Surveillance Open Access
Like 1



The total incidence of invasive meningococcal disease (IMD) in Europe has been declining in recent years; however, a rising incidence due to serogroup W (MenW), predominantly sequence type 11 (ST-11), clonal complex 11 (cc11), was reported in some European countries.


The aim of this study was to compile the most recent laboratory surveillance data on MenW IMD from several European countries to assess recent trends in Europe.


In this observational, retrospective study, IMD surveillance data collected from 2013–17 by national reference laboratories and surveillance units from 13 European countries were analysed using descriptive statistics.


The overall incidence of IMD has been stable during the study period. Incidence of MenW IMD per 100,000 population (2013: 0.03; 2014: 0.05; 2015: 0.08; 2016: 0.11; 2017: 0.11) and the proportion of this serogroup among all invasive cases (2013: 5% (116/2,216); 2014: 9% (161/1,761); 2015: 13% (271/2,074); 2016: 17% (388/2,222); 2017: 19% (393/2,112)) continuously increased. The most affected countries were England, the Netherlands, Switzerland and Sweden. MenW was more frequent in older age groups (≥ 45 years), while the proportion in children (< 15 years) was lower than in other age groups. Of the culture-confirmed MenW IMD cases, 80% (615/767) were caused by hypervirulent cc11.


During the years 2013–17, an increase in MenW IMD, mainly caused by MenW cc11, was observed in the majority of European countries. Given the unpredictable nature of meningococcal spread and the epidemiological potential of cc11, European countries may consider preventive strategies adapted to their contexts.


Article metrics loading...

Loading full text...

Full text loading...



  1. Ladhani SN, Beebeejaun K, Lucidarme J, Campbell H, Gray S, Kaczmarski E, et al. Increase in endemic Neisseria meningitidis capsular group W sequence type 11 complex associated with severe invasive disease in England and Wales. Clin Infect Dis. 2015;60(4):578-85.  https://doi.org/10.1093/cid/ciu881  PMID: 25389259 
  2. Knol MJ, Hahné SJM, Lucidarme J, Campbell H, de Melker HE, Gray SJ, et al. Temporal associations between national outbreaks of meningococcal serogroup W and C disease in the Netherlands and England: an observational cohort study. Lancet Public Health. 2017;2(10):e473-82.  https://doi.org/10.1016/S2468-2667(17)30157-3  PMID: 29253430 
  3. Eriksson L, Hedberg ST, Jacobsson S, Fredlund H, Mölling P, Stenmark B. Whole genome sequencing of the emerging invasive Neisseria meningitidis serogroup W in Sweden. J Clin Microbiol. 2018;56(4):e01409-17.  https://doi.org/10.1128/JCM.01409-17  PMID: 29321195 
  4. Abad R, López EL, Debbag R, Vázquez JA. Serogroup W meningococcal disease: global spread and current affect on the Southern Cone in Latin America. Epidemiol Infect. 2014;142(12):2461-70.  https://doi.org/10.1017/S0950268814001149  PMID: 24831052 
  5. Campbell H, Parikh SR, Borrow R, Kaczmarski E, Ramsay ME, Ladhani SN. Presentation with gastrointestinal symptoms and high case fatality associated with group W meningococcal disease (MenW) in teenagers, England, July 2015 to January 2016. Euro Surveill. 2016;21(12):30175.  https://doi.org/10.2807/1560-7917.ES.2016.21.12.30175  PMID: 27035055 
  6. Martin NV, Ong KS, Howden BP, Lahra MM, Lambert SB, Beard FH, et al. Rise in invasive serogroup W meningococcal disease in Australia 2013-2015. Commun Dis Intell Q Rep. 2016;40(4):E454-9. PMID: 28043219 
  7. Campbell H, Saliba V, Borrow R, Ramsay M, Ladhani SN. Targeted vaccination of teenagers following continued rapid endemic expansion of a single meningococcal group W clone (sequence type 11 clonal complex), United Kingdom 2015. Euro Surveill. 2015;20(28):21188.  https://doi.org/10.2807/1560-7917.ES2015.20.28.21188  PMID: 26212140 
  8. Repubblica Italiana [Italian Republic]. Piano Nazionale Prevenzione Vaccinale. PNPV 2017-2019. Repubblica Italiana; 2017.Italian. Available from: http://www.salute.gov.it/imgs/C_17_pubblicazioni_2571_allegato.pdf
  9. Knol MJ, Ruijs WL, Antonise-Kamp L, de Melker HE, van der Ende A. Implementation of MenACWY vaccination because of ongoing increase in serogroup W invasive meningococcal disease, the Netherlands, 2018. Euro Surveill. 2018;23(16):2-6.  https://doi.org/10.2807/1560-7917.ES.2018.23.16.18-00158  PMID: 29692317 
  10. Rijksoverheid [Government of the Netherlands]. Blokhuis kondigt grootschalige extra vaccinatie aan: Ruim half miljoen kinderen krijgen oproep. [Blokhuis announces large-scale extra vaccination: More than half a million children reveive a call]. The Hague: Rijksoverheid; 2018. Dutch. Available from: https://www.rijksoverheid.nl/actueel/nieuws/2018/07/17/blokhuis-kondigt-grootschalige-extra-vaccinatie-aan-ruim-half-miljoen-kinderen-krijgen-oproep
  11. Tryfinopoulou K, Kesanopoulos K, Xirogianni A, Marmaras N, Papandreou A, Papaevangelou V, et al. Meningococcal Carriage in Military Recruits and University Students during the Pre MenB Vaccination Era in Greece (2014-2015). PLoS One. 2016;11(12):e0167404.  https://doi.org/10.1371/journal.pone.0167404  PMID: 27907129 
  12. Nationales Impfgremium [National vaccination commitee]. Impfplan Österreich 2012. [Vaccination scheudule Austria 2012].German. Available from: http://www.doc-for-kids.at/uploads/lexikon_pdf/impfplan_2012.pdf
  13. Beresford NJ, Martino A, Feavers IM, Corbel MJ, Bai X, Borrow R, et al. Quality, immunogenicity and stability of meningococcal serogroup ACWY-CRM197, DT and TT glycoconjugate vaccines. Vaccine. 2017;35(28):3598-606.  https://doi.org/10.1016/j.vaccine.2017.03.066  PMID: 28408122 
  14. Wong S, Lennon D, Jackson C, Stewart J, Reid S, Crengle S, et al. New zealand epidemic strain meningococcal B outer membrane vesicle vaccine in children aged 16-24 months. Pediatr Infect Dis J. 2007;26(4):345-50.  https://doi.org/10.1097/01.inf.0000258697.05341.2c  PMID: 17414400 
  15. The European Commission. Commission Regulation (EU) No 2018/945 of 22 June 2018 on the communicable diseases and related special health issues to be covered by epidemiological surveillance as well as relevant case definitions. Official Journal of the European Union. Luxembourg: Publications Office of the European Union. Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32018D0945&from=EN
  16. Ladhani SN, Waight PA, Ribeiro S, Ramsay ME. Invasive meningococcal disease in England: assessing disease burden through linkage of multiple national data sources. BMC Infect Dis. 2015;15(1):551.  https://doi.org/10.1186/s12879-015-1247-7  PMID: 26626321 
  17. Eurostat. Population on 1 January by age and sex. Eurostat. [Accessed 22 Mar 2018]. Available from: http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=demo_pjan
  18. Office for National Statistics (ONS). Population estimates for the UK, England and Wales, Scotland and Northern Ireland: mid-2016. London: ONS; 2017. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/bulletins/annualmidyearpopulationestimates/mid2016
  19. Jolley KA, Maiden MC. BIGSdb: Scalable analysis of bacterial genome variation at the population level. BMC Bioinformatics. 2010;11(1):595.  https://doi.org/10.1186/1471-2105-11-595  PMID: 21143983 
  20. Tsang RSW, Ahmad T, Tyler S, Lefebvre B, Deeks SL, Gilca R, et al. Whole genome typing of the recently emerged Canadian serogroup W Neisseria meningitidis sequence type 11 clonal complex isolates associated with invasive meningococcal disease. Int J Infect Dis. 2018;69:55-62.  https://doi.org/10.1016/j.ijid.2018.01.019  PMID: 29414677 
  21. Lucidarme J, Scott KJ, Ure R, Smith A, Lindsay D, Stenmark B, et al. An international invasive meningococcal disease outbreak due to a novel and rapidly expanding serogroup W strain, Scotland and Sweden, July to August 2015. Euro Surveill. 2016;21(45):30395.  https://doi.org/10.2807/1560-7917.ES.2016.21.45.30395  PMID: 27918265 
  22. Jelfs J, Munro R, Wedege E, Caugant DA. Sequence variation in the porA gene of a clone of Neisseria meningitidis during epidemic spread. Clin Diagn Lab Immunol. 2000;7(3):390-5. PMID: 10799451 
  23. Achtman M. Microevolution and epidemic spread of serogroup A Neisseria meningitidis--a review. Gene. 1997;192(1):135-40.  https://doi.org/10.1016/S0378-1119(97)00083-8  PMID: 9224883 
  24. Caugant DA, Frøholm LO, Bøvre K, Holten E, Frasch CE, Mocca LF, et al. Intercontinental spread of a genetically distinctive complex of clones of Neisseria meningitidis causing epidemic disease. Proc Natl Acad Sci USA. 1986;83(13):4927-31.  https://doi.org/10.1073/pnas.83.13.4927  PMID: 3088568 
  25. Lucidarme J, Hill DM, Bratcher HB, Gray SJ, du Plessis M, Tsang RS, et al. Genomic resolution of an aggressive, widespread, diverse and expanding meningococcal serogroup B, C and W lineage. J Infect. 2015;71(5):544-52.  https://doi.org/10.1016/j.jinf.2015.07.007  PMID: 26226598 
  26. Taha MK, Achtman M, Alonso JM, Greenwood B, Ramsay M, Fox A, et al. Serogroup W135 meningococcal disease in Hajj pilgrims. Lancet. 2000;356(9248):2159.  https://doi.org/10.1016/S0140-6736(00)03502-9  PMID: 11191548 
  27. Mölling P, Bäckman A, Olcén P, Fredlund H. Comparison of serogroup W-135 meningococci isolated in Sweden during a 23-year period and those associated with a recent hajj pilgrimage. J Clin Microbiol. 2001;39(7):2695-9.  https://doi.org/10.1128/JCM.39.7.2695-2699.2001  PMID: 11427599 
  28. Elias J, Schouls LM, van de Pol I, Keijzers WC, Martin DR, Glennie A, et al. Vaccine preventability of meningococcal clone, Greater Aachen Region, Germany. Emerg Infect Dis. 2010;16(3):465-72.  https://doi.org/10.3201/eid1603.091102  PMID: 20202422 
  29. Lappann M, Claus H, van Alen T, Harmsen M, Elias J, Molin S, et al. A dual role of extracellular DNA during biofilm formation of Neisseria meningitidis. Mol Microbiol. 2010;75(6):1355-71.  https://doi.org/10.1111/j.1365-2958.2010.07054.x  PMID: 20180907 
  30. Christensen H, May M, Bowen L, Hickman M, Trotter CL. Meningococcal carriage by age: a systematic review and meta-analysis. Lancet Infect Dis. 2010;10(12):853-61.  https://doi.org/10.1016/S1473-3099(10)70251-6  PMID: 21075057 
  31. de Whalley PC, Snape MD, Kelly DF, Banner C, Lewis S, Diggle L, et al. Persistence of serum bactericidal antibody one year after a booster dose of either a glycoconjugate or a plain polysaccharide vaccine against serogroup C Neisseria meningitidis given to adolescents previously immunized with a glycoconjugate vaccine. Pediatr Infect Dis J. 2011;30(11):e203-8.  https://doi.org/10.1097/INF.0b013e318224fb14  PMID: 21673612 
  32. Gibbons CL, Mangen MJ, Plass D, Havelaar AH, Brooke RJ, Kramarz P, et al. Measuring underreporting and under-ascertainment in infectious disease datasets: a comparison of methods. BMC Public Health. 2014;14(1):147.  https://doi.org/10.1186/1471-2458-14-147  PMID: 24517715 

Data & Media loading...

Submit comment
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error