Invasive meningococcal disease in older adults: current perspectives and call for action

Aim Invasive meningococcal disease (IMD) presents a substantial burden in older adults, usually ineligible for protective immunization. We reviewed clinical epidemiology and current immunization policies to highlight current unmet needs in older adults.Findings IMD in older adults represents a substantial proportion of the overall disease burden. Atypical presentations are common, often associated with less common serogroups.Message While most attention is on disease in younger individuals, there remains a need to increase awareness of IMD in older adults and reconsider immunization policy.Purpose Invasive meningococcal disease (IMD) is a devastating condition. While most attention is directed towards disease in children and adolescents, IMD poses an important cause of morbidity and mortality in adults >= 60 years. While immunization is a critical component of healthy ageing strategies, meningococcal immunization is not routinely offered to older adults. The aim of this review was to summarize clinical and epidemiological aspects of IMD and available immunization strategies, with a particular focus on disease in older individuals, to emphasize the importance of this rather neglected area.Methods An expert working group was established to evaluate clinical and epidemiological data to raise awareness of IMD in older individuals, and develop suggestions to improve the existing burden.Results Routine child and adolescent meningococcal immunization has substantially reduced IMD in these targeted populations. Consequently, prevalence and proportion of IMD among those >= 60 years, mostly unvaccinated, is increasing in developed countries (accounting for up to 25% of cases). IMD-related mortality is highest in this age-group, with substantial sequelae in survivors. IMD due to serogroups W and Y is more prevalent among older adults, often with atypical clinical features (pneumonia, gastrointestinal presentations) which may delay timely treatment.Conclusions IMD in older adults remains overlooked and greater awareness is required at clinical and societal levels. We encourage clinicians and immunization policy makers to reconsider IMD, with a call for action to remedy existing inequity in older adult access to protective meningococcal immunization.