Introduction: Why Adolescents Are a Critical Window for IMD Prevention
Meningococcal disease (IMD) can strike at any age, but adolescence presents a uniquely vulnerable window. Recent expert discussions highlight that in many regions, the most common IMD-causing serogroups shift across ages and settings, making timely vaccination during adolescence essential. In the US, MenB accounts for a large share of IMD in young people aged 11–23 years, while European data show similar patterns of risk during adolescence. Health care professionals (HCPs) are urged to seize opportunities to vaccinate before transmission peaks in communal settings and close-contact environments.
Adolescents: A Reservoir for Transmission
Carriage of Neisseria meningitidis in the nasopharynx peaks during adolescence, with studies showing carriage rates around 23.7%. This positions teens as potential reservoirs and transmitters of IMD, particularly in crowded living conditions such as summer camps and shared housing. Tobacco exposure, including passive smoking, has also been linked to increased nasopharyngeal colonisation and IMD risk, underscoring the need for targeted prevention in this age group.
Vaccination: Beyond Infant Immunisation
Despite clear age-related risk, adolescent vaccination uptake for MenB remains suboptimal. Experts emphasise that the adolescent period is a strategic time to reinforce immunity in those vaccinated as infants, and to vaccinate vaccine-naïve individuals before leaving paediatric care. Conjugate vaccines (MenACWY) are widely used in adolescence, and pentavalent MenABCWY is now authorised in the USA, expanding protection across serogroups. Yet MenB vaccines, which protect against the most prevalent serogroup in adolescents, are not as ubiquitously implemented, leaving a protection gap in many national programmes.
Clinical Sequelae: The Long Shadow of IMD
Survivors of bacterial meningitis frequently face lasting sequelae, including hearing and vision impairment, cognitive deficits, seizures, and motor or speech impairments. The burden is substantial: about one in five survivors experience long-term effects, impacting quality of life, education, and social participation. Delays in recognizing IMD in adolescence often lead to more complex and costly sequelae compared with younger children, highlighting the need for vigilance and rapid response by families and healthcare teams.
Timing and Scheduling: A Flexible, Data-Informed Approach
Vaccination timing varies by country, but experts agree on several core principles. Integrating vaccines into existing adolescent health visits can improve uptake, reducing missed opportunities. Co-administration of MenACWY and MenB vaccines can strengthen messaging and improve coverage across serogroups. While some countries target early adolescence for routine MenACWY boosters, others offer catch-up vaccines into early adulthood. The optimal strategy depends on local epidemiology, healthcare infrastructure, and the logistics of delivering vaccines in settings where teens spend time, such as schools, universities, and camps.
Practical Strategies for Healthcare Providers
To optimise IMD prevention in adolescence, HCPs should:
– Use local surveillance data to tailor vaccination timing to the age distribution of cases and ongoing outbreak signals.
– Ensure clear, adolescent-friendly communication that engages teens directly in discussions about disease risk and protective benefits.
– Consider co-administering MenACWY with MenB vaccines where feasible, while recognising that MenB vaccines are not interchangeable and boosters should align with the initial vaccine series.
– Integrate vaccination reminders within routine care pathways, such as pre-summer camp check-ins or annual health visits, to maximise uptake before high-risk periods.
Education and Public Awareness: Bridging Knowledge Gaps
Many adolescents underestimate the risk of IMD, viewing themselves as invincible. Patient advocates describe the heavy, lasting burden of disease and the importance of early, informed decisions. Clinicians should be prepared to explain potential outcomes, share patient stories where appropriate, and direct families to reliable resources. Education should extend beyond the clinical setting, including school-based vaccine drives and community health campaigns to reach vaccine-naïve youths.
Conclusion: Turning Insight into Action
Preventing adolescent IMD requires a coordinated effort: timely vaccination, informed scheduling, proactive education, and robust surveillance. The central message from experts is clear: the only non-optimal age for vaccination is after IMD has occurred. By embedding vaccination into paediatric care, leveraging school and community touchpoints, and using local epidemiology to guide decisions, healthcare teams can reduce the risk of IMD in adolescence and its heavy, lifelong impact.
