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In November 1999 the Department of Health introduced a national vaccination programme using newly licensed meningococcal serogroup C conjugate vaccines (MenC).1 In the largest national mass vaccination campaign ever undertaken in the UK, all people under the age of 18 years are being offered vaccination: three doses for infants as part of the primary vaccination schedule at 2, 3, and 4 months of age; two doses for infants age 4–12 months; and one dose for individuals aged 1–18 years. The cost to the government has not been made public. Vaccination started a year earlier than originally planned and the UK is the only country thus far to have licensed and introduced the vaccine. Prior to the campaign there was no experience of using the vaccine outside the setting of a clinical trial. What is the rationale behind this ambitious programme and what unanswered questions remain?
The burden of disease
Every paediatrician knows the severity of invasive meningococcal disease and the speed at which previously healthy children can become prostrate. Five major serogroups (A, B, C, Y, and W135) are responsible for the majority of disease, the serogroup being determined by the nature of the capsular polysaccharide. The prevalence of different serogroups varies in different regions and in different age groups. Globally the greatest burden of disease comes from serogroup A which is responsible for massive epidemics in the “meningitis belt” of sub-Saharan Africa and an endemic rate which is more than 10 times that in industrialised countries.2 In much of Western Europe including the UK, more than 90% of disease is caused by serogroups B and C. Serogroup C accounts for 25–40% of cases, with the relative proportion varying in a cyclical manner from year to year. In 1995, there were 1890 reported cases of invasive meningococcal disease, an increase of 43% …