal serogroups A C Y and W135 is in use in the United States. A 'tailor-made' group B meningococcal vaccine was successfully used to control an epidemic of meningococcal disease in New Zealand. Other group B meningococcal vaccines are in development. Despite routine vaccination against pneumococcus in the United States, this organism is still the commonest cause of meningitis. Pneumococcal vaccines need to include more serotypes to offer broader protection.

SUMMARY: Great progress has been made in developing vaccines that prevent meningitis. The remaining challenges are to introduce vaccines with broad protection against meningococci and pneumococcus, develop an effective vaccine against group B meningococcus and to get these highly effective vaccines to those areas of the world that most need them.