Trends in meningococcal disease: challenges for vaccine control when disease is rare

In most wealthy and in many middle income countries, capsular group B Neisseria meningitidis (MenB) remains an important cause of invasive disease, particularly in the era of control of other major bacterial pathogens, such as MenC, Haemophilus influenzae type b, and vaccine-type pneumococcus. Two new MenB vaccines (now licensed in many countries) provide the potential for a comprehensive approach to controlling these invasive bacterial pathogens. However, decisions about vaccination at the population level are complex when there are low rates of disease: cost-effectiveness is a particularly important factor.