Epidemiology, management, and prevention of meningococcal infections.

Neisseria meningitidis is the cause of significant morbidity and mortality worldwide, both in epidemic and endemic disease form. The use of serotyping, subtyping, and multilocus electrophoresis has had a significant impact on determination of the epidemiology of meningococcal disease. Recent advances in understanding the pathogenesis of meningococcal disease, include information on the role of cytokines and other inflammatory mediators, which may contribute to establishment of additional diagnostic and treatment options. Early treatment is required to improve outcome along with the use of prophylaxis to prevent secondary disease. Vaccines against groups A, C, Y, and W135, are available but have limitations, with regard to efficacy and duration of protection. Over the past decade there has been rapid progress in the development of a vaccine against group B disease, with protective trials underway in several countries. However, varying results have been found and these vaccines have not reached a stage of providing universal protection against group B meningococcal disease.