Although U.S. meningococcal disease incidence has declined dramatically between 1996 and 2021, there was a rebound in 2022 and 2023.
In 2023, 423 cases of meningococcal disease were reported—the highest number observed since 2014. As of March 2025, more than half the states have reported cases of meningococcal disease. This year, Virginia alone reported more than 40 cases in February.
In many jurisdictions, the increases are primarily due to serogroup Y sequence type (ST)-1466, a strain susceptible to prophylaxis and treatment. In addition to observing a predominance of cases—64%—among Blacks, a disproportionate number of people with HIV were infected in 2023, according to Amy Rubis, MPH, an epidemiologist at the National Center for Immunization & Respiratory Diseases, CDC.
“We’re also seeing an unusual age distribution among cases caused by this strain, with almost no cases in children or adolescents,” Ms. Rubis said. Just more than 35% of ST-1466 serogroup Y cases were among people ages 24 to 44, and almost 40% of cases were 45 to 64 years in 2022-2023. “We don’t know if that’s just the epidemiology of this strain or if the adolescent vaccination program is successfully protecting the 11- to 20-something age group.”
Public health officials have also seen a significant increase in penicillin resistance and penicillin and ciprofloxacin dual-resistant cases, which are mostly serogroup Y, mainly sequence type ST-3587. This strain is affecting Latino people disproportionately, with 74% of dual-resistant cases and 53% of penicillin-resistant only cases reported among Hispanic populations for the past six years.
As for ciprofloxacin-resistant cases, the CDC reported an increasing number of resistant isolates not belonging to serogroup Y, according to Ms. Rubis. “Ciprofloxacin resistance is increasing, and multiple jurisdictions have moved away from using ciprofloxacin for prophylaxis.”
New Vaccine Approved
In February 2025, the FDA approved the MenABCWY pentavalent vaccine (Penmenvy, GSK), which combines the MenB-4C and MenACWY vaccines. The Advisory Committee on Immunization Practices (ACIP) has been reviewing the data, and the new vaccine is on the April 15-16 meeting agenda. So far, the safety profile of this vaccine is favorable and similar to MenB-4C. However, more adverse events occurred for the pentavalent vaccine than with MenACWY, consistent with the greater reactogenicity of MenB-containing vaccines compared with those containing only MenACWY, according to data that was presented at the June 2024 ACIP meeting.
The CDC reported that the immunogenicity of the pentavalent vaccine was noninferior to that of MenACWY. Additionally, the prespecified success criteria for comparison of pentavalent and MenB-4C 0,2 months was met for three of four strains (fHbp, NHBA and NadA) and in comparison with MenB-4C 0,6 was met for two of four strains (fHbp and NadA). However, 24 months following pentavalent vaccination, titers waned substantially for serogroup A and three B strains: fHbp, NHBA and PorA.
“The [ACIP] work group also noted that the PorA indicator strain is important because PorA represents the full outer-membrane vesicle component of the vaccine, and response to this indicator strain has bearing on cross-protection,” explained Sarah F. Schillie, MD, MPH, MBA, an epidemiologist also in CDC’s National Center for Immunization & Respiratory Diseases.
Of note, no data were available about the immunogenicity of this new vaccine in immunocompromised individuals. “I really worry about the complete lack of knowledge of immunocompromised response to vaccine, vaccine efficacy, etc.,” said Camille N. Kotton, MD, FIDSA, FAST, the clinical director of Transplant and Immunocompromised Host Infectious Diseases at Massachusetts General Hospital and a former ACIP member. “I would encourage many researchers to do more research so that we could make good guidance. I worry that we’re leaving a significant at-risk population perhaps less well protected.”
Being considered by the ACIP is the schedule option for meningococcal vaccinations. Currently, the recommendation is for the first dose of MenACWY to be administered at age 11 or 12 and the second dose at 16, as well as both doses of MenB-4C between age 16 and 23 based on shared clinical decision-making. Because there has been significant pushback in previous years against shared clinical decision-making, the workgroup is considering the incorporation of either routine vaccination or risk-based vaccination for MenB (MMWR Morb Mortal Wkly Rep 2024;73[15]345-350).
The sources reported no relevant financial disclosures.
This article is from the April 2025 print issue.